West Virginia I/DD Waiver Web application user`s manual for service
Contents
1. TITLE XIX MR DD WAIVER PROGRAM Welcome Mike Rowe Alert Coordinate Case s Change Password Logout ALERTS MEDICAID LAST NAME FIRST NAME DELETE ALERT O3912125874 233 14 5439 TREX WAL DELETE Figure 3 01 Below figure 3 02 is another example of an alert informing you of a discharge ALERTS These cases have been discharged and will be removed from your caseload 30 days fram the discharge date MEDICAID LAST NAME FIRST NAME DISCHARGE DATE 12845018337 oS cteaketoy UNDERHILL GOLDA 9711 2006 Figure 3 02 Page 6 Coordinate Case s Alert Coordinate Case s Change Password Logout a A Service Coordinator can access the following screen by clicking the link Coordinate Case s or will be directed to this screen immediately after logging on if no Alerts exist This screen will list one or more clients assigned to you and enable you to perform Service Coordination for each client Clicking the SELECT button to the right of the client s detail line will direct you to the Demographics screen illustrated in figure 3 20 Once purchase data has been established clicking the EDIT button will direct you to the Purchasing screen illustrated in figure 3 80 Initially however clicking EDIT will direct you to the same Demographics screen as clicking SELECT Welcome Mike Rowe Alert Coordinate Casets Change Password Logout SERVICE COORDINATION The following case2. relevant information in the discussion box below this field Click the Check box to indicate status of the DD 16 CONSUMER DISCHARGE FROM TITLE XIX MR DD WAIVER Consumer Name AMES BOND Consumer ID fioooooooa ooo SC Provider WESTBROOK HEALTH S SC Provider ID a 00000 Create Date Submit Date E o j SC Provider Staff Member Completing this Discharge Mike Rowe Reason for Discharge o ae pe Informant Name oOo O ooo iff pooo Jj Informant Phone oOo tC Informant Email Address Informant Address1 Informant City Informant Address 2 o y Informant State Unspecified Informants Zip Code l The completed DD will beshas been submitted to BHHF SAME SUBMIT Submit to BHHF to discharge this consumer Figure 3 70 A Service Coordinator with Read Only privileges may only view this data A Service Coordinator with Read Write privileges may update data fields that are not protected e g grayed out which can only be modified via BHHF Clicking SAVE after modifying the data fields will update the record N A for Read Only Clicking SUBMIT by a Service Coordinator having e Read Write privileges will send the data to your Provider Administrator e Read Write and Submit privileges will send the data to APS Healthcare WV Page 15 Purchase Requests CASE INFORMATION MEDICAL INFORMATION SERVICE AND SUPPORT PURCHASING Select ees Name MADELYN ALDRIDGE A
3. following page Respondent 1 First Name FRED Respondent 1 Phone 304 555 1254 Respondent 2 Phone 304 232 5542 Respondent 3 First Name DEBBIE sd Respondent 3 Phone 304 565 4236 Respondent 4 First Name _ Respondent 4 Phone Respondent 1 Last Name SMITH Relationship to Respondent 1 Father sd Respondent 2 Last Name 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 9 Discussion relevant discussion goes here MEDICAL SAE SUBRAT CLEAR TRANSFER DISCHARGE Figure 3 20 A Service Coordinator with Read Only privileges may only view this data A Service Coordinator with Read Write privileges may update data fields that are not protected e g not grayed out which can only be modified by BHHF Clicking MEDICAL will direct the user to the medical information screen figure3 30 Clicking SAVE after modifying data fields will update the record N A for Read Only Clicking SUBMIT by a Service Coordinator having e Read Write privileges will send the data to your Provider Administrator e Read Write and Submit privileges will send the data to APS Healthcare WV Clicking TRANSFER will direct the user to the transfer screen fi
4. APS Healthcare Inc West Virginia WV Title XIX MR DD Waiver Web Application User s Manual for Service Coordinators September 2006 Version 1 0 Page 1 Table of Contents I Overview Technical Requirements 2 Il The Login Process 2 Z22222 O8 Changing Your Password 4 Ill Service Coordinator Functions ee Alerts LLL 9 SC Menu Service Coordination ee 6 Demographics R Medical L LL LL LLL LLL 10 Health and Safety ee 12 Transter LL LL LL LL LLL LLL LLL LLL LLL 13 Discharge eee 14 Purchase 19 IV Logout Ending your Session 16 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 then 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 Ciphe
5. Protocol Identified Health and Safety Issues must be addressed in the consumer s IPP DEMO MEDICAL CONTINUE PURCHASE Figure 3 40 A Service Coordinator with Read Only privileges may only view this data A Service Coordinator with Read Write privileges may update data fields that are not protected e g grayed out which can only be modified via BHHF Clicking Demo will direct the user back to the Demographic screen figure 3 20 Clicking Medical will direct the user back to the Medical screen figure 3 30 Clicking Continue will direct the user to the Service Coordination screen figure 3 10 Clicking Purchase will direct the user to the Purchase screen figure 3 80 Page 13 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 TRANSFE
6. R BY SC TRANSFER SERVICE COORDINATION PROVIDERS Consumer Name AMES BORD APS Consumer ID 1o0o00000 SC Provider WESTBROOK HEALTH S SC Provider ID 3 n SC Provider Staff Member Completing this Request Mike Rowe Transfer Service Coordination To P l Consumer Has Requested as SC if possible Reason for SC transfer SELECT 0 SY 2 Effective Date of SC transfer to new provider Last date of current SC service delivery FO The completed DD 16 will do has been submitted to the Bureau for BH amp H Facilities SAME SUBMIT I understand this transfer request willbe processed at the time the DD 16 has been received reviewed accepted Figure 3 60 A Service Coordinator with Read Only privileges may only view this data A Service Coordinator with Read Write privileges may update data fields that are not protected e g grayed out which can only be modified via BHHF Clicking SAVE after modifying the data fields will update the record N A for Read Only Clicking SUBMIT by a Service Coordinator having e Read Write privileges will send the data to your Provider Administrator e Read Write and Submit privileges will send the data to APS Healthcare WV Page 14 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
7. enance No al Ma Continued on following page Page 11 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 i Prim Expression recent DDS s72 1 2006 Speaks Maladaptive Observation Hurtful to Self Hurtful to Others No No No Destructive to Property Disruptive Mal Habits Mo r Mo r Po ka Offensive Withdrawal Uncooperative Yes ha Yes Yes Functional Behavior Assmt Behavior Plan Behavior Protocol Mo T ho r Po ka Psych Referral Behavior Plan Protocol No X Yes Axis I Primary Axis I Secondary vi 1 09 71 09 Axis II Primary Axis II Secondary 71 09 E 71 09 fa Axis III Axis IY Axis Y lv7i 09 Occupational Problems 002 vi SAWE SUBMIT CLEAR DEMO TRANSFER DISCHARGE Figure 3 30 A Service Coordinator with Read Only privileges may only view this data A Service Coordinator with Read Write privileges may update data fields that are not protected e g grayed out which can only be modified via BHHF Clicking Demo will direct the user back to the Demographic screen previously illustrated figure 3 20 Clicking SAVE after modifying the data fields will update the record N A for Read Only Clicking SUBMIT will direct you to the Health and Safety screen illustrated in figure 3 40 Note A Service Coordinator having e Read Write privileg
8. es will send the data to your Provider Administrator e Read Write and Submit privileges will send the data to APS Healthcare WV 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 12 Service Coordination Health and Safety HEALTH AND SAFETY INFORMATION First Name Middle Initial Last Name Suffix JAMES FREDDIE GORDON 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 Behavior 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
9. ge 25 Service Coord ltest test Eligibility e80 2006 o re Da Services IDT Date ov 30 2006 initial nta Environmental b Adaptation Annual IPP 30 2006 Extended Professional p Total Budget 23000 Services Medical Evaluation Evaluation Er ns Loe Program Plan gt Development Units Psychiatric Psychological APPALACHIAN COMI P Srvc Coord 8 30 2006 11 28 2006 Pend 12 126 0 APPALACHIAN COMM Delete Edit Residential Habilitation 2nd Quarter Service StartDate EndDate Status eee Cost Preferred Provider Delete Edit Srvc Coord 11 29 2006 2 27 2007 Pend fii 115 6 APPALACHIAN COMN _Delete Edit ard Quarter Quarterly ost Preferred Provider Delete Edit Service StarntDate EndDate Status oes Cost Preferred Provider Delete Edit Srvc Coord 2 28 2007 5 29 2007 Pend f1 15 5 APPALACHIAN COMM Delete Edit 4th Quarter Service StarntDate EndDate Status Service StarntDate EndDate Status pele Cost Preferred Provider Delete Edit Srvc Coord 5 30 2007 8 29 2007 Pend fit nss APPALACHIAN COM Delete Edit Remaining Balance 22527 5 Return SUBMIT Figure 3 80 Page 16 IV Logout Alert Coordinate Case s Change Password Logout Figure 4 10 wy When finished log out by clicking the Logout link as shown in Figure 4 10
10. gure 3 60 Clicking DISCHARGE will direct the user to the discharge screen figure 3 70 Page 10 Service Coordination Medical Pressing the MEDICAL button displays the following page CASE INFORMATION MEDICAL First Name Middle Initial Last Name Dames coup BOND Suffix Social Security Number 54 65 4654 Medicaid Number Date of Birth 35135135135 8 17 1981 The information in this section should correspond to the individual s most recent annual medical evaluation DD 2A current physician orders and or medical reports Date of most recent DDZA 8 21 2006 lan 150 Height Inches Weight Pounds Mobility Continence Catheter Wheelchair self Propelled Continent No Y Illeostomy Colostomy Feeding No ad No ad Feeds Self Special Diet Hygiene ision Therapy Yes ha Needs Assistance Speech Therapy Occupation Therapy Physical Therapy Mo Mo Yes x Soaks Dressing Traction Casts Oxygen Mo ki Mo Yes k Suctioning Tracheostomy Yentilator Mo No No Diagnostic Services I Fluids Arm Hand Yes ki Mo Some Daily Activities Limites Yision Hearing Seizures Vision Problems Limit Readins Hears Only Loud Woices May Use Hearing Aid None Or Controlled Health Care RNZ Physician Dietician Many Or Significant Limitations On Daily Activities Monthly e Mo ad Medications Med Health Problems Med klood Mo Neo T ho r Med Seizures Med Health Maint
11. r 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 Changing your Password After successfully logging on you may choose to change your password via the Change Password link at the top right of your screen Cee EK gh re le i EJ e
12. re mt err ac Se a T E ar por at ca Department of Health amp Human Reso es Bureau for Medical Services TITLE XIX MR DD WAIVER PROGRAM Welcome Mike Rowe Alert Coordinate Cases Change Password Logout Figure 2 11 ged 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 our 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 functions Alerts Alert Coordinate Case s Change Password Logout U When a Service Coordinator logs on if Alerts exist the following screen will be displayed listing the various kinds of alerts Figure 3 01 is an example of an alert indicating your agency s Administrator has assigned a case to you This case will now be listed among any others you may be managing which can be viewed by clicking the Coordinate Case s link as illustrated on the following page You may choose to remove this alert by clicking the DELETE button to the right of the alert detail line Bariri joku Wia Department of Hea ith amp Human R sources Bure au for Medical Services
13. s have been assigned to this Serice Coordinator LAST NAME FIRST NAME IPP Date DD A Date DD 3 Date CASE PURCHASE TREE VAL 9 11 2006 9 10 2006 0 10 2006 SELECT EDIT BOND JAMES 6 21 2006 6 21 2006 6 21 2006 SELECT EDIT Figure 3 10 Page Service Coordination Demographics CASE INFORMATION DEMOGRAPHICS First Name Middle Initial Last Name Dames coro BOND Suffix Social Security Number Medicaid Number 654 565 4654 25135135135 Waiver Eligibility Date IPP Date a 24 2006 s 21 2006 Date of Birth Gender Marital Status s 17 1981 Male Race Ethnicity Primary Language Alaska Native Hispanic or Latino English Street Address city State 1212 LINT TINPER wy bi Zip Code 65454 Driving Directions Continued on following page Page 8 Individual s Legal Status Legally Competent Adult wust be Adult Service Coordinator First Name Service Coordinator Last Name Mike Rowe Service Coordinator Phone Service Coordinator Email Address 204 385 1786 mrowe westbrook com Individual s Type of Residence Biological Or Adoptive Family of Other Waiver Consumers Facility Day in Individual s Residence Habilitation lo Yes Yes Competitive Community Day Habilitation Prevocational Training Supported Employment Employment Yes Yes Yes Technical Education Education Level Current School Yes None Preschool Program continued on
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