Sectin 28 Rehabilitative and Cmmunity Supprt Services KEPRO Mapping Dcument Initiating Requests in KEPRO Lgin t Kepr Care Cnnectin (must be dne using Internet Explrer, IE Tab fr Chrme, r using parallels n a Mac) via https://carecnnectinme.kepr.cm. T initiate a new Prir Authrizatin fr a student whm yu have nt yet received a Prir Authrizatin: Select the UM r DSP tab at the tp Select New Request Input the student s Medicaid ID in Member ID and ne additinal field Select Verify Verify the Member infrmatin matches the student Select Add New Request
Inputting Infrmatin fr a Prir Authrizatin General guidelines: Once yu have initiated a request, write dwn the Case ID number fr future reference The KEPRO pages detailed belw with screen shts are the required pages accrding t KEPRO and can be fund n ur website under Resurce Center/Maine/Sectin 28 KEPRO Schl Based Guidelines After cmpleting fields n a page, always click n the blue Save and Cntinue buttn s that yur infrmatin will be saved KEPRO pages: Member Infrmatin Fields will pre-ppulate with the crrect infrmatin, but duble check against Member Infrmatin (frm MSB S SUGGESTED ITP bxes 1-4) Select Save and Cntinue Guardian Infrmatin nt required Select Save and Cntinue
Administrative Duble check that the Authrizatin Type is crrect Prir Authrizatin (PA) use fr a student whm yu have nt yet received an authrizatin fr that service Start Date fr Current Authrizatin Request Yu can submit a request up t 5 days prir t tday s date fr a PA (n earlier than MSB S SUGGESTED ITP bx 5) Review Type select Children s Services Categry f Service select Rehab and Cmmunity Supprt Services Sectin 28 Select Save and Cntinue
Requesting Agency Requesting Staff First Name District Infrmatin Sectin 28 Supervisr s Name (frm MSB S SUGGESTED ITP bx 12) Requesting Staff Last Name District Infrmatin Sectin 28 Supervisr s Name (frm MSB S SUGGESTED ITP bx 12) Requesting Staff Phne (With Area Cde) District Infrmatin Telephne # (frm MSB S SUGGESTED ITP bx 13) Requesting Staff Email District Infrmatin Email (frm MSB S SUGGESTED ITP bx 14) Utilizatin Manager/Supervisr Name District Infrmatin District KEPRO Cntact Persn (frm MSB S SUGGESTED ITP bx 8) Utilizatin Manager/Supervisr Phne District Infrmatin Telephne # (frm MSB S SUGGESTED ITP bx 10) Utilizatin Manager/Supervisr Email nt required Is this agency/individual the treating prvider? Select Yes Select Save and Cntinue
Diagnstic Assessment Date f Diagnstic Assessment Diagnsis Assessment Date (frm MSB S SUGGESTED ITP bx 22) Enter ICD-10 Diagnsis (frm MSB S SUGGESTED ITP bx 21) Select Save and Cntinue
Services Requested General Guidelines It is very imprtant that yu chse the service ptins with Schl-Based service in the title It is very imprtant that yu nt chse the service ptins with Specialized Services in the title Per plicy requirements surrunding Specialized Services, MSB recmmends that schls nt bill fr these sectins unless yu are certain that yu have met all prgram requirements. KEPRO Screen Select Add New Prcedure Request Service select the service shwn regardless f grup size(s)
Frequency Medically Necessary Treatment Service Infrmatin Frequency (frm MSB S SUGGESTED ITP bx 37) Billing Prvider ID Select yur district s NPI Service Length PA maximum number f days is 30 Units use Medically Necessary Treatment Service Infrmatin Frequency & Duratin (frm MSB S SUGGESTED ITP bx 37) with frmulas belw PA maximum number f units is 40. A CSR must be submitted fr additinal units. Sectin 28 des nt have a cap n hw many units can be billed per day. Hwever, fr Sectin 28, 15 min. = 1 unit T calculate the number f units required fr a prir authrizatin, we wuld suggest using the fllwing frmulas t help yu There are 129 schl days in 180 calendar days Explanatin: 180 X 5/7 = 129 schl days Sec. 28 units requested = 129 X fifteen min. segments/day = Sec. 28 units requested Example: Fr 3.5 hurs f Sec. 28, calculate first hw many fifteen minutes segments are in 3.5 hurs 3.5 hurs/day X 4 (fifteen-min. segments/hur) = 14 fifteen-min. segments/day Thus, using the frmula abve fr Sec. 28... 129 X 14 fifteen -min. segments/day = 1,806 units requested Select Save
Symptms/Behavirs Only Agency Invlvement and Family/Scial Invlvement Sectins are required Agency Invlvement Sectin Agency Invlvement defaults t Special Ed/504 Family/Scial Invlvement Sectin Family/Scial Invlvement Family/Scial Invlvement (frm MSB S SUGGESTED ITP bx 46) Hld dwn the Ctrl r Cmmand key t select mre than ne item frm the list Select Other if Other bx was filled in n MSB S SUGGESTED ITP Other Family/Scial Invlvement Family Scial Invlvement (frm MSB S SUGGESTED ITP bx 46) Only applicable if Other bx was filled in n MSB S SUGGESTED ITP Rate Overall Level f Family Invlvement in Treatment Gals Rate Overall Level f Family Invlvement in Treatment Gals (frm MSB S SUGGESTED ITP bx 47) Rate Overall Level f Natural Supprts invlvement with the Client/Family Rate Overall Level f Natural Supprts invlvement with the Client/Family (frm MSB S SUGGESTED ITP bx 48) Select Save and Cntinue
Psychiatric Medicatins Ntes List f Psychiatric Medicatin (frm MSB S SUGGESTED ITP bx 25)
Clinical Indicatrs Use the X in the chart (frm MSB S SUGGESTED ITP bx 26) t select the apprpriate Current Severity and Histry f Severity fr each f the clinical indicatrs Treatment and Service nt required Select Save and Cntinue RDS nt required Select Save and Cntinue
Treatment Plan Individual Treatment Plan Sectin picture included n p. 15 Describe Member s Strengths and Skills Strengths/Skills (frm MSB S SUGGESTED ITP bx 27) Hld dwn the Ctrl r Cmmand key t select mre than ne item frm the list Is the Member/Caregiver Invlved in Frming the Treatment Plan Sectin 28 Treatment Team Child (frm MSB S SUGGESTED ITP bx 15) If bx 15 gives child s name tggle answer t Y If bx 15 gives n/a and reasn tggle answer t N List thse invlved with the develpment f the plan Sectin 28 Treatment Team (frm MSB S SUGGESTED ITP bxes 15-19) Disabilities and Accmmdatins Required fr the Delivery f the Service Special Accmmdatins (frm MSB S SUGGESTED ITP bx 41) Is Substance Abuse an Issue? nt applicable t this service Date Current Treatment Plan was Develped Member Infrmatin Date f MSB S SUGGESTED ITP develpment (frm MSB S SUGGESTED ITP bx 6) Date Next Treatment Plan is t be Develped calculate 1 year after previus answer Treatment Plan Gals Sectin Select Add New Gal
Prblem Statement Prblem Statement (frm MSB S SUGGESTED ITP bx 28) Treatment r Rehabilitatin Lng Term Gal Measurable Lng Term Gal #1 with Target Date (frm MSB S SUGGESTED ITP bx 29) Target Date Measurable Lng Term Gal #1 with Target Date (frm MSB S SUGGESTED ITP bx 29) Treatment r Rehabilitatin Shrt Term Gals Measurable Shrt Term Gal #1, 2, 3, etc. with Target Date (frm MSB S SUGGESTED ITP bx 29 a, b, c, etc.) Target Date Measurable Shrt Term Gal #1, 2, 3, etc. with Target Date (frm MSB S SUGGESTED ITP bx 29 a, b, c, etc.) Prgress Since Last Review Prgress (frm MSB S SUGGESTED ITP bx 30) Services t be Prvided Medically Necessary Treatment Services Infrmatin Service (frm MSB S SUGGESTED ITP bx 37) Duratin f Services Medically Necessary Treatment Services Infrmatin Duratin (frm MSB S SUGGESTED ITP bx 37) Frequency f Services Medically Necessary Treatment Services Infrmatin Frequency (frm MSB S SUGGESTED ITP bx: 37) Prvider f Services Medically Necessary Treatment Services Infrmatin-Service Prvider Designatin (frm MSB S SUGGESTED ITP bx 37) Repeat Treatment Plan Gals Sectin fr as many Measurable Lng Term Gals as are included n the MSB S SUGGESTED ITP
Select Save and Cntinue Additinal Reprting Data nt required Select Save and Cntinue
Transitin Discharge Plan Text bx at bttm nly field required Plan fr Transitin/Discharge Measurable Discharge Criteria/Plan (frm MSB S SUGGESTED ITP bxes 42-45) Additinal Inf General guidelines This sectin will nt cpy ver in a future Cntinued Stay Review
Briefly describe the behaviral health needs Can be used t prvide any infrmatin nt captured elsewhere in the request KEPRO Screen Additinal Inf Reasn fr Service (frm MSB S SUGGESTED ITP bx 24) Additinal Cmments (frm MSB S SUGGESTED ITP bx 49) Treatment Prgress (frm MSB S SUGGESTED ITP bxes 52, 55, 58 as applicable) Dcument Uplad Select yur dcument type frm the drp-dwn windw Click n Brwse and lcate the file yu are wanting t attach Select Attach These steps can be repeated as needed based n Dcument Type Selectin. Please nte that nce accepted int the KEPRO prtal it cannt be edited
Submit t KEPRO Select Submit t KEPRO
T initiate a Cntinued Stay Review fr a student whm yu have already received a Prir Authrizatin: Select the DSP tab at the tp Select Search Request Input Medicaid ID in Member ID Select Search
Find the mst recent apprved Prir Authrizatin/Cntinued Stay Review Select EXT This functin cpies all the infrmatin inputted frm yur Prir Authrizatin/Cntinued Stay Review (except fr the Additinal Cmments page) int yur new request. Frm here yu may cntinue t review the fllwing windws infrmatin fr accuracy and/r mdificatin needs. Under the Services Requested windw: Select Mdify next t the requested service and update thse fields t accmmdate fr the medically necessary 180-day request.
Select Submit t KEPRO
Checking the Status f a Request Lgin t KEPRO Care Cnnectin (must be dne using Internet Explrer, IE Tab fr Chrme, r using parallels n a Mac) via https://carecnnectinme.kepr.cm. Select the UM tab at the tp Select Dwnlad Ntificatins Select Get Daily Archived Ntificatins In the Ntificatin Search Results Select Dwnlad fr any files yu have nt yet received Fllw the prmpts t pen the Excel file In the Excel file Check the bigraphical infrmatin in clumns D, E fr each service requested Check the status f the services request in clumn O yu must check this fr each service rw line CM-AUTH indicates the service has been authrized/apprved Check clumns H-L t determine if all infrmatin was prcessed crrectly G t clumn Q fr Prir Authrizatin number This number must be input in Lumea under the billing dates tab in rder fr billing t ccur Yu can cntact yur MSB Claims Analyst fr assistance in managing this tab
Check clumn U fr any ntes frm the reviewer Any ther status ther than CM-AUTH will need further attentin Lk t clumn U fr detailed ntes n what further infrmatin may be needed r what steps must be taken in rder t remediate the situatin Yu can call KEPRO at 1-866-521-0027 Optin 4 t speak with a reviewer n yur particular Case ID