WV Title XIX MR/DD Waiver Web Application User`s Manual for
Contents
1. Speech Therapy Occupation Therapy Physical Therapy Mo Yes Yes Soaks Dressing Traction Casts Oxygen Mo No No Suctioning Tracheostomy Yentilator Mo Mo Mo X Diagnostic Services IY Fluids Arm Hand Yes Mo i Some Daily Activities Limites Yision Hearing Seizures Vision Problems Limit Readine Hears Only Loud voices May Mone Gr Controlled Health Care RN Physician Dietician Few or Slight Limitations On C Daily No Medications Med Health Problems Med ood Yes Yes Yes Continued Page 19 Med Seizures Med Health Maintenance Mo Yes The information in this section should correspond to the individual s most recent psychological evaluation DD 3 and or current functional analysis Date of most Prim Expression recent DDS 08 25 2006 Mone Maladaptive Observation Hurtful to Self Hurtful to Others No ad No ha No Y Destructive to Property Disruptive Mal Habits Mo Mao ka ho ka Offensive Withdrawal Uncooperative Mo Mlo Ao ka Functional Behavior Assmt Behavior Plan Behavior Protocol Mo T Meo Alo Psych Referral Behavior Plan Protocol No Po Axis I Primary Axis I Secondary Ga 09 F ca OY Ee Axis II Primary Axis II Secondary Ga 09 ja ca 09 g Axis III Axis IY AXIS v71 09 No Identified Stressor 00s ki DEMO SAWE SUBMIT CLEAR Figure 3 40 Note that certain fields have been pre filled by BHHF and cannot2. Directions I 79 North to exit 58 Drive 2 miles and take right Individual s Legal Status Legally Competent Adult Must be Adult e Service Coordinator First Name Service Coordinator Last Name Service Coordinator Phone Service Coordinator Email Address 555 518 4848 aohudapshealthcare cam Individual s Type of Residence Residence Provider Provider Phone Residence Number Biological Or Adoptive Family SS of Other Waiver Consumers es Facility Day in Individual s Residence Community Day Habilitation Habilitation fo Mo Mo F Competitive Prevocational Training Supported Employment Employment Mo Mo Mo bi Technical Education Education Level Current School No bd High ochoolGED Not In School continued on following page Respondent 1 First Name FRED Respondent 1 Phone 304 555 1234 Respondent 2 First Name SAM Respondent 2 Phone Spe ee aa e Respondent 3 First Name DEBBIE Respondent 3 Phone 304 565 4236 Respondent 4 First Name _e Respondent 4 Phone Discussion Respondent 1 Last Name SMITH Relationship to Respondent 1 Father Respondent 2 Last Name Salvo Relationship to Respondent 2 Adult Companion Respondent 3 Last Name Fazio Relationship to Respondent 3 Respite Provider Respondent 4 Last Name Relationship to Respondent 4 _ Page 16 MEDICAL HLTH SFTY TRAN
3. Services for that location figure 3 21 Page 13 Manage Services continued MANAGE SERVICES LOCATIONS fIP CODE SERVING ick Jackson Er Environmental Adaptation Environmental Accessibility Adaptation to Vehicle Environmental Accessibility Adaptation to Home M Medical Evaluation M 40 64 years New Member M Adolescent 12 17 years New Member M 18 39 years New Member M Late Childhood 5 11 years New Member M Late Childhood 5 11 years Established M65 years and over New Member M Infant age under 1 year New Member M Early Childhood 1 4 years New Member M 40 64 years Established i 65 years and over Established M Infant age under 1 year Established i 18 39 years Established M Early Childhood 1 4 years Established M Adolescent 12 17 years Established M Program Flan Development M Skills Specialist Residential M Social Worker Skills Specialist Day Residential Habilitation Agency Residential Habilitation 1 33 l Agency Residential Habilitation 1 4 3 l Agency Residential Habilitation 1 13 l Agency Residential Habilitation 1 23 C Community Residential Habilitation 5 M Service Coordination M Service Coordination submit Figure 3 21 service categories e g Medical Evaluation can be expanded and collapsed by clicking the or button adjacent to the category Clicking the check box of a parent category will select ALL children services under the parent
4. You can un check service s under the parent by clicking the existing check mark Once the desired services are selected click Submit Page 14 Service Coordination Alert Manage Services Other Options Logout Manage Accounts of Menu a An agency Administrator has the same cumulative rights as Service Coordinator s under that agency and may choose to perform the function of a Service Coordinator Administrators can assign client s to themselves then click the SC Menu link which will direct them to the following Service Coordination screen SERVICE COORDINATION The following cases have been assigned to this Service Coordinator MEDICAID l LAST NAME FIRST NAME CASE PURCHASE 684608460454 3351 35 1351 FRY JAMES a la ra EDIT 12345678987 351 65 4456 MCCLOUD RHONDA a ea EDIT Figure 3 30 Clicking SELECT will display the following client case Demographics information screen CASE INFORMATION DEMOGRAPHICS First Name Middle Initial Last Name Dames FRY Medicaid Number 68468468454 Suffix Social Security Number Seiad ante ce ak Waiver Eligibility Date IPP Date jav21 2006 a 21 2006 Date of Birth Gender Marital Status 5 15 1987 Male Mever Married Race Ethnicity Primary Lanquage White continued on following page Non Hispanic or Latina English Page 15 Street Address city State 1212 LANE WAY LAPLAND av Zip Code 35154 Driving
5. be changed by the provider agency Enter data into remaining fields Clicking Demo will direct the user back to the Demographic screen previously illustrated figure 3 31 Clicking SAVE after modifying the data fields will update the record Clicking SUBMIT will send the data to APS Healthcare WV Page 20 Service Coordination Purchase Pressing the Purchase button displays the following page CASE INFORMATION l a e SERVICE AND SUPPORT PURCHASING Select Service Support Name JAMES BROWN Age f Adult Companion r Service Coord Dave Berkowitz Eligibility B72172006 FSIS Service IDT Date 5 21 2006 PurchasePeriod initial Adaptation Total Budget 15000 Extended Professional p Services ist quarter ursing Services a Annual Service StantDate EndDate Status z Cost Preferred Provider Delete Edit Program Plan b Units Development Service Coord 8 21 2006 11 19 2006 S d joo 524 0 RUSSELL NESBITT SE Delete Edit Psychiatric Psychological ae Gaiam lof ave Services 2nd Quarter Residential Habilitation d Respite Care StartDate EndDate Status Slo Cost Preferred Provider Delete Edit Service Coordination b ocial Histor p Service Coord 11 20 2006 2 18 2007 Saved 555 5827 5 RUSSELL NESBITT SE gt Delete Edit wa ard Quarter Annual Service StartDate EndDate Status Units Cost Preterred Provider Delete Fdit Service Coord 2 19 2007 5 20 2007 Sa
6. 6 mia SSSSC wi nta x Environmental p Adaptation Annual IPP v30 2006 Extended Professional p Total Budget 23000 Services Medical Evaluation Nursing Services b 1st Quarter EE PE E il i StartDate EndDate Status sets Cost Preferred Provider Delete Edit Psychiatric Psychological APPALACHIAN COMM Srvc Coord 8 30 2006 11 28 2006 Pend 12 126 0 APPALACHIAN COMM Delete Edit Residential Habilitation d 2nd Quarter Respite Care b Service StartDate EndDate Status pine Cost Preferred Provider Delete Edit ord Quarter ee ea Preferred Provider Delete Edit Units Srvc Coord 2 28 2007 5 29 2007 Pend fii 116 5 APPALACHIAN COMM Delete Edit 4th Quarter Service StantDate EndDate Status ee Cost Preferred Provider Delete Edit Srvc Coord 5 30 2007 8 29 2007 Pend fi nss APPALACHIAN COM Delete Edit Remaining Balance 22527 5 Return SUBIT Service StarntDate EndDate Status Figure 3 05 Page 10 Manage Accounts Alert Manage Services Manage Accounts SC Menu Other Options Logout a An Administrator can access the following screen by clicking the link Manage Accounts or will be directed to this screen immediately after logging on if no Alerts exist This screen will list client s assigned to your agency and enable the agency Administrator to assign a Service Coordinator to each client via a drop box list as illustrated below In this example the field
7. APS Healthcare Inc West Virginia WV Title XIX MR DD Waiver Web Application User s Manual for PROVIDER ADMINISTRATORS who manage Service Coordinators October 2006 Version 1 0 IV Table of Contents Overview Technical Requirements The Login Process Changing Your Password Service Coordinator Administrator Functions Alerts Rejecting a Referral Accepting a Referral Pending Service Referrals Purchase Requests Manage Account Adding Service Coordinators Manage Services SC Menu Service Coordination Demographics Health and Safety Medical Purchase Transfer Discharge Logout Ending your Session Page 1 o Ol O 10 11 12 14 14 17 18 20 21 22 23 Page 2 I Overview Technical Requirements Overview The APS Title XIX MR DD Waiver Web Application will allow provider agencies to submit requests for authorizations for MR DD Waiver services Technical Requirements 1 You must have a computer with Internet access The registration program supports only Internet Explorer IE 5 0 and higher If you wish to print any forms out you must also be connected to a printer 2 If you are experiencing difficulties logging on or using the program please do the following e Check to confirm that your browser s security settings are set to 128 bit encryption This can be done in your Microsoft Internet Explorer session by clicking Help and the
8. SFER DISCHARGE Figure 3 31 Note that certain fields have been pre filled by BHHF and cannot be changed by the provider agency Enter data into remaining fields Clicking MEDICAL will direct the user to the medical information screen figure3 40 Clicking HLTH SFTY will direct the user to the Health and Safety screen figure 3 41 Clicking TRANSFER will direct the user to the transfer screen figure 3 60 Clicking DISCHARGE will direct the user to the discharge screen figure 3 70 Page 17 Service Coordination Health and Safety HEALTH AND SAFETY INFORMATION First Name Middle Initial Last Name Suffix JAMES FREDDIE CORDON Social Security Number Medicaid Number Date of Birth 696 52 0646 37237433849 3 30 1969 Based upon case information submitted by the service coordinator 1 Health and or Safety Issue s have been identified F Mobility M PN Physician Care l Incontinence F Medication Health l Catheter F Medication Mood Behavior llleastomy Medication Seizures l Colostomy Observed Maladaptive Behaviors l Gastric Tube l Hygiene Total Care Soaks Dressings Traction Casts Oxygen M Suctioning l Tracheotomy ventilator F IW Fluids Vision l Hearing F Seizures F Hurtful To Others l Destructive To Property C Disruptive Behavior F Unusual Repetitive Habits l Offensive Behaviors F Withdrawal Inattentive Behavior F Uncooperative Behavi
9. Select Service Coordinator to Manage is blank therefore ALL clients for your agency unassigned or assigned to Service Coordinators will be listed To view clients for a specific Service Coordinator simply select that Service Coordinator in the field Select service Coordinator to Manage and the resulting list will be restricted to that Service Coordinator s existing case load Once the Administrator has completed Service Coordination reassignment clicking the Save Reassignments button will save these changes Clicking the SELECT button to the right of the clients detail line will direct the Administrator to the Case Management screen previously illustrated in figure 3 03 The Administrator can review the information and assign or change a Service Coordinator from this screen also Alert Manage Services Manage Accounts 5C Menu Ghange Password Logout ACCOUNT MANAGEMENT Select Service Coordinator to Manage SELECT CLEAR Click Add New Serice Coordinator save Reassignments MEDICAID SSN LASTNAME FIRSTNAME ASSIGNED TO ee Sheene ae RAIAMNICK se 35168465454 3513 BROMAN JAMES RAJAMNMICK SELECT afon epee ge ONES 08468468454 1351 FRY JAMES JJONES ee le eal fou are viewing results i 2 ofa total af 2 records JRICHARDSONP save Reassiqnments JRICHAROSONSC PROVIDER RAIAMNICK Figure 3 10 Additionally note that an Administrator can add Service Coordinator s to their agency on th
10. T NAME REFERRAL ACTION 35132135137 Ba nel eects Ret iaa BERR HALLEY SELECT There are pending service referrals for the following consumers MEDICAID SSH LAST NAME FIRST NAME REFERRAL ACTION 35166465454 3354 51 3513 BEROAN JANES SELECT 654605465454 684 66 4683 STROBE LISA SELECT s21251352132 654 968 7898 BOON DAMIEL SELECT The following purchase requests are awaiting your approval MEDICAID LAST NAME FIRST NAME REFERRAL ACTION 05428798712 54 98 7987 ALDRIDGE MADELYH SELECT Figure 3 01 Clicking SELECT to the right of a record will direct you to a specific web page relative to the category of the alert Note the various categories of alerts above each column heading in figure 3 01 e recently referred cases is illustrated in figure 3 02 and discussed This alert appears when BHHF has referred a consumer to your agency for service coordination e pending service referrals is illustrated in figure 3 04 and discussed This alert appears when a consumers interdisciplinary team is asking your agency to provide service s for the consumer as outlined in the individual program plan e purchase requests is illustrated in figure 3 05 and discussed This alert appears when a service coordinator with read or read write only privileges has created a service purchase request requiring your approval before submission to APS Page 6 Recently Referred Cases The recently referred cases alert appears wh
11. anging your Password After successfully logging on you may choose to change your password via the Other Options Change Password link at the top right of your screen ooge panie ARETE RSLS y Department of Health amp Human Resources Bureau for Medical Services TITLE XIX MR DD WAIVER PROGRAM Welcome aps hc SENECA HEALTH SERVICES Alert Manage Services Manage Accounts SC Menu Other Options Logout Provider Download Change Password Figure 2 11 E Clicking this link will direct you to the following screen allowing you to choose a new password Note that you must enter your existing password in the data entry field Password then enter your new password and confirm your new password in the appropriate data fields CHANGE PASSWORD Change Your Password Password New Password Confirm Mery Password Change Password Cancel Figure 2 12 To complete the action of changing your password click Change Password Page 5 lil Service Coordinator Administrator functions Alerts Alert Manage Services Manage Accounts SC Menu Other Options Logout When an Administrator logs on if Alerts exist e g a client has been referred to your agency the following screen will be displayed listing the alert record s Manage Services Manage Accounts 5C Menu Change Password Logout ALERTS The following cases have been recently referred and require action MEDICAID SSN LAST NAME FIRS
12. ata to APS Healthcare WV Page 23 IV Logout Alert Manage Services Manage Accounts SC Menu Other Options Logout Figure 4 10 1 When finished log out by clicking the Logout link as shown in Figure 4 10
13. ate radio button will select the desired level e Read Only view their assigned case load records only e Read Write ability to inout data for their case load and of course view e Read Write and Submit ability to input data view and submit case load data to APS Note when a Service Coordinator with Read Write Submits data the data will go to the Administrator of that Agency to be reviewed and then submitted by the Administrator to APS After specifying the desired user account parameters click CREATE USER Then fax or mail the Web User Request form to APS Healthcare WV address fax number is on bottom of form and upon receiving the form an appropriate APS representative will activate the user account Page 12 Manage Services Alert Manage Services Manage Accounts SC Menu Other Options Logout a An Administrator can access the following screen by clicking the link Manage Services This screen will list locations for your agency and allow you to indicate the Waiver services provided at each location The information provided by your agency is entered into a database that will indicate your availability to provide Waiver services when interdisciplinary teams use the APS service purchase screens to select services for individual consumers MANAGE SERVICES LOCATIONS ZIP CODE SERVING EDIT 15548 Epone Hancock Jackson EDIT Figure 3 20 Clicking the EDIT button will direct you to a screen listing
14. delivery tsts sisSOY The completed DD 16 will doshas been submitted to the Bureau for BH amp H Facilities SAME SUBRAT I understand this transfer request willbe processed at the time the DD 16 has been received reviewed accepted Figure 3 60 Clicking SAVE after modifying the data fields will update the record Clicking SUBMIT will send the data to APS Healthcare WV Page 22 Service Coordination Discharge Pressing the Discharge button displays the following page This screen will facilitate the discharge of a client Select a Reason for Discharge via the drop box selection and add any relevant information in the discussion box below this field Click the Check box to indicate status of the DD X CONSUMER DISCHARGE FROM TITLE XIX MR DD WAIVER Consumer Name JAMES BROWN consumer ID SC Provider 321 SC Provider ID 321 Create Date o Submit Date SC Provider Staff Member Completing this Discharge Dave Berkowitz Reason for Discharge fo E Informant Name C j CA Informant Phone Informant Email Address Informant Address1 Informant City Informant Address 2 Informant State Unspecified Informants Zip Code oOo The completed DDO will be has been submitted to BHHF SAVE SUBRAIT Submit to BHHF to discharge this consumer Figure 3 70 Clicking SAVE after modifying the data fields will update the record Clicking SUBMIT will send the d
15. en BHHF has referred a consumer to your agency for service coordination Clicking SELECT to the right of a specific record under the Alerts category recently referred cases will display the following screen for reviewing client data The Administrator can then ACCEPT or REJECT the referral by clicking the appropriate button at the bottom of this screen note the ACCEPT button resides above the REJECT button currently hidden by the expanded reason for rejection drop box displayed below for illustrative purposes If REJECT is selected you must select a reason from the drop down menu Clicking the reject button will display a rejection discussion clarification text box in which you can briefly discuss clarify the reason your agency cannot accept the referral Clicking submit will send the referral back to BHHF so they may re assign the case to a different provider CASE INFORMATION First Name Middle Last Name Suffix Name VAL BART TREX Gender Male Social Security Number Medicaid Number Date of Birth Waiver Enrollment Date 233 14 5439 03912 125874 10 10 1986 9 10 2006 Street Address Street Address 13 RUE MORGUE AVENUE City State Zip Code cross LANES wy 25161 Please select a reason for Rejection Unspecified Unspecified Already at Max Capacity for SC Temporarily unable to take new clients Other Reason Figure 3 02 Page Recently Referred Cases Accepti
16. is screen by clicking the link Add New Service Coordinator above the upper Save Reassignments button Clicking on this link will direct the Administrator to the web page illustrated in figure 3 11 Page 11 Adding Service Coordinators REQUEST NEW SERVICE COORDINATOR ACCOUNT Enter Information for the New Service Coordinator First Mame Last Name O Primary Phone Number sis secondary Phone Number User Name Password o Confirm Password pO E mail security Question Security Answer Permissions Read Only C Read Write Read Write and Submit CREATE USER Figure 3 11 The Administrator will enter the relevant information as prompted by the data field labels The User Name will be the actual identifier with which the Service Coordinator will log onto the MRDD web site An example although not limited to these constraints for a Service Coordinator with the First and Last Name of John Smith may have the User Name of smith The Administrator will specify a password and confirm the password Note that the password is case sensitive A Security Question and Answer must be specified This will be used for account reset if a user account is locked and should be unique for the user An example question might be Mother s maiden name with the answer Jones Permissions define the level of access rights for this specific Service Coordinator Clicking the appropri
17. n click About Internet Explorer The resulting display will specify the Version of Internet Explorer you are running along with the encryption specification in terms of Cipher Strength e Upgrade your browser to Internet Explorer 5 0 or higher v Warning you must have Windows 98 or higher v To download a free upgrade of IE visit http www microsoft com windows ie downloads ie6 default asp e Reset your Internet security to Medium lt Right Click on your IE icon v Choose Properties v Select the Securities tab v Click Default level This application follows Health Care Financing Administration HCFA security regulations and will comply with Health Insurance Portability and Accountability Act HIPAA regulations Consequently there are multiple levels of security For more information on the security of this online application please contact APS _ Healthcare Inc at 304 343 9663 Page 3 ll Logging on Go to the Title XIX MR DD Waiver Program web site at https wvmrddwaiver apshealthcare com and logon with your assigned User Name and password Welcome APS Healthcare West Virginia Department of Health amp Human Resources Bureau for Medical Services TITLE XIX MR DD WAIVER PROGRAM LOG IN User Name Password Figure 2 10 You will be directed to the appropriate web page inherent to your user name role e g as an Administrator Service Coordinator etc Page 4 Ch
18. ng a Referral lf the Administrator clicks ACCEPT the following screen will be displayed allowing the assignment of a Service Coordinator to the case in the data field Select Service Coordinator who will manage this account Clicking the arrow in this field will display a list of Service Coordinators previously established by your agency Clicking on the desired Service Coordinator s name will populate this data field Clicking OK at the bottom of screen will save this selection CASE INFORMATION First Name en Last Name Suffix Name JAMES FRY Gender Male Social Security Number Medicaid Number Date of Birth Waiver Enrollment Date 35 1 35 1351 65468468454 5 15 1987 s72 1 2006 Street Address Street Address fi212 LAME WAY city State Zip Code LAPLAND wy 35154 Select Service Coordinator who will manage this account z OK CLEAR Figure 3 03 Page 8 Pending Service Referrals The pending service referrals alert appears when a consumer s interdisciplinary team is requesting that your agency provide service s for the consumer as outlined in the individual program plan You will receive this alert once the IDT s request has been authorized and sent to you by APS Healthcare Clicking SELECT to the right of a specific record under the Alerts category pending service referrals will display the following screen REFERRAL INFORMATION sisi STEVELOUIRWIN Age Be Se
19. or Functional Behavioral Assessment Recommended by Psychologist l Behavior Plan Recommended by Psychologist l Behavior Protocol Recommended by Psychologist C Psychiatric Referral C Continue Behavior Plan Protocol Identified Health and Safety Issues must be addressed in the consumer s IPP DEMO MEDICAL CONTINUE PURCHASE Figure 3 41 Clicking Demo will direct the user back to the Demographic screen figure 3 31 Clicking Medical will direct the user back to the Medical screen figure 3 40 Clicking Continue will direct the user to the Service Coordination screen figure 3 30 Clicking Purchase will direct the user to the Purchase screen figure 3 50 Page 18 Service Coordination Medical Pressing the MEDICAL button displays the following page CASE INFORMATION MEDICAL First Name Middle Initial Last Name frames FRY Suffix Social Security Number 2351 35 1351 Medicaid Number Date of Birth 65468468454 5 15 1987 The information in this section should correspond to the individual s most recent annual medical evaluation DD 7A current physician orders and or medical reports Date of most recent DDOZA loa 20 2006 fao 160 Height Inches Weight Pounds Mobility Continence Catheter Transfer With Assistance Continent Mo Illeostomy Colostomy Feeding Mo x Mo Feeds self Special Diet Hygiene ision Therapy Mlo ha Needs Assistance Mo
20. rvice Coord solomon ts i i i sSsSCS Eligibility baoo Social Security Number 353 76 8989 Medicaid Number 03987866666 StartDate EndDate Units ServiceCode ACTION Agency Res Hab 1 2 9 11 2006 9 10 2007 2000 T2017 U3 Adult Comp I 1 1 6 11 2007 9 10 2007 25 55135 UAu4 Adult Comp I i 1 a 1l2 2007 6 10 2007 25 S5135 UAU4 Adult Comp I i 1 12 11 2006 3 11 2007 25 S5135 UAU4 Adult Comp I 1 1 9 11 2006 12 10 2006 25 351355 UAU4 SUBMIT View Demo lew Medical iew Purchase Figure 3 04 Clicking the SUBMIT button will transmit your Accept Reject selection as illustrated in figure 3 04 The Demographic Medical and Purchase screens are discussed in detail later in this manual but can be accessed via the respective buttons illustrated in figure 3 04 Page 9 Purchase Requests The purchase requests alert appears when a service coordinator with read only or read write permissions has created a service purchase request requiring your approval before submission to APS Clicking SELECT to the right of a specific record under the Alerts category purchase requests will display the following screen for the provider administrator to review and then submit to APS CASE INFORMATION eaten MEDICAL INFORMATION SERVICE AND SUPPORT PURCHASING Select ada a a Name MADELYN ALDRIDGE Age 25 Service Coord ltest test Eligibility 5 30 2006 Ta Sa Day Services IDT Date E 30 200
21. ved 555 5827 5 RUSSELL NESBITT SE Delete Edit 4th Quarter Annual StartDate EndDate Status Units Cost Preferred Provider Delete Edit Service Coord 5 21 2007 8 20 2007 Saved 665 e275 RUSSELL NESBITT SE Delete Edit Remaining Balance 3406 5 Dave Submit Figure 3 50 Page 21 Service Coordination Transfer Pressing the Transfer button displays the following page This screen will facilitate the transfer of a client to another Provider The desired Provider can be selected via the drop box adjacent to the data field Transfer Service Coordination To A Service Coordinator can also be specified though this field is not required Select a Reason for SC Transfer via the drop box selection and add any relevant information in the discussion box below this field Specify an Effective Date of SC Transfer to new provider along with the Last date of current SC service delivery both in mm dd yyyy format Click the Check box to indicate status of the DD 16 SC TRANSFER BY SC TRANSFER SERVICE COORDINATION PROVIDERS Consumer Name JAMES BR Wy APS Consumer ID SC Provider PROVIDER is SC Provider ID a321 SC Provider Staff Member Completing this Request Dave Berkowitz Transfer Service Coordination To Consumer Has Requested iY as SC if possible Reason for SC transfer SELECT be Effective Date of SC transfer to new provider OoOo Last date of current SC service
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