SAMPLE POLICY WORK

Roles and Responsibilities:

• Enrollment Specialists and Intake Staff work together to gather, scan, and verify all required documents. • IT and Records Management Teams ensure that the electronic repository is updated promptly and remains secure under HIPAA and state data protection guidelines. • Compliance Officers review a sample of documents quarterly to check for inconsistencies and ensure that all submissions meet regulatory requirements.

Step 3: Internal Enrollment Meeting and Review

Procedural Guidance:

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Pre-Enrollment Review Meeting:

– Once documentation is verified, a formal meeting is scheduled that includes the Enrollment Specialist, a Care Coordinator, an Eligibility Specialist, and a member of the Compliance Team. – During the meeting, the team reviews the applicant’s file in full detail, discussing any potential issues or clarifications needed before proceeding. – The discussion includes compliance with TN.0357.R05.00 criteria, clarity of documented evaluations, and recommendations for the appropriate level of care.

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Confirmation and Documentation:

– Minutes of the meeting are recorded, including a summary of the discussion, any follow-up actions required, and final decisions made regarding enrollment status. – Upon agreement, the applicant’s file is marked as “Provisional Enrollment Approved” pending coordination with TennCare. • Checklist Review: – A comprehensive checklist is completed to confirm that all steps (eligibility confirmation, document collection, internal review) have been executed. – This checklist is attached to the applicant’s digital file for internal audit purposes.

Roles and Responsibilities:

• Care Coordinators lead the internal meeting, ensuring all aspects of clinical and eligibility information are considered. • Enrollment Specialists document the decisions and verify that all required forms and supporting documentation are present. • Compliance and Regulatory Team Members provide oversight and validate that the internal process aligns with regulatory standards.