MA 97 For Incontinence Procedure

STEP 2: SENDING THE MA97 TO THE CONSUMER

Once each step is completed, representatives should contact the consumer to keep them up to date with the process.

BEFORE sending the MA97 to the consumer, contact them for the following reasons:

• To let them know the MA97 is coming out to them, with a self-addressed stamped envelope and explain what they must complete.
• Verify their mailing address.

Representatives should make the consumer aware of any documentation that they are still waiting for from the doctor, answer any questions the consumer may have, AND verify the consumer’s mailing address.

When sending the MA97 to the consumer, representatives should:

• Include a self addressed stamped envelope (SASE) with the employee handling the MA97’s initials in the bottom left hand corner.
• Include the consumer letter.
• On the MA97 highlight #’s 33 & 34 where the consumer must sign.

The reason representatives should put their initials on the self-addressed stamped envelope is to make the sorting process easier when the mail comes each day. If Management sees an envelope addressed to a specific employee they will give it to them.

All MA97 requests use the same Consumer Letter template for each request. Representatives simply have to update the letter for each request.

The following areas need to be updated on the Consumer Letter:

• The date.
• The consumer’s full name (in two areas)
• The requested items description.
• The doctor’s full name.
• The employee who is completing the form’s information.

A copy of a Consumer Letter has been included at the end of this section of the procedure, with the highlighted areas to be completed.

Shown below is a Consumer Letter that has been highlighted for convenience with the areas that need to be completed:

After the consumer letter has been printed, representatives must highlight the areas where the consumer should complete for convenience.

Shown below are the areas that should be highlighted for the consumer letter.

ENTER A NOTE

Representatives should enter a note in the system that states the following:

• What the MA97 is for
• Where the MA97 went
• What went with the MA97

The topic should always be MA97. If an MA97 has been sent multiple times, representatives should number the requests. MA97 (for the first request) 2ND MA97, 3RD MA97, etc.

An example of how a note will look is shown below:

After sending the MA97 to the consumers representatives should be sure to update their follow up list and the MA97 Prior Authorization Checklist for efficiency.

MA97
BACK FROM CONSUMER

Once the MA97 is returned to our office, representatives must make sure that the consumer signed.

If another representative signed the MA97 for the consumer, representatives MUST make sure the signature belongs to that of the power of attorney.

If the person who signed is NOT the power of attorney, the MA97 must be returned to the consumer for signature.

If the consumer has a hard time writing, their mark of some kind must be given. Explain to the consumer that these are the states guidelines, and not ours.

STEP 3:
SENDING THE MA97 TO THE STATE

Once each step is completed, representatives should contact the consumer and the care manager to keep them up to date with the process.

When calling the care manager, representatives are just keeping them up to date with the process. We should NOT be asking the care manager to assist in anyway. If the care manager offers, that is acceptable.

When calling the consumer, representatives are calling to keep them up to date with the process.

When the MA97 comes back from the consumer, representatives need to complete the following on the form:

• # 26 B & C
  • If this is the initial request both B & C will be the same date. Representatives should take into account that will take 3-5 weeks for the state to reach a decision. The date representatives enter should be 3-5 weeks in advance. Representatives should always put the beginning of the month.
  • Example: The initial MA97 comes back 12/15/14, the date the representative should put on the MA97 is 01/01/15.
• # 30
  • Representatives should count the number of pages that will be sent to the state. Please note: the MA97 should NOT be included in the count.

Complete the rest of the prior authorization checklist. At this time, representatives should be double checking the MA97 to make sure that everything is accurate before continuing the prior authorization steps.

All of the following documentation should be sent to the include:

• The MA97 form.
• The medical justification form.
• The letter of medical necessity request.
• The prescription.
• The initial request letter (ONLY if it is the initial request).
• The lab work/clinical documentation.

INITIAL REQUEST LETTER

• When it is a consumer’s initial request for an increase on a product, the state wants to know the following information:
  • All of the item’s (that Medicaid covers) the consumer receives on a monthly basis.
  • The patient’s total daily usage.
  • The MA97 total units write up explanation.
    • This is the combination of what the consumer is requesting through PA/MA and the MA97.
      • Ex: The consumer is requesting 2 extra boxes of gloves per month, the following may be how to phrase the write up paragraph:
        • “The patient is requesting 2 extra units of Non-Sterile Gloves for a total of 4 units per month. The 4 total units would be a combination of the 2 units already covered through Medical Assistance and the 2 units that the consumer is requesting in this MA97.”
• The following must be updated on the initial request letter:
  • The date
  • The consumer’s name
  • The consumer’s date of birth
  • The consumer’s recipient number
  • The consumer’s address
  • The requested item’s decription
  • The consumer’s standing order w/ units per month
  • The consumer’s total daily usage
  • The consumer’s total write up
  • The MSI employee’s information

Listed below are all of the highlighted areas that need to be updated for an initial letter:

Representatives need to make a copy of all the documentation that is sent to the state.

After making the copies, remove the staples out of the MA97 and keep the copy. The original goes to the state. Sometimes the doctor’s office will take the carbon copy, which does not hinder the process at all but is discouraged.

Staple all the MSI copies together and put them in the consumer’s chart.

Seal the envelope with all of the original documentation inside (only required original is the MA97) and send all of the documentation to the state at the address listed below:

Waiver Services Outpatient
PA/1150 Waiver Services
P.O. Box 8188
Harrisburg, PA 17105

Weigh the envelope on the scale and put the request out for the mail man.

ENTER A NOTE

Representatives should enter a note in the system that states the following:

• What the MA97 is for.
• Where the MA97 went.
• What went with the MA97

An example of what the note should look is listed below:

After sending the MA97 to the consumers representatives should be sure to update their follow up list.