Provider Direct Business Processes
Somerville Cambridge Elder Services
Draft Procedures 4/7/2011
For vendors for whom SCES is the Lead Agency
(Group 1:)
Technical assistance:
Via email:
Via phone: 999-555-1212
Leave your name, agency, phone # and description of the problem.
We will respond to your calls or emails within half a business day, for example emails or calls received by noon will get a response by 4 p.m., emails or calls received at 4 p.m. will get a response by the next morning. A response is not necessarily a solution to the problem, as we have no control over the software and servers, and must report all of those issues ourselves.
For all vendors using Provider Direct
Our current business process is that case managers communicate by phone and that is confirmed with the Fax. Essentially that will not change, except that information will be available on Provider Direct rather than via Fax.
Case managers will be held to a standard that data entry into SAMS will happen within one business day of the phone call. For new services, it will be within one business day of the Start Date being confirmed by the vendor, as long as they hear before or on the Start Date. We are experiencing more difficult cases upon start up, due in part to statewide protective services triaging, and to a local increase in housing buildings coming under Federal regulations. We need to hear that service actually started, otherwise we will get errors as we try to bill EOEA.
Case managers will call vendors only if closing a client's service with the vendor or closing the client entirely. Those will show as terminated. Vendors will not get a call if the client just transfers programs. Those will show up as Care Enrollment transfers: Home Care Basic/Non-Waiver to ECOP, for example, and in that case, Home Care Basic/Non-Waiver Care Management will become inactive and ECOP will become active. If you have any questions about an "inactive" status, call the case manager.
The comment area on suspensions will be visible to vendors. We only use that in nutrition for comments about home delivered meals, so progress notes about suspensions will continue to be the "record" for documenting conversations and actions about suspensions. Case managers will call on suspensions and reinstatements.
Case managers will call about service plan changes. Service plan changes, for example increasing from 4 units to 8 units per week or changing service schedules, apparently will not show up in the change log unless a comment is made in the service plan, but will be reflected in the client's service plan. It has not been our practice to make comments on service plan changes, so we will have to monitor this to see if it is an issue.
As is the current practice, if you have issues about a client, call the case manager, and if they are not available, you can contact the on-call case manager and then the on-call supervisor.
Provider Direct Business Processes 04072011.doc