DATE: JUNE 24, 2002
Subject: Pilot Program for Electronic Submissions of FL2's
Distribution: County Directors of Social Services
Medicaid Eligibility Staff
It is anticipated that in July 2002, the Division of Medical Assistance (DMA), along with Electronic Data Systems (EDS), and ProviderLink, Inc. will begin a pilot program initiating electronic submissions of FL2's for nursing facility admissions in Wake County. The electronic method would replace the need to complete a hard copy FL2. Counties will be notified by an EIS terminal message when the pilot begins.
The pilot involves WakeMed in Wake County, Wake County Department of Human Services, Carolina Nursing and Rehabilitation, City of Oaks (Britthaven), Integrated Health Services, The Laurels and Raleigh Rehabilitation. Two durable medical providers, Knight's Medical and Apria, will also participate.
Though this pilot is being conducted in Wake County, other counties whose residents are placed in nursing facilities from WakeMed will be affected.
Providers are not required to participate in this pilot program. The pilot program will take place over the next three months.
The authorized individual (discharge planner, provider, social worker or case manager) will complete the FL2 client data fields on a computer screen. The data will be transmitted to the attending physician for approval and for password authentication. The physician can then transmit the FL2 back to the originator or directly to EDS through ProviderLink, Inc. over a secure server. The FL2 must be electronically submitted within 10 days of the physician's authentication.
If the FL2 is incomplete, the individual submitting the electronic FL2 will receive an error message and the form will not be transmitted to EDS until it is completed correctly.
EDS Prior Approval nurses can then access the FL2 through the ProviderLink website. The nurses will review the electronic submission onscreen and decide if the client meets the North Carolina Medicaid nursing facility level of care criteria. EDS will then enter the decision and transmit that decision back to the originator of the request through the ProviderLink's server and website.
Any authorized individuals that do not have ProviderLink capabilities can still send and receive a hard copy FL2 by fax through the ProviderLink system. The hard copy FL2 will have a bar code on the form. Do not remove the bar code. The bar code is needed for ProviderLink, Inc. to submit the form as an electronic version to EDS.
Medicaid staff in other counties will receive the FL2 hard copy of the electronic submission if a client from their county is placed in a nursing facility from WakeMed.
A hard copy of the electronic FL2 is attached to this Administrative Letter.
Medicaid policy regarding prior approval or Utilization Review remains unchanged.
Individuals seeking nursing facility placement must first be evaluated through the Pre-Admission Screening and Annual Resident Review (PASARR) process. Electronic submissions lacking the First Health PASARR number will receive an error message and the form will not be transmitted to EDS until the PASARR number is obtained.
If the pilot is successful, DMA will consider expanding it to other providers and vendors.
You may obtain more information regarding ProviderLink, Inc. by accessing their website, www.providerlink.com/ns4Nav.htm.
If you have any questions about this project please call Lynne Perrin, Chief, Institutional Services at (919) 857-4020.
Nina M. Yeager
[This material was written by Denise Rogers, Policy Consultant, Medicaid Eligibility Unit.]
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.