UNITY 2-3-4

INTAKE
 EPACES AND MEDICAID CODES
ePACES is the acronym for the Electronic Provider Assisted
Claim Entry System, a web-based application which will allow
Providers to create/submit claims and other transactions. ePaces
is the system used to verify pt’s insurance.
1. Medicaid Managed Care Plan (HARP) -> HMO.
2. Health and Recovery Plan (HARP) -> HMO.
3. HIV Special Needs Plans (SNP) -> handled like a Plan to
plan transfer. Confirm with the pt if the doctor accept VNS SNP.
4. Medicaid Advantage/Dual Eligible Plans: Plan to Plan
transfer. Confirm if the pt's doctor accept VCM dual plan and
refer to VCM dual plan.
5. MA Advantage Plus Plans: Plan to plan transfer. Confirm
with Mariel to which Advantage Plus plan refer the pt, confirm
if pt's doctor accept it and refer to the plan chosen.
6.Program For All Inclusive Care For The Elderly (PACE)
Plans: Plan to Plan transfer, confirm with Mariel to which
PACE plan refer the pt, confirm if the pt’s doctor accept it and
refer to the plan chosen.
7. Managed Long Term Care (MLTC) Partial Cap Plans:
plan to plan transfer, confirm with pt hours of service that is
receiving, ask Mariel to which MLTC plan refer the pt,
confirm if the pt´s doctor accept it and refer to the MLTC plan
chosen.
8. Fully Integrated Dual Advantage (FIDA): Plan to Plan
transfer, confirm with Mariel to which FIDA plan refer the pt,
confirm if the patient´s doctor accept it and refer to the plan
chosen.
9. Fully Integrated Dual Advantage (FIDA) – Individuals
with Developmental Disabilities (IDD): Plan to Plan transfer,
confirm with Mariel to which FIDA IDD plan refer the pt.
 CHHA (CERTIFIED HOME HEALTH
AGENCIES)
◦ When a new pt needs immediate skilled short-term services, we refer them to CHHA. With this an HHA with special
certification will provide service for the duration a nurse or therapist is in the home.
◦ This service gives max. 120 days of care or 10 hours per week of care. Typically the CHHA service is billed through
Medicare, we also use CCHA to provide services if necessary until conversion to MLTC.
◦ To refer a pt to CHHA: Using the CHHA contact list, send via email to the CHHA selected the Clinical and Progress notes
along with the Parent Care referral form filled by the doctor who discharged the pt.
◦ The CHHA preferred for pts in the Bronx is Rebekah as the first option, for pts in the other States the preferred CHHA is
Excellent.
◦ All of the referrals of Marketer Terelliz that come from Lincoln Hospital must be sent to CHHA
◦ All of the referrals of Marketer Daniella that come from Advantage Care Physicians must be sent to CHHA.
 CDPAP
◦ Medicaid Consumer Directed Personal Assistance Program – An adult who is not legally responsible for a pt’s care and
support may be a CDPAP assistant for that consumer. CDPAP is a Medicaid program that enables a self directing individual or
their designated representative, to assume the responsibilities of their own care.

◦ Identify during welcome call if the pt is interested on CDPAP and verify again when referring the pt to the MLTC plan. The
CDPAP registration must start when the pt is transferred to the MLTC plan, however, if the pt decides to apply for CDPAP and
already provided the Potential PA information -> call the potential PA immediately and inform about the requirements, so
he/she can gather all of the documentation needed.

1. PA REGISTRATION
CDPAP
REGISTRATION
PA and Consumer application filled
out by the potential PA and by the
pt.
2. To get CDPAP Auth. Send to
the MLTC the DOH form
PA SS card and photo ID (like
driver’s license)
PA Medicals
Once PA registration documents
Resources dep. Of Parent Care and
are obtained, it should be sent to
Mariel.
It must be properly filled by a
doctor who saw the pt the last 30
days along with the MOU form
signed by the pt.
PP blood test or quantiferon TB
gold
5 panel drug screen
Measles and Rubella lab reports
She will send it to the Human
so they can process the PA
registration.
If PPD Positive, PA need to include
a Chest X-ray, if positive-> PA
cannot work.
If marijuana positive -> PA can
continue. If any other drug, he/she
cannot.
If “Not immune” PA will have to
get the MMR vaccination (2 doses)
and fill out MMR declination form.
 ESSEN MED
◦ Essen Med is the first option Parent Care use to obtain CFEEC or DOH form for a patient.

◦ Essen Med is an agency associated with Parent Care that provides Inhome Medical services, patients are referred to Essen
Med with the objective of receive a Medical appointment with a doctor that is sent by Essen Med to the patient´s house, this
doctor will fill out all of the forms Parent Care request to be filled out at the time of the visit.

1. Verify pt. insurance covers
EssenMed
4. Send Referral form with
needed forms via e-mail.
7. After appointment is set up
follow up the day after the
date of the appointment to
make sure it went through.
2. Refer pt to EssenMed
5. If the don’t reply e-mail
received after 24 hrs. reply e-
mail asking for the received
info.
If the appointment went
through successfully ->
follow up 3 days after until
you receive the form
requested.
If they don’t agree you need
3. Fill out Essen Med Referral
to contact with MD office. If
form.
pt agrees:
If they couldn’t reach the pt
6. Ask for updates every 2 you should conference call
days until they set up the pt with Essen Med to
appointment. make sure appointment is set
up.
If the appointment didn’t went
through go back to step 6 and
continue with flow.
 MD OFFICE OR PCP OFFICE

◦ MD or PCP office is the second option to obtain CFEEC or DOH forms when the patient´s insurance does not covers Essen
Med services. We need to confirm with the pt his/her PCP information (name and phone) and ask when was the last time
he/she saw the doctor, the doctor should´ve seen the patient in the last 30 days to be able to fill out the form needed.
 1. Confirm with the pt his/her PCP info. (name and phone #)

2. Ask pt. last time they saw a doctor (needs to be 30 days max.)

3. Call PCP office to obtain fax number

4. Fill out the forms needed with pt demographical info.

5. Fill out the Parent Care fax cover

6. Go to Jelltel eFax and send the forms along with PC Fax cover to the Fax # of PCP.

7. Call the MD/PCP office back to confirm that fax was received.

8. Once they confirmed, do follow-up calls every 2-3 days until they fax you the form filled out back.
 WHITEGLOVE
◦ Whiteglove is a Medicaid consulting agency associated with Parent Care to assist with those patients with Medicaid issues,
such as:
◦ - When the patient does not have Medicaid
◦ - When the patient´s Medicaid is expired and needs to Recertify
◦ -To remove some restriction exception codes on the patient´s Medicaid.

1. Let the patient know why you
need to refer him/her to
Whiteglove
2. Inform the patient that WG
will call them an request some
documentation.
3. Fill out the Whiteglove
referral form with patient’s info.
4. Send the referral through
email.
8. Applications can take up to 6
months depending on the case
7. If you don´t see an update note
on Boltintake in more than 3
days, you can ask for update via
email by replying the email
thread.
6. Once Whiteglove confirms
received: check on updates on
the Boltintake WG web every 2
or 3 days. Copy the notes from
Boltintake and paste them on
Smartsheet.
5. Whiteglove should reply
confirming received in 24 hours,
in case they don´t, you should
request it via email.
9. If Whiteglove couldn't reach
the pt: conference call the patient
with Whiteglove to make sure
the process continues.
10. If the pt declines services
with Whiteglove, call pt to verify
why he/she wants to stop the
process.
If the pt accept to continue with
the process, you should request
Whiteglove to reopen the case; If
pt keeps declining with you,
follow procedure of case closing.
If a pt already applied to Medicaid through
another source, ask if they authorize you to
track the Medicaid application. If yes, send
WG an email with pt full name, SSN and
DOB requesting to track the pt’s Medicaid
application, so WG will let you know when
the pt´s Medicaid is approved and you can
continue with the LTC Process.
 REFERRAL FORMS
◦ It is a document used to refer from one agency to another to request a service, every agency has its own Referral form with its
own design. It must be filled out with pt’s demographic info and sent to the appropriate agency by using the Referral contact
list.
 SMARTSHEET
◦ When a new referral arrives, the Intake rep must stop what is doing register the new referral on SS. Make the first contact with
the patient.
◦ Attach all referral forms and documents to SS.
 Once a case is referred to MLTC: move
the row to Pending MLTC ss. Marketers
The column “Case Status” must be
has no access to this SS, but they can
frequently updated since it determine and
request updates at any time. Important allow to identify the situation of every pt.
updates will always be emailed to
marketer once available.
SMARTSHE
PENDING MLTC: when a case is
moved to Pending MLTC change the
color (Blue if Pending CFEEC evaluation Update the column “CFEEC” on pending
ET or Yellow for Pending UAS evaluation),
MLTC with the date of the CFEEC
evaluation appoint., and update the columns
pink and other colors on Pending MLTC “UAS” with the date of the UAS evaluation.
are managed by Mariel.
GENERAL
When a pt request to put the case on hold,
For Marketers and Parent Care highlight the case row in orange ad change the
RULES sheets: when a marketer does a case status as well
follow up with the pt or CM or SW,
highlight the case row in blue and When pt is referred to WG change the
change the case status. case row color to Pink and change the
case status as well
COLOR RULES
 OUTREACH PROTOCOL
◦ Referrals coming later than 4pm can be followed up the next day. 4 initial outreach attempts on all cases as follows:
◦ The intake rep must start the email thread to send marketers all updates regarding the case, this must be done by using the
option “reply all” on the email (eFax) where the referral came in (make sure to put the marketer´s email on the TO: box and
CC Intake2, the subject for new referrals internal email thread must be as follow:

Pt´s full name/facility/Social Worker (SW)

Ex. Subject: Rosa Martinez/Bronx Care/Elba Rodriguez

If 4th attempt If Marketer didn’t Do follows up on

If by the 2nd unsuccessful: inform
marketer and ask how to
request to close case, every 72 hours to all
outreach attempt proceed (they may decide
do a 5th and last cases with successful
outreach attempt 1 outreach outcome or
you cannot reach if they will conduct a pt
visit) week after the 4th on a specific date if
pt inform • If marketer request attempt requested by the
marketer via to close case, move it • If unsuccessful, close patient.
email thread to to Unreachable 2020 the case and inform  All cases will be
assist with on Smartsheet. marketer via email assigned by
thread. Marketer and placed
alternate contact on marketers SS.
#
 CASES CLOSING PROTOCOL
◦ PT REFUESED SERVICES: Convince the pt to stay with us, offer CDPAP, use all sources available. If unsuccessful send e-
mail to the marketer explaining the situation.

◦ PT UNREACHABLE: after following outreach protocol send info. to marketer.

◦ Send update in the 2nd unsuccessful outreach attempt with the date and time info.
◦ Send update at the 4th unsuccessful attempt with info. About the dates and time.
◦ Follow up In 1 week after 4th attempt, if unsuccessful send info about the dates and time of the unsuccessful attempts and inform you will
close the case.

◦ PT PASSED AWAY: send information to marketer via e-mail.

 CFEEC APPOINTMENT
◦ A nurse sent from the Maximus agency of NY will evaluate the pt and will inform the pt if he/she was approved or not.
◦ If pt is not approved -> inform they can apply for LTC in 60 days again, if pt wants to apply, you can set up a callback to do it.

◦ In the HMO referral types, the MLTC helps to set up the appointment, but If the MLTC is unable to reach the pt for the
CFEEC appointment, conference call the pt with the Maximus agency of NY to make sure the appointment is scheduled.
◦ Call pt one day before the appointment to do a reminder and one day after the appointment to know the outcome.
◦ UPDATE the Pending MLTC sheet properly: change the color to blue when the pt is pending for CFEEC evaluation, add the
date of the CFEEC in the CFEEC column and change the case status on SS.
 UAS APPOINTMENT
◦ When a pt is approved for LTC during CFEEC evaluation, the MLTC should schedule the UAS appointment to check the
amount of hours per day and days per week that pt will receive home care with the MLTC plan.

◦ A nurse evaluates the pt to check the POC that will be offered to pt. If MLTC couldn’t reach the pt -> conference call pt with
the MLTC.

◦ Call the pt one day before the appointment to do a reminder and one day after appointment.

◦ UPDATE the Pending MLTC sheet properly: change the color to Yellow when the patient is pending for UAS evaluation, add
the date of the UAS in the UAS column and change the case status on Smartsheet.
 Referral Type 1 – Straight Medicaid
1. Identify Marketer.
(TERELLIZ: BRONX CARE, FACILITY: FOREVER YOUNG, MOSHE, THE LINCOLN HOSPITAL, REBECCA CHHA, DANIELLA:
ADVANTAGE CARE, SEND TO CHHA)
2. Check if it’s not a closed case by searching by name on SS.
3.If it is a new case -> fill out new blank row on the marketer’s sheet with info. on the referral.
4. Check the pt’s insurance.
5. Do WELCOME CALL-> fill the missing tabs on SS, check if pt wants CDPAP, check on PCP info.
6. Schedule Maximum’s visit-> Conference call, a nurse will determine if pt is approved for LTC.
7. Refer to MLTC indicated by Mariel
8. UAS visit
9. POC Plan of Care- Follow up with MLTC until received, Check with patient to make sure they are satisfied, if they are not satisfied, refer to another
MLTC (ask Mariel to which one)
10. HRA: If patient is happy, advise MLTC to submit to HRA.
11. FINAL STEP: Follow up with MLTC until auth received, once approved, advise auth specialist.