- How do I make a referral
for ADvantage services?
- What do I do
when I have Member that may not meet ADvantage
Program appropriateness or Level of Care?
- How do I
get answers to my question about Case Management
standards, the Conditions of Provider Participation,
or other contractual documents
- What
if I have a question about Member specific
service plan authorization decision?
- What do I do if I
have a claim issue associated with Case
Management or Personal Care?
- What do I do if I have
a claim issue related to DME?
- What is the status of
my PA?
- Why was my request for
ADvantage Program PA denied?
- How do I
change my agency's referral status or add
or delete services?
- What
do I do when I have a grievance or complaint
to report on behalf of a Member?
- What
do I do when a Member has a grievance or
complaint regarding my agency or its services
and or staff and I cannot get it resolved
to our mutual satisfaction?
How do I make a referral
for ADvantage services?
If the person applying for services has
an active Medicaid number, refer the person
to their local DHS County Office. If the
person does not have an active Medicaid
number, call 1-800-435-4711 or fill
out an
IS01 LTCA Referral
Fax Form. Include the
name, agency, telephone and fax numbers
of the referring party. It is
important to provide all the information
requested to prevent a delay in the process
while the missing information is obtained.
Fax only the completed referral form to
the number listed on the form.
Due to confidentiality, other information
should NOT be provided until requested by
a signed release.
Due to confidentiality, LTCA cannot respond
to follow-up inquiries regarding the status
of a referral. Please direct
all status questions to the individual that
you referred to the ADvantage Program.
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What do I do
when I have a Member that may not meet ADvantage
Program appropriateness or Level of
Care?
Written documentation is essential to facilitate
timely follow-up with DHS and LTCA. Please
fax documentation to 918.879.1275, Attn:
Director of Long Term Care Programs or mail
information to Long Term Care Authority,
130 N. Greenwood, Tulsa Oklahoma 74120,
Attn: Director of Long Term Care Programs.
Please do not send detailed confidential
information through e-mail due to the sensitive
nature of these issues, in particular.
In a time-sensitive emergency, you may contact
the Director of Long Term Care Programs
at 918.583.3336, but written documentation
will need to be faxed or mailed to provide
the level of detail necessary to resolve
the issue.
Please send only general informational inquiries
to
asd.providerquestions@okdhs.org.
Member specific information necessary to
resolving complex issues should remain protected.
Please fax or mail specific documentation.
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How do
I get answers to my question about Case
Management Standards, the Conditions of
Provider Participation, or other contractual
documents?
First, become knowledgeable by reading the
Case Management Standards and Conditions
of Provider Participation accessible through
this website. If questions remain,
then e-mail
Provider?@ltca.org
For agency questions regarding Case Management
Standards or Conditions of Provider Participation
please include your name and the agency's
name in the e-mail. This information
is necessary to respond appropriately to
your questions. Please do not use
the Member's name in the e-mail; use only
the Member's Medicaid number.
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What
if I have a question about a Member specific
Service Plan Authorization decision?
The fastest resolution occurs when a copy
of the document in question is provided.
Fax your questions along with a copy of
the plan or condition that is in question
to 918.879.5334. This is a
dedicated line for Service Plan Authorization
issues. A response will be provided within
24 to 48 hours unless the issue is extremely
complicated or a large number of documents
are requested.
You may also send e-mail to
Provider?@ltca.org Please
note that responses to questions received
by e-mail take longer because the document
in question is not provided and we must
pull the Member's chart. Include your name
and the agency's name when using e-mail.
Your inquiries cannot be appropriately responded
to without this information. Do
not use the Member's name in the e-mail;
use only the Member's Medicaid number
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What do I do if
I have a claim issue associated with Case
Management or Personal Care?
The quickest resolution occurs when the ADv21
process has been followed and the documentation
is completed properly so we have sufficient
information to fully research the issue.
When completed, fax a copy of the ADv21
and the remittance statement that is in
question to 918.583.0742. This is
a dedicated line for claims issues with
a 24 to 48 hour turnaround time unless the
request contains a large number of claims
or issues.
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What do I do if I have
a claim issue related to DME?
When a PA has been issued but the claim
is being denied, please follow-up with OKHCA
before contacting LTCA for assistance. If
you need to contact LTCA for assistance,
fax the Member and claim information to
918.583.0752. Please note: prior
authorization does not guarantee payment.
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What is the status of
my PA?
To check the status of a PA request, fax
the inquiry to 918.583.0742 along with the
Member information, the approximate date
the PA request was sent, and the item for
which the PA was requested.
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Why was my request for
ADvantage Program PA denied?
First, review the service plan to determine
if there are any conditions (incorrect pay
source, not AD vantage covered
etc.) present.
Second, contact the case manager to determine
if there were any changes to the service
plan that could affect this.
Third, if you are still unable to resolve
the issue, fax the inquiry along with the
denial and other Member information to 918.583.0742
for review.
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How do I
change my agency's referral status or add
or delete services?
Call 918.879.5288 regarding agency referral
status or agency requests to add or delete
services or service areas.
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What
do I do when I have a grievance or complaint
to report on behalf of a Member?
Call the Member Inquiry Service at 1.800.435.4711
to inquire and/or provide information regarding
complaint or grievance issues or to report
a concern on behalf of a Member.
Please indicate that this is regarding a
complaint or grievance on behalf of a Member.
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What
do I do when a Member has a grievance or
complaint regarding my agency or its services
and or staff and I cannot get it resolved
to our mutual satisfaction?
First assist the Member in filing a formal
grievance/complaint with the agency following
agency Member grievance/complaint resolution
procedures. When the agency cannot satisfactorily
resolve a Member grievance or complaint,
provide the Member Inquiry Service (CIS)
number (1.800.435.4711) to the Member or
the Member's legal representative and instruct
them to state the call is regarding a grievance.
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