PRE ORDER CALL PROCEDURE
Before a consumer can get their supplies from MSI, there is a list to check all necessary requirements are available.
This is an example of a new consumer who just got the prescription and now ready for an order.
These are the tabs to check:
- VIEW AOB
- VIEW RX
- RECENT ORDERS
- MANUAL CERTIFY ELIGIBILITY
- HOLD CODE
- FO NOTE
For the new consumer, it is allowed to send the first order without the AOB. For consumers without AOB. For consumers without AOB. This is how it looks like.
For the 2nd shipment, the VIEW AOB should look like this:
This is how it looks like if a consumer has a valid RX.
These are examples when RX can be the reason of holding the consumer’s order.
RX is blank
When the RXFromDate, Refills, RXToDate are refilled, CSRs still need to make sure the RX Status.
There are different RX Status that can affect a consumer’s order.
- OK – It means that RX is valid and can be use until the valid date provided.
- Missing Refills – It means that doctor’s office sent RX but the Refill Part is missing.
- For Illinois consumers – They can have 12 maximum refill (meaning 1 year supply of items).
- For all other state – Can only get a maximum of 5 refills every prescription.
- NotDrsSignature – It means that there is a different doctor who signed the RX.
- DxCode – It means that the diagnosis code provided on the RX is not about incontinence and should be billable to Medicaid.
This is an example of a blank Recent Order
This is an example of the Recent Order View with order.
How to Check Eligibility with Pennsylvania Medicaid
- LOG ON to the Pennsylvania Medicaid Website – https://promise.dpw.state.pa.us/portal/provider/MyHome/tabid/204/Default.aspx?s53=spiooy55p5spjr45rxlujmix&s19=/8NiIAWryR7gmzx/2Rx38ik7Ir0=
- LOG IN to your account using your PAMA Username and Password
3. Hit the Eligibility Tab, then fill in the form using ANY of the consumer’s information:
A. Recipient ID + DOB
B. Social Security Number + DOB
C. Name + DOB
4. Once loaded, the results will look like this.
If a consumer’s Medicaid will have a result like this
They will need to call Pennsylvania Medicaid Hotline at 8005378862. Most of the time, consumers just need to update their income information or paperworks that needs to be filled out. Once fixed, consumers can now get incontinence supplies to us again.
HOLD CODE/ FO NOTE
There will be a lot of reasons why consumers can not get our services.
- Ineligible to get the service – The consumes Medicaid may not be an active at the time they should get their monthly supply.
- Consumer is in a Facility – Most of the time, consumer who are confined in a facility received their supplies from the facility they are staying with. These facilities get their own products from a supplier they are contracted with. This company will then bill this facility. That is why MSI stop sending them supplies. The Hold Cold for this are:
- Long Term Care
- Short Term Hospital/ Nursing Home
- Long Term Hospital/ Nursing Home
3. Consumer can also put their orders on hold. Sometimes, it can be because they do not use the products so much or they are beginning to be better. The Hold Code for this are:
- As Need Basis
- Hold Til Further Notice (HTFN)
4.Dissatisfied with MSI. Consumer can also stop sending consumer’s supplies if they request to because they are not happy with our products or simply
5. MCO NON PAR – Consumer’s insurances is not incontract with MSI.
6. No AOB – Consumer’s very 1st order can go out, but the second order cannot be sent out without the AOB form. An AOB follow up can be done 3 days after they got their 1st order. Given that they want to change/ add products, we still can’t send another shipment even if its replacement.
7. No RX – If a consumer gets the supplies from MSI and Medicaid is the payor, they require a licensed physician, registered with Medicaid to sign the RX. For out-of-state consumers, CRNP, physician assistant and medical licensed doctor can sign the RX given that they can provide all necessary information needed on the RX.
A consumer may get the RX but make sure that the status is OK.
8. Billing Hold – If a consumer was put on this type of hold code, it can be one of these reasons:
- Doctor’s Issue – For PA, this can be used if the doctor that we have on file is not active with Medicaid.
- Insurance Issue – MSI might encounter different denial codes when it comes to filing a claim to consumer’s insurances. As a result, MSI will put the orders on hold until the problem is fixed.
9. Different Supplier – If a consumer gets incontinence supplies to us and also gets the same incontinence supplies to another company, tendency is whoever of these two companies billed Medicaid first then they will be the one to get paid. To avoid this, MSI needs to make sure that we are the sole provider of the incontinence supplies. MSI should advise the consumer to choose which company the consumer wants to get supplies with. Whoever it is, one company should be termed. If no decisions made yet, MSI should put the consumer on holf for Different Supplier.
10. No Contact – If a consumer’s account was put on this type of hold, that means that MSI tried reaching out to this consumer for the past 4 months but to no avail.
- No option to leave voicemail
- No ringing
- Number is not working/ disconnected/ temporarily not available
How to put consumer’s account on no contact:
- MSI can send orders out to a consumer for 3 consecutive months even if the pre-order call results are all voicemail or any of the reasons above.
- On the 4th month
- If CSR will call consumer and/or Care Manager, if someone answered, ask them if an order is needed. If yes, proceed with the monthly order and ask for another phone number to call in case we can’t reach them.
- If CSR called in and still uncontacted leave voicemail ask if an order is needed and letting the consumer know that MSI will stop sending them supplies until they will give us a call . After, we will put the hold code on. No Contact. Chat the main office so we can send NO CONTACT LETTER.
11. Deceased – MSI won’t be sending supplies to a deceased consumer. If one will receive a phone call from the emergency contact of our deceased consumer, express sympathy and try to get the date of death.
How to term an account for a deceased consumer:
- Take note of what happened to the call
- Go to FO
- Set all products to N and enter the date of death
- If there is an RX sent to the consumer’s doctor, have a supervisor delete it.
- Put DECEASED in FO Note.
- Click Add in Insurances and Term all insurances
- Untick the Add New Insurance Plan
- Choose one insurance and put a termination date (Ex. Day of death)
- Make sure that the INS. ACTIVE box is untick.
- Save and close.
- Choose one insurance then save and close
- Repeat until all insurances are termed
- Set all products to N and enter the date of death
- Go back to FrmViewCustomer, in Update Hold Code choose DECEASED.
- Chat Main office to pull out the consumer’s paper records.