Community HealthChoices Operations Manual for Vendors

 

Introduction

 

This manual applies to the following types of Community HealthChoices (CHC) vendors:

·  Fiscal Employer Agents (FEA)

·  Independent Assessment Entity (IAE)

·  Independent Enrollment Broker (IEB)

·  Managed Care Organizations (MCO) providing Long-Term Services and Supports (LTSS) benefits to participants enrolled in CHC and eligible to receive LTSS.  CHC-MCOs can find managed care operations (Ops) memos related to physical health services on the Office of Medical Assistance Programs’ website located at https://dpwintra.dpw.state.pa.us/HealthChoices/. 

 

The purpose of this manual is to define procedures that CHC vendors must follow in order to meet certain requirements in the department’s agreements, and to provide information related to contractual provisions.

 

 

The manual contains a section for each vendor type although vendors will be able to access Ops memos directed to other vendor types.  Each Ops memo contains an eight-digit number (X-XXX-XX-XX) as described below.

 

Number

Meaning

1st number in sequence (X)

 Each vendor is assigned a number which designates  

 to whom the memo applies.  The designations are as  

 follows:

     1.    Fiscal Employer Agents

     2.    Independent Assessment Entity

     3.    Independent Enrollment Broker

     4.    Managed Care Organization

2nd number in sequence (XXX)

 Internal tracking number.

3rd number in sequence (XX)

 Designates the year issued.

4th number in sequence (XX)

 Designates the memo sequence for the internal

 tracking number in a year.

 

 

The manual contains a section that includes instructions on reporting requirements.  There are two types of reports, Operational Reports (OPS) and Quality and Utilization Management Reports (QMUM).  If the report pertains to the operations of a vendor, the report is denoted as OPS-XXX.  Reports related to quality or utilization are denoted as QMUM-XXX.