– In instances where the initial evaluation is ambiguous, additional consultations with specialist clinicians are arranged.
Step 3: Internal Review and Quality Assurance 1. Preliminary Report Review:
– The draft PAE report is reviewed by the Eligibility Specialist to ensure that all necessary assessments have been documented and that the recommendations align with established ICF/IID criteria. – The specialist confirms that the report includes standardized test results, diagnostic observations, and a detailed rationale for the recommended level of care.
2.
Managerial Oversight:
– Once the Eligibility Specialist provides initial approval, the report proceeds to a managerial review. – A senior supervisor or Director of Care Services reviews the evaluation summary, ensuring that all clinical and regulatory guidelines have been adhered to. – Any additional recommendations or required modifications are captured in review notes. 3. Final Approval and Documentation: – Following satisfactory managerial review, the report is tagged as “Final Confirmation” within the centralized electronic records system. – A secure digital version of the final PAE is archived, complete with version control details (submission dates, review notes, and final approver’s signature).
Step 4: Communication and Submission to TennCare 1. Preparation of Regulatory Submission:
– A comprehensive digital summary of the PAE is produced. This summary adheres to TennCare reporting formats and includes all required data fields. – The summary, along with associated supporting documentation (test scores, clinical notes, manager’s review, etc.), forms the complete submission packet for TennCare.
2.
Transmission Protocol:
– The Communication Liaison within the Compliance and Regulatory Affairs team verifies that the packet is complete. – Utilizing secure communication channels, the package is electronically transmitted to TennCare or its designee. – A confirmation receipt is obtained from TennCare, and this receipt is recorded in the individual’s digital record.
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