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Foster Child Placement

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Link the foster child to the foster home by identifying the service identifying the placement within the home. The user will also assign the case manager linking her/him to the foster child and the foster home.

  1. Go to: Avatar MSO > Care Management > Foster Child Placement
  2. On the Select Client screen, search for and select a foster child.
    • Click Brief Member Review to generate a report on the child's medical history.
    • Click Member Placement History to generate a report on the child's placement history.
  3. In the Funding Source Authorization Is For field, select the funding source if one does not default based on the Default Funding Source identified in the Foster Care Defaults form.
  4. In the Provider To Be Authorized field, select the appropriate foster home for the child's placement.
  5. In the Benefit Plan field, select the plan if one does not default based on the plan linked to the Default Funding Source.
  6. The Authorization Number is automatically generated. This number can be used internally for tracking services being reimbursed.
  7. In the Placement Level of Care field, select the level of care required for this placement.
  8. In the Current Placement Status field, select whether this placement is Approved, Denied, or Pending.
    • If Pending or Denied, select the reason in the Current Placement Status Reason field.
  9. In the Initial Or Continuing Placement field, select whether this authorization is an Initial authorization, a Continuing authorization, or a Copy of an existing authorization. This is used to track if this is the first placement or a different placement due to having to move the child.
  10. In the Begin Date Of Placement field, enter the date that the placement for the child begins in the foster home.
  11. The End Date Of Placement field defaults to the child's 18th birthday, but can be edited if the placement ends for any reason prior to this date. Once edited, the defaulting function is overridden and the field must be updated manually.
  12. In the Next Review Date field, enter the date when you would like to review the child's placement in this home. This is used for reporting.
Adjudication
  1. In the Inhibit Adjudication For Services Claimed During Authorization Period field, select the authorization types if you need to inhibit services for the foster child based on the authorization type.
  2. In the Claim Status for Inhibited Services field, select whether inhibited services should be marked as Approved, Denied, or Pending.
    • If Denied, select a reason in the Claim Status Reason for Inhibited Services field.
  3. In the Exclude Procedure Code Group Definition field, select one or more procedure code groups to exclude from adjudication inhibition. If adjudication is being inhibited for some types of authorizations, selecting one or more procedure code groups will allow services employing one of the included CPT or revenue codes to be adjudicated.
  4. In the Exclude Revenue Code field, select one or more revenue codes to exclude from adjudication inhibition. If adjudication is being inhibited for some types of authorizations, selecting one or more revenue codes will allow services employing one of those codes to be adjudicated.
  5. In the Exclude CPT Service Code field, select one or more CPT codes to exclude from adjudication inhibition. If adjudication is being inhibited for some types of authorizations, selecting one or more CPT codes will allow services employing one of those codes to be adjudicated.
Summary
  1. The Total Estimated Liability field, displays the total estimated liability amount.
  2. In the Procedure Code Type field, select whether to use a CPT Code or a Revenue Code.
  3. In the Code Authorized field, search for and select the code that represents the child's daily placement.
  4. In the Requested Units field, enter the number of units that were requested by the placement.
  5. In the Units Authorized field, enter the number of units that were granted.
  6. The Estimated Liability Code field, displays the total liability codes, for the authorized service codes.
    Estimated liability is calculated by multiplying the number of Units Authorized, by the service cost.
  7. When finished, click Submit.
► SQL Tables
  • SYSTEM.history_member_auths
  • SYSTEM.history_member_care_manager
  • SYSTEM.service_auth_detail
  • SYSTEM.service_auth_sv

 

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