MA1004

If the eMCR is from DDD, make sure the DDD Notice of Intended Action is attached. If it is not, contact the DDD case manager to request it. Place the document in the customer’s case file in DocuWare under Correspondence.

NOTE     If the customer is appealing the DDD denial, wait until the appeal is resolved to ensure that the correct PAS tool is used. Speak with an Benefits and Eligibility Manager for more case-specific guidance.

BEFORE opening the new PAS, update the customer’s DD status.

From the PAS Records page, click on the “pencil” icon from the last PAS assessment to open the DD History page.

End-date the last DD Status record and click save. This will create a new row in the DD History.

In the new row, add the new DD status and the begin date, and save. This will bring you back to the PAS Records page and the updated DD status will display on the Pending PAS line.

NOTE     Ensure the PAS type is correctly stated as “Reassessment”, and that the correct DD status is displaying.

Complete the PAS. 

NOTE     Make sure the correct PAS tool was generated. See Identifying the Appropriate PAS Tool for details.

Send to Physician Review, if necessary.

NOTE     Explain in the summary the reason that the PAS is being done.

Is the customer medically eligible?

• If YES, contact PAS QC to review the final PAS.

• If NO, discontinue ALTCS eligibility. Verify that the PAS Reassessment letter generated by HEAplus is correct.

Contact the DDD Support Coordinator and the EPD Case Manager in order for them to make arrangements for transition of services without interruption.

Notify the Benefits and Eligibility Specialist and request the case be dispositioned.

NOTE     Will NOT change unless the case is dispositioned.

Review the notice to see if it is correct. If it is not correct, suppress it in HEAplus, and notify your Benefits and Eligibility Manager and PAS QC of the corrections needed.