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Check out our
news page!
11/7/2006
MEORC COG has gone live with PAWS XML uploads, and other counties are
being phased in by ODMRDD. Let us know
if you want to get moved up the implementation list.
9/18/2006
Franklin County and MEORC will be testing the PAWS XML upload process
this week. Once they have completed their testing, we plan to release
the necessary update to the rest of the counties and COGS we serve.
We plan on making the process available to meet ODMRDD's 10/1/2006
deadline.
7/10/2006
ODMRDD has announced their desire to completely eliminate paper from
the PAWS process by the end of September 2006. In a few cases,
this will mean the manual entry of PAWS information on ODMRDD's web
site. These cases include transitioning to the new Waiver
Reimbursement rates, changes in plan years, etc. For all other
cases, Gatekeeper will allow you to create/update your PAWS information
and then upload it to ODMRDD via their web site. This process is
still in the testing phase at this time, but we are working with ODMRDD
to move it to a production status as quickly as we can.
3/23/2006
Zero-Entry is now available! Click
here to find out how Zero-Entry can
save your agency time & money.
2/28/2006
We have more detailed information available for Advisor users
concerning the PAWS/MBS changes effective next week.
Click
here to download the document.
2/27/2006
We have a Gatekeeper update available to
accommodate the new PAWS format effective 3/2/2006.
This document supplies Gatekeeper users with the information
necessary to produce PAWS forms as required by ODMRDD beginning
3/2/2006. It covers the following:
 | Entering PAWS in Gatekeeper |
| Sending PAWS to ODMRDD (via fax or email) |
| Sending PAWS to Providers (via fax or email) |
| Sending PAWS to Providers (via
www.ohioMRDD.com) |
| Examples |
| How to get the updates (the update is available
on our Downloads page) |
2/23/2006
Here is an update for MR/DD Providers concerning the PAWS/MBS
changes that are effective next week.
The changes being introduced March 2nd
are very significant in that they enable the system to incorporate much
more flexibility than its original design allowed. This flexibility
requires several changes to the way providers bill for services and
track utilization. For a document fully describing the changes and
their effects on your agency,
click here. We have also provided a brief summary of the five
most significant issues below:
- Providers will still bill using the service codes as defined
in the original Waiver Reimbursement Rule (e.g. APC, AMW, ATN,
etc.). They will NOT use the new summary service codes to bill.
Changes to Advisor:
Advisor 6.0.x includes the ability to bill ODMRDD with the
appropriate service codes, group sizes, etc. No changes are
required.
- The provider’s UCR must be included on every claim submitted
to ODMRDD, because the rate authorized is no longer included on
the PAWS. ODMRDD will then pay the provider the lower of the UCR on
the claim and the appropriate state-wide rate.
Changes to Advisor:
Advisor 6.0.x includes the ability to bill ODMRDD with a rate
included on the file. No changes are required, though we will
enhance the capabilities in Advisor 6.1.0 to include the ability to
submit a claim with a rate higher than the state-wide rate while
maintaining the ability to invoice and apply payments given the
lower of the state-wide rate or UCR.
- Providers must include the appropriate staff size on each
claim submitted to ODMRDD.
Changes to Advisor:
Advisor 6.0.2 (now available) includes the ability to bill ODMRDD
with the appropriate staff size included on the claim. For those
providers still running Advisor 6.0.1, ODMRDD will determine the
appropriate staff size for claims that do not include it: you do NOT
have to have Advisor 6.0.2 to bill ODMRDD on March 2nd.
- Providers may want to track two different types of
utilization for purposes of invoicing ODMRDD: 1) units by
frequency period and 2) dollars by PAWS line.
Changes to Advisor:
Advisor 6.1.0 will include the ability to track service utilization
based on both units per frequency period AND dollars per PAWS line.
Advisor 6.1.0 is scheduled to be available in early June.
- Many providers will also want to compare the forecasted
levels of services at the various staff/group sizes with the actual
services they provide. This information will NOT be available
on ODMRDD’s web site. It must be obtained either directly from the
County Board or through our
www.ohioMRDD.com website.
Changes to Advisor:
Advisor 6.1.0 will include the ability to track service forecasts
vs. actual service delivery by staff and group size. Advisor 6.1.0
is scheduled to be available in early June.
2/12/2006
IMPORTANT: We have an update on the PAWS changes that are
coming on March 2nd!
Many of you have been to one of the sessions hosted by ODMRDD regarding
the new PAWS and MBS changes scheduled to begin on March 2nd, 2006.
Not surprisingly, many of you have had questions regarding our plans for
Gatekeeper given what you've heard at these sessions.
We have updated the
Gatekeeper - Authorizing and Monitoring Services document to reflect
our latest thoughts on the topic. Most of the changes were made to
Steps 3 through 5 in the document. It also includes some "real"
Gatekeeper examples of screen prints and PAWS forms which may help you
understand the changes we intend to make to Gatekeeper. As we've
reminded you in the past, it is important that you read and understand
this document.
The changes to Gatekeeper will come in two phases:
- Short-term: On or around March 2nd, you will be receiving a few
minor reporting updates which will allow you to print (or email) the
necessary PAWS forms to ODMRDD.
- Longer-term: Gatekeeper 9.0 will include many of the Utilization
Review features not supported in the current version of Gatekeeper.
This includes the ability to track services provided at ratios not
originally forecasted. The release date for Gatekeeper 9.0 is
not set yet, but we expect it to be in early April.
1/24/2006
We have recently discovered a problem with the process used to make
PAS forms "Permanent" in Gatekeeper version 8.3.x. Under normal
circumstances, Gatekeeper automatically refreshes the utilization
(authorized vs. paid) information when making a PAS permanent. In
the current release of Gatekeeper, this process sometimes fails to
create the utilization. For those of you billing your Day
Habilitation out of Gatekeeper, this in turn prevents your Day Hab
billing from being marked as "Reimbursable" and included on your ODMRDD
billing files. We will be correcting this issue in the next
release of Gatekeeper, but wanted to let you know the steps you need to
take to fix it now. This problem occurs when there is more
than one PAS for a consumer that is not marked as Permanent. In
some cases we have found PAS from several years in the past that were
just never made Permanent. To find cases of this, you can run the
"Non-Permanent PAS" report from the Reports window. To
correct the problem:
- Find the the "extra" PAS and make it permanent. Save.
- Reset the PAS this is missing it's utilization information.
Save.
- Make the PAS reset in step 2 Permanent. Save.
- Use the Quick Print Utilization report to make sure utilization
was create correctly.
1/23/2006
We are pleased to
announce that we have filled the Gatekeeper Implementation & Support
position that has been vacant for several months. Jim Enneking
started with us yesterday. Jim comes to us from the Allen County Board
of MR/DD, where he worked to support both their IT services as well as
their Gatekeeper installations. Welcome Jim!
1/13/2006
There are significant changes coming to Ohio's PAWS and MBS systems.
Some of these changes originate from a proposal submitted to ODMRDD by a
PAWS workgroup that met last summer. This group included
representatives from County Boards, COGs, providers and ODMRDD.
As a provider of software and services to County Boards and providers
across the state, we were also asked to participate. The
proposal, accepted by ODMRDD in October of 2005, calls for changes to
the PAWS and MBS systems to simplify some issues created by the new Waiver
Reimbursement Rule. Specifically, this Rule unintentionally
necessitates PAWS forms which are either over-authorized or
short-spanned. These cumbersome PAWS forms would also require
frequent revisions...too frequent to be practical. The
changes expected to Gatekeeper and www.ohioMRDD.com to accommodate the
changes outlined in this proposal are available in the
Gatekeeper - Authorizing and Monitoring Services document.
Click on the link to review the document. IT IS CRITICAL
THAT YOU READ AND UNDERSTAND THIS DOCUMENT THOROUGHLY. It
outlines many tools you will need to successfully authorize and monitor
services under this new proposal. Again, it is CRITICAL THAT
YOU READ AND UNDERSTAND THIS DOCUMENT THOROUGHLY. In
addition to the changes to PAWS and MBS related to the proposal, there
is also an "e-PAWS" initiative currently under way. e-PAWS
will allow County Boards and COGs to get their PAWS information to
ODMRDD electronically, eliminating the need for ODMRDD to re-key them
into their system. ODMRDD is providing two options to faciliate
this:
First, you will be able to UPLOAD your PAWS information to ODMRDD via
an "XML" file, similar to the way billing files are uploaded today.
This will allow to you maintain and control your forecasted and
authorized data in your local Gatekeeper system, while providing ODMRDD
the PAWS information they need to pay claims submitted by providers.
The power and flexibility of Gatekeeper's Service Authorization module
will allow you to track and compare forecasted units and ratios with
actual services provided. For those choosing this option, Primary
Solutions will be doing the necessary testing with ODMRDD in the coming
weeks...Gatekeeper 9.0 will include the ability to generate a correct
file to upload to ODMRDD.
Second, you'll be able to key your PAWS information directly into
ODMRDD's web site, similar to the way IIF data can be keyed today.
This will be useful for those who do NOT have a local system like
Gatekeeper to enter and track their PAWS history. Note that
information keyed into ODMRDD's will NOT be available to download to
your local Gatekeeper database. ODMRDD has sent a letter to some
counties asking for participation in the testing of this website.
Most Gatekeeper counties have told ODMRDD that they prefer to
transmit their PAWS information to ODMRDD, and are therefore not
interested in this option.
Gatekeeper 9.0 will be released as soon as possible after the above
changes are completed with ODMRDD. We do not expect these changes
to be nearly as sweeping as the recent PAWS changes included in
Gatekeeper 8.3.x. We will also be holding training sessions at our
offices to help people navigate the new PAWS world that is coming.
If you have any questions for us on all this, please don't hesitate to
contact us at any time!
12/07/2005
Voucher History File Format Change: We learned
yesterday that the format for the Voucher History files that some
Gatekeeper clients use to update Gatekeeper's database with waiver
claims paid to providers has changed for the third time in five months.
We have made the change to Gatekeeper version 8.3.3, but you will need
to download a patch to get the change. Click
here to access our Gatekeeper
downloads page.
11/23/2005
Day Hab Payments: We just got word from several
County Boards that they have received payments for their Day Hab
billing. No such news from any private providers yet...maybe
soon...
11/16/2005
Level 1 Day Hab: This is a reminder for everyone
that the original CPT4 code listed for the FDH service on ODMRDD's web
site was incorrect. The correct code is: T2020:U5:U1:U1.
PLEASE NOTE THAT ANY BILLING SUBMITTED WITH THE INCORRECT CODE CANNOT BE
PAID BY ODMRDD. You will need to correct the code in Gatekeeper,
recreate your billing files and retransmit them to ODMRDD. A
document outlining the correct way to set-up Day Hab in Gatekeeper can
be downloaded
here. Note too that this issue was addressed by Matt Curren in
a 10/21/2005 email sent to all providers.
11/10/2005
TCM: We have just become aware of a July 26th memo from
Sue Ellen White of ODMRDD with a short sentence describing the need to
include Service Location for TCM claims submitted for dates of service
after July 1. This letter was sent to all Superintendents and COG
directors. An excerpt from the letter is below:
The last communication we had received from the state on this topic made
it clear that Service Location would be required ONLY for Day Hab and
the other new Waiver Reimbursement Methodology services. We
discovered this issue because Jefferson County's recent TCM billing was
ALL rejected due to an invalid service location on the claims.
Click
here to download
a document describing how to set-up Gatekeeper to
correctly handle this situation.
11/09/2005
County-Specific Rates: Gatekeeper 8.3 is built to
automatically select the correct rate for ratio-based services based on
the service, vendor type, group size, and the county assigned in
Gatekeeper. We will need to change this to select the correct rate
based on the service, vendor type, group size and SERVICE LOCATION as
indicated on the PAS Detail line.
11/03/2005
The MR/DD world in Ohio continues to spin at a
rapid pace, and we want to try to slow it down a little here to explain what
is happening and how it will affect you. If you have any questions or
corrections, please contact us and let us know.
File Formats: There have been a variety of
issues surrounding ODMRDD's file downloads. They changed the "file
extension" on many of them, and added a "staff size" component as well.
This has rendered some of Advisor and
Gatekeeper's file import mechanisms
inoperable until we get a small fix out to you. We'll contact you
when it is ready. Day Hab and PAWS: Several counties have reported
that ODMRDD is requiring group size to be included when submitting PAWS.
I emailed Tim Smith with this question, and he confirmed with me that
you do NOT need to have group size on the PAWS...at least as long as it
remains a daily rate. You do have to have Service Location
included however.
UCRs: Gatekeeper 8.3 does NOT have the ability to
define provider UCRs that are LOWER than the state-wide waiver
reimbursement rates. We understand that this is a problem for
some, and will incorporate this functionality into Gatekeeper 8.4, which
will also include changes pertaining to e-PAWS and the new PAWS format
as described below. e-PAWS: There has
been a fair amount of confusion surrounding the "e-PAWS" initiative that
ODMRDD is working on. This consists of two parts. First,
ODMRDD is planning to allow counties not using software to create and
manage their PAWS to enter their PAWS on-line via a web browser.
This will be roughly equivalent to how Counties enter data via the ITS
system. Second, ODMRDD is planning to allow counties that DO use
software to create and manage their PAWS to transmit that information to
the state via an "XML" file and to eventually make that process
"real-time". This will allow counties to continue to use
Gatekeeper without the hassle or data entry problems that exist today.
New PAWS: Just when you thought you understood the
group size, service location and modifier fields on the new PAWS...it is
getting ready to change again with a target effective date of 1/1/2006.
Here is the deal. The current system typically requires that EVERY
combination of possible ratios be authorized on the PAWS so that
providers can bill and be paid. For example in a setting with four
consumers, counties would need to authorize 1:1, 1:2, 1:3 ,1:4, 2:3 and
3:4 services. This will often result in a huge PAWS that must be
"short-spanned" to avoid going over the funding range cap for the
individual. The new PAWS will instead allow you to authorize
the maximum units and dollars for a given service type (e.g. HPC -
Routine) for some specified time period. Providers would then be
able to bill and be paid for ANY ratio of service, as long as they don't
exceed the unit OR the dollar maximums on the PAWS. They would, of
course, still be limited to the services and ratios as stated on the
ISP.
There are still many details to be worked out, and the clock is
ticking LOUDLY. We will, of course, be making the appropriate
updates to Advisor and
Gatekeeper as soon as is humanly possible.
Check back here for updates as we have them. Adding
"20/20" functionality to our software: Many of you have
asked about the possibility of adding functionality similar to Franklin
County's "20/20" to our Advisor and Gatekeeper software. This is
certainly on our list of things to accomplish, and will be prioritized
as early as possible in 2006. At this time, we feel compelled to
update our software to handle the impending ODMRDD changes.
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