Employee Set up Checklist

Employee Set Up Checklist

The RBHA Employee Set Up Checklist is a document that ensuresemployees are correctly set-up in our Active Directory, Great Plains, and EHR systems. It is critical that this form is completed correctly on new hires and staff that have accepted both full-time and part-time opportunities in a different department/program to ensure that staff have access to shared folders, get emails, have access to document services and bill at the right rate for those services.

The RBHA Employee Set Up Checklist has designated sections for the Human Resources Department, IT Department and the Hiring Supervisor to complete. Below are detailed instructions on how this form will be completed.

• Human Resources will complete the top gray section labeled “To Be Completed by the HR Department Only”. This section will be completed,in it’s entirety, within 24-hours of HR contacting the new hire and the job being accepted or within 24-hours of an existing employee accepting a new part-time or full-time position.
• The section labeled “Effective Date for Addition/Change” should coorespond with the hire date.
• After HR staff completes his/her section, the RBHA Employee Set Up Checklist will be forwarded to the hiring supervisor for further information.

Signature of HR staff completing form: ______Date:______

• Q&Swill complete the the top gray section labeled “To Be Completed by the HR/Q&S Department Only” and the pink section labeled “To Be Completed by the Q&A Only” for Interns/Students only.
• After Q&S staff completes his/her section, the RBHA Employee Set Up Checklist will be forwarded to the hiring supervisor for further information.

Signature of Q&S staff completing form: ______Date:______

• Hiring Supervisors are responsible for completing all sections not labeled for either HR, Q&S, or IT. This includes the following sections: Signature Credentials, Provider Type, Tree View, Staff Credentials, Team Credentials, Rate Class, Provider Identifiers, Dashboard Layouts, Trusted Providers, Progress Note Override, Other RBHA Programs, and the appropriate portion of Equipment needs. After completing the appropriate sections of this form, please forward it either inter-office mail titled “IT Department – Employee Set up” or email to “”.

Signature of Hiring Supervisor completing form: ______Date:______

• IT will complete blue sections labeled “To Be Completed by RBHA IT Only”. These sections will be completed when HR or Q&S and the hiring supervisor have entirely completed the form and it is received by the designated IT employee.

• The Statement of Acknowledgement and Responsibility will be completed by the new/existing employee, hiring supervisor and IT respresentative when equipment is initially checked out to the employee. The Supervisor is responsible for returning equipment to the IT department, upon an employee’s departure, at which time the Equipment Reconciliation portion of this form will be completed with IT staff.

Glossary of Terms

Clinical Signature Credentials: The purpose of this field is to indicate what letters a provider will have behind his/her name. This field is important for report purposes and completion of clinical documents that populate the signer’s signature.

Tip: Most staff should only have the one highest signature credential held unless h/she also has a License Eligible designation entered

in this field.

Licensed Staff: These letters should reflect the highest licensure designation/credential of the staff person, if applicable. Examples include: LCSW, LPC, LCP.

Unlicensed Clinical Staff: A Qualified Mental Health Professional (QMHP) should be classified as either QMHP-C for providers of children’s services and QMHP-A for providers of adult services. For staff that cross adult and children’s services, please indicate this credential as QMHP-A, QMHP-C. Do not include the specific degree(s) that the staff person holds. For example, if a staff person is a MSW, QMHP-C then h/she only needs the QMHP-C designation as a signature credential. QSAP should be entered in this field regardless of the provider’s degree if h/she meets the requirements for that credential.

License Eligible Clinical Staff: Licensed Eligible Staff are providers who are registered with their specific licensing board (Social Work, Counseling, or Psychology) and thus meet the Medicaid qualification for this signature credential. Staff eligible through the Board of Social Work should be identified as SW Supervisee. Staff eligible through the Board of Counseling should be identified as Res. Counseling. Staff eligible through the Board of Psychology should be identified as Res. Psychology.

Provider Type: General grouping of providers. i.e. Primary Service Provider, Emergency Services.

Tree View: The tree view is located on the left side of the main window when logged into Profiler. It is made up of folders and forms. When a tree view is assigned to a provider, it dictates what the staff person has access to on the tree and thus, in the system

Staff Credential: Defined as "who" can provide a service i.e. LEMHP, QMHP. The Credential assigned to a Provider allows that provider to schedule and/or perform specific services.

Team Credential: A group of clinical providers within a company who provide services to a client (i.e. Adult Mental Health). A provider must be on the treatment team before scheduling a service with the client.

Rate Class: Defined as "how" a service is billed based on who provides it. i.e.QMHP, MD, Nursing, etc. The rate class assigned to a provider will define "how" services performed by that provider are billed. There must be only one rate Class assigned for a provider.

Dashboard: This classification is used to designate the view options on the provider’s dashboard (PSP, Prescriber, CSU, Front Desk)

Trusted Providers: This classification allows staff to access another provider’s dashboard and to schedule appointments on their behalf. If a staff person is not “trusted” to a provider, then h/she is unable to schedule appointments for that provider or to view the Dashboard.

Progress Note Override: This checkbox needs to be selected if a provider has the ability to Supervisor/Final Sign Progress Notes for staff.

Equipment Needs: This section will allow the IT department to prepare the required equipment for the staff to use.

RBHA Employee Set up/Change Request

To be completed by HR/Q&S Only
New request Change/Update Request Termination/Resignation Date:
Date of Request:Effective Date for Addition/Change:
Last Name:First Name:Middle Name: Staff ID#:
Supervisor Name:
Division: Unit: Location:
To be completed by Q&S Only
Intern/Student Dates of Internship:Begin:End:

Signature Credentials (see above for explanation):

Provider Type (check one option only):

Emergency Services

Primary Service Provider

MedicalAttending Physician yesno

Clinical Support Staff

Clinical Supervisor

Auditor (read-only access to system)

Psyc Tech

Billing Staff

Front Desk Staff

IT Staff

Prevention Providers

Prior Authorization Specialist

Billing Support

Medical Records

Part C

Tree View (check one option only):

AMMedicalClinical Supervisor

AuditorPart C

Billing/FinancePreAuth Staff

Clinical Support AdminPSP

CSUVICAP

Staff Credentials (check all that apply):

ADSMD-PSYForensic EvaluatorLCNS

CASSNPLCPLMHP-E

CPREQIDPLMFTLPN

EI-SCQMHPLSATPRN

EI-SQSAPMTRSS

HIV CertifiedTraineePCP

InterpreterEI-PQPP

LPCFacilityMAT Certified Physician

LCSWID Contract Provider

Team Credentials (check all that apply):

C&F Services Part C Services

ID Contract ProviderREACH

Part C ContractAdult MH Service

RBHA Other ServicesEmergency Services

VICAPMedical Services

CSUSUD Services

ID

Rate Class (select only one option):

(**Note: Supervisors, if this staff is a Licensed employee notify Q&S administrative staff immediately to begin the credentialing process. )

(**Note: Supervisors, if this intern can bill for services notify HR administrative staff immediately for document requests and credentialing.)

MDQSAP Para ProfessionalPart C OT/PT/ST

LCSWLMHPResident LPC

LCPQMRPIntern (Billable)

NursingLPCIntern (Non-billable)

PNPService Coordinator

QSAP w BSDevelopmental Services Professional

QSAP w MastersPart C SC

QMHPPart C Drs Prof

Provider Identifiers:

National Provider Identifier

DEA

License Number

Dashboard Layout (select only one option):

Crisis StabilizationPrescriber

Front DeskPrimary Service Provider

Trusted Providers (list all staff that willschedule appointments or need to view dashboard of staff):

Does this employee require Dr. First access? Yes No If yes, Provider (prescribing capability) Provider Agent

Does this employee require Progress Note Overide? Yes No

Does this employee work in any other RBHA program? Yes No If yes, Program Name:

(ID ONLY) Does this employee need IDOLS access? Yes No

If yes, chose one: Submitter Provider Enrollment Approver

Equipment Needs?

(Staff are required to work in the community at least 50% of the time for Laptops and Aircards.)

Desktop
Laptop
Cellphone
Desk Phone
Aircard
Epad / To be completed by RBHA IT Only
Computer Name:
Computer Name: Serial Number: RBHA Tag: Case:
Phone Number: Model:
Phone Number:
Model Number: Phone Number:
Serial Number:

Additional Equipment:

To be completed by RBHA IT Only
Username (computer login - to be determined by IT): ____________
Email Address (to be determined by IT): ______
Active Directory Account Created by: ______
Profiler Account Created by: ______

Statement of Acknowledgement and Responsibility

I, ______, acknowledge receipt of the above equipment on, ______.

(Print Name)(Date)

1. I understand that I am being entrusted with valuable tools to assist me in accomplishing tasks related to my job.
2. I also understand that I am responsible for safeguarding any data related to the Richmond Behavioral Health Authority (RBHA).
3. If the laptop is lost or stolen, I agree to notify the MIS Director immediately.
4. I agree to use this laptop specifically for job related purposes.
5. I will be held accountable for the loss of the laptop or any of its components listed (checked) above.
6. Upon resignation, I agree to schedule an appointment with the IT department for an equipment check and maintenance.
7. I agree to return the all equipment assigned above immediately upon request andafter giving notice of resignation or upon termination of employment (including retirement) to my supervisor.

My signature indicates my acknowledgment of the items issued to me and my responsibility for the safe keeping of same. Additionally, I authorize RBHA to deduct the cost of said equipment from my pay should it be lost or damaged as a result of my negligence.

Employee Signature: ______Date: ______

IT Signature: ______Date: ______

Supervisor Signature: ______Date: ______

------Equipment Reconciliation ------

Upon the employee’s departure from the agency, the supervisor will be responsible for returning all equipment assigned to the above staff to the IT department with 10 business days of termination/resignation. The cost of any equipment not returned will be charged to the program responsible for equipment (The termination fee for phones and aircards will be $175.00 per item). The below signatures indicate that all equipment was returned to the IT department or that the supervisor has been made aware of charges for lost equipment.

Missing Equipment

Total Amount Charged:

Supervisor Signature: ______Date: ______

IT Signature: ______Date: ______

Supervisor’s Terminated Employee Checklist

Employee Name / Employee Number / Term Date
Inform HR (via PAF)
Eligible for rehire?
□Yes □ No
Administrative:
□Provide/collect change of address
□Collect or verify computer system(s) or equipment
□Collect parking security card
□Collect cell phone
□Collect Office Keys
□Collect Name Badge
□Cancel RBHA credit card (notify purchasing officer)
□Departure is communicated to staff
□Other RBHA property ______
Involuntary Termination Only:
□Documentation of performance issues and disciplinary action and provide to HR.
□Termination Letter Signed by CEO
□All reasonable attempts made to collect RBHA property.

All RBHA property collected and delivered to HR Department:

______
Supervisor’s Signature Date

Received by HR Department:

______
Authorized HR Signature Date

RBHA Employee Set UpChecklist 5/12/2014 1