Transcript Slide 1
Sandhills Center Provider Orientation Customer Service Department Overview Presented by Gene McRae, Customer Service Director Mike Markoff, Customer Service Coordinator Customer Services Department Customer Service is the Sandhills Center link to the consumer and the public. This is accomplished via the 1-800-256-2452 toll free phone line. The Customer Service Department has three sections: • Customer Service Representatives • Member Eligibility and Enrollment • Clinical Triage and Referral Customer Service Representatives: These staff answer the 1-800 line and determine if the caller needs: Clinical screening triage and referral Information about behavioral health services Information about community resources Enrollment information Make a complaint Initiate an appeal Callers to the 1-800 line will be asked if the call is a crisis and if it is, they will be immediately transferred to a licensed clinician for further assistance. Member Eligibility and Enrollment Process Medicaid/Non-Medicaid clients/members must be enrolled in the Sandhills Center system prior to requesting service authorizations or billing. To accomplish this, use the following process: Go to the Sandhills Center website at: http://www.sandhillscenter.org Click on the “For Providers” heading Click on; “Provider Forms” See and click on; “Click here to Access the New Admission Forms” Your Choices will be: Record Number Request Form Assessment Only Form Consumer Admission Form Demographic Update Form Member Eligibility and Enrollment Process Continued…. Choose the form (s) based on your need: Record Number Request Form – use this form to submit basic member information and obtain a Sandhills Center record number Assessment Only Form – use this form only when an assessment/evaluation is completed and a full admission is not required at this time. Consumer Admission Form – this form must be submitted within 30 calendar days of initiating any service or support. Additional instructions are provided under this section on the Sandhills Center website. Demographic Update Form – use this form to update member/client information such as target populations, diagnosis, address, financial status and marital status etc. If you have questions contact Member Eligibility and Enrollment at 1-800 256-2452. Clinical Triage and Referral Goal The primary goal is to perform initial Screening, Triage and Referrals of members from our eight county catchment area to local providers within their county of residence. Our ultimate goal is to insure all persons who have a need for MH/DD/SA services have access to quality service providers on a 24hrs,7days a week,365 days per year basis provided by a Licensed Clinical Specialist. Background The Health Call Center was established on March 31, 2009 Consists of four Licensed Clinical Specialists The Director is a Licensed Professional Clinical Triage and Referral Continued… This section is staffed by licensed clinicians who screen clients and link them to appropriate services. This may include: An appointment at an outpatient clinic near them Linkage to crisis services Information on services and providers near them to allow for client choice If caller volume increases, call roll over to the voice recording unit (VRU) and are returned within 30 minutes. Readily available for direct consultation is the Medical Director The Call Center operates during normal business hours Monday through Friday 8:30 a.m. to 5:00 p.m. There is a contractual agreement with PBH who mirrors these services during After Hours, which included 5:00 p.m. – 8:30 a.m., weekends, Holidays and Emergency closing situations (i.e. inclement weather, power outages, etc.) NOTE: clients are given choices based upon their clinical need, proximity, payer, and time frame needs). Calcium Calendar Scheduling System: Providers are required to have a contractual agreement with SHC Maintain an appointment/follow up status system through the use of Calcium Calendar, an electronic scheduling system. Appointments are scheduled by the Customer Services Clinical triage Staff on the Provider’s Calcium Calendar to perform comprehensive assessments of referred members. Providers must contact the Customer Services Director to request being set up on Calcium Calendar. Network Management verifies the providers contractual agreement Providers indicate their chosen population that they serve in the performance of an Assessment, for example, Mental Health, Substance Abuse, Developmental Disability, Adult, Children, etc. Calcium Calendar Scheduling System Continued…. Providers also indicate payer sources o Integrated Payment and Reporting System (IPRS) o Medicaid The form (located on the Sandhills Center website under the Provider tab) is completed with all the requested information and processed by the Information Technology (IT) department. IT creates the Calcium Calendar, assigns User Name and Password and provides the provider with a PowerPoint presentation training tool. Please keep your calendar updated to increase your referrals! More than one staff should know the password and user name