Page 11 - CCS Polices and Procedures

Crew Consulting Services
Policies and Procedures
5.4 Staffing Issues

Any vacancies will result in other case managers covering cases for 60 days or less while a replacement is being
hired and trained. During vacations, case managers will be required to conduct billable services for the month for
a set number of individuals. The case manager ’s supervisor will be responsible to attend to any issues that arise
during the case manager ’s temporary absence.
5.5 Billing
Company Director will oversee all billing and reimbursement. CCS as a case management provider will bill and be
reimbursed from the date of the in-home assessment after all conditions included in sections 1002.1 of the EDWP
(CCSP and SOURCE) General Services Manual have been met. All services must be authorized on the member’s prior
authorization for services (PA) on GAMMIS. Care coordination services for a EDWP (CCSP and SOURCE) member,
payable at one unit per member per unit.

CCS as a case management provider will:
1. Use a current DCH Billing Manual.
2. Check the EDWP (CCSP and SOURCE) member's Medicaid eligibility each month.
3. Not provide services without authorization from the care coordinator.
4. Prepare claims carefully and submit claims timely after the service has been provided.
5. To assure maximum use of EDWP (CCSP and SOURCE) service dollars.
6. Re-authorized units as appropriate. To ensure that claims that are denied due to de-authorization may be re-
submitted in a timely manner.
7. Timeliness – CCS will bill monthly at a minimum.
8. Bill only for actual dates and units of service provided.
9. Keep copies of all documentation such as Remittance Advices and document all telephone contacts (name(s),
agency, date and time of contact) made regarding billing.
10. Carefully review each Remittance Advice for accuracy and address problems timely.
11. Re-submit any and all denied claims when the problem has been corrected. *Note: DXC does not maintain
the denied claim on file.
12. Attend training offered on EDWP (CCSP and SOURCE) Billing.

6. Scope of Services

Education

For all patients requiring active case management services, case management is expected to ensure and provide
education relevant to the effective progression of care, the appropriate level of care and safe patient transition.

Specifically:

• Provide information to the health care team, patient/family/caregiver regarding available resources and
benefits for acute and post-acute services that ensure patient choice and a safe and timely transition
• Identify clinical, psychosocial and/or operational learning opportunities that negatively affect care or
reimbursement and provide the health care team, community partners, patient/family/ caregivers education
that will address or resolve the issues.

Version Date: 6/23/2018 Page 11 of 33