MO HealthNet Inpatient Certification Transition
ACS Completes Backlog Of Retrospective Review RequestsMO HealthNet Division’s current agent, Affiliated Computer Services, has completed its review of the backlog of retrospective certification requests incurred by the former medical review agent, Health Care Excel. The status of hospitals’ retrospective certification requests can be viewed via the provider access option on Cyber Access’ Web portal. Please refer to MHD’s update if the retrospective certification request is not available online or if you have not obtained login instructions for Cyber Access.
Hospitals Urged To Schedule Training On CyberAccess Inpatient Certification Tool
The MO HealthNet online inpatient certification request tool, CyberAccess, is scheduled to launch in early May. Before the launch date, all hospitals must have a user account setup in CyberAccess, and the hospital’s utilization review or case management staff must have completed training. If your hospital has not set up its inpatient certification account and scheduled staff training, please contact Affiliated Computer Services Inc. at 888/581-9797 or MoHealthNetCyberAccess@acs-info.com.
MO HealthNet Issues New FAQs To Address Inpatient Certification
MO HealthNet Division has issued new FAQs to address inpatient certification and training on CyberAccess. An updated report demonstrates how MHD and Affiliated Computer Services continue to reduce the backlog of inpatient certifications.
MO HealthNet Continues Work On Certification Requests; New ACS Tracking Tool Available
MO HealthNet Division continues to work on reducing the backlog of retrospective and current certification requests. The backlog of retrospective certifications from the previous certification contractor, Healthcare Excel; the conversion to a new contractor, Affiliated Computer Systems; and the current paper-based process have created delays in authorizations, extended phone wait times and delays in payment on retrospective claims. MHD has been kept informed by MHA of the problems this has created for hospitals and is working to improve the current process while continuing to work on a process to submit inpatient certifications online via CyberAccess.
A new CyberAccess certification tracking tool is now available for providers to view the status of certifications and daily discharge hospital reports. ACS staff is training hospital staff on this new tracking tool. In late May, the CyberAccess tool will offer new features that enable online certification requests. Hospitals will be able to:
- submit requests for inpatient initial or continued stay certifications
- receive a determination of the request in real time
- receive a tracking number for requests that require further approval
Until then, MHD advises that there are several things hospitals can do to facilitate a timely response to their requests and improve the certification process. For new certifications and continued stay requests, hospitals should do the following.
- Only use the new MHD certification request form. If this form is not used, the request may not be accepted.
- Fax the required form and face sheet to 866/629-0737.
- Do not submit duplications of previously faxed requests.
- Have all the required information (see MHD certification request form) available before calling ACS at 800/766-0686. This includes the NPI of attending physician, NPI of facility, diagnosis or chief complaint code. If this information is not available at the time of your call, you may be returned to the queue so other callers can be helped while you retrieve this information.
- Leave a call back number(s) where the ACS nurse can reach you. If you cannot be reached, a message will be left, if possible. If it is not possible for ACS to leave a message, ACS will attempt to call you three times over a reasonable time frame. If no connection is made, you must call ACS back. It would be optimal to use a number that will roll over to another phone if the line is busy, or leave a cell phone number that case managers carry with them when they are on the nursing units.
- Complete and return the provider contact form so that ACS has the correct contact information for outreach training. Include all staff who will need training in CyberAccss.
For retrospective reviews, please note the following.
- Do not call about the status of retrospective review cases.
- Do not fax any duplicate retrospective review cases.
- All retrospective reviews should be completed by Wednesday, March 31.
If you have questions, please contact Sharon Burnett at MHA.
What Hospitals Need
Previous Reports
Feb. 1, 2010
Jan. 20, 2010
Presentations
Hospital Inpatient Certification and Concurrent Review (October 2009)
Questions on the Current Inpatient Certification Process
Return to Previous