When Should a Consumer Be Discharged?

Discharge Module

The Discharge module is used to submit, receive and review consumer discharge requests to ultimately send to CDW. Discharge requests will be created by Providers,MCOsas well asSystem Generated for consumers not receiving services by a set number of days from the last DOS. Discharges are intended for State consumers ONLY and to meet state requirements in keeping data up-to-date at the State level (CDW).

When should a consumer be discharged?

1)If a State insured consumer has not received an SA service in over 60 days from last claim DOS. system generated - YES

2)If a State insured consumer has not received an MH service in over 180 days from last claim DOS. system generated – YES

3)If a State insured consumer has not received an IDD service in over 550 days from last claim DOS.

system generated – No, not at this time

Discharge Process Types

First, it is important to understand in AlphaMCS there are two ways to initiate the consumer Discharge process by way of manually creating and starting the process, or taking over an AlphaMCS system generated discharge.

Manual Discharge: This type of discharge request is initiated manually by either a provider or the MCO by clicking CREATE from within the Discharge module.

System Discharge: This type of discharge request is automatically created nightly by AlphaMCS for any MH or SA consumer who has not received an SA service in over 60 days oran MH service in over 180 days. These will be in a submitted status for review and completion. The system will not automatically discharge a consumer.

Discharge Types

There are three different types of discharges in AlphaMCS: a Full Discharge, a Service Only discharge and an SA Move.

Full Discharge: This is for State enrolledconsumers who have completed an episode of care. Approving a Full Discharge will discontinue ALL open State Authorizations and end date the consumers State insurance using the discharge date on the discharge form. A discharge record (12) will also be sent to CDW.

Service Only Discharge: A service only discharge is used to indicate that a consumer is no longer receiving a service by the provider listed on the discharge request. This does not affect any authorizations and is simply used to record discontinued services for reporting and tracking purposes.

SA Move: This would be used when the consumer cannot currently be located by the provider or MCO and their current status is unknown. When discharged for this reason, an 18 record will be sent to CDW.

Discharge Module and Layout(TOP)

When a provider or MCO staff memberdetermines that a patient should be discharged, they will submit a discharge request forUM staff to review. The reviewer will then eithercomplete the dischargeorsend back to the provider.

To view all discharge requests, go to Menu > Clinical Utilization Management Discharge

Discharge RequestsBase Tile(TOP)

The Discharge Requests Base tile is the main tile for viewing all discharge requests. By default the list will populate with all discharge requests currently assigned to the user logged in.

Quick Action Buttons

The Full Discharge checkbox is used by MCO staff to quickly approve a request. This box is only active and can be used when all CDW required fields are recorded in the appropriate fields.

The SA Move checkbox will prompt MCO staff to complete data fields required to send the SA Movement record to CDW (covered later in the document). The SA Move checkbox will only be active after all the SA Fields in the discharge have been completed.

Note: For the system to generate discharges, AlphaMCS will identify SA patients by the latest SA claim DOS,as well as the procedure code on the claim, to get the diagnosis group description. If the description is SA, and that patient has not had claims in 60 days, then the request is auto-created. Review stored procedure: asp_cre_disch_req

Note: For system generated Discharges that do not have a provider or service, most likely this consumer never had a STATE claim processed through the AlphaMCS system either because they were uploaded to MCS from legacyor has only received Medicaid services.

Reviewing a Discharge(TOP)

To work a discharge request, click on the “3” view button to expand the record, then click Update. If you are responsible for assigning out Discharge requests, you can assign to another staff member by clicking the Assign button. You can alsoTake Assignment to work the request yourself. MCO staff who are qualified to review discharges must be in the Discharge Request Reviewer (DISR) function group for their name to be accessible in the list.

Deleting a Discharge

If you choose to delete a discharge request, first you will have to be in the correpsonding Discharge role with delete permissions in your MCO system. The delete button will only be available for fully discharged records. If Discharge and Full Discharge is selected and SUBMITTED, the button will become available.

When this is used, the record will show up in the list with a status of Deleted as long as you have Inactive or All selected in your filter search.

Also if a discharge is deleted and the consumer truly has not received an SA service over 60 days and they have not been discharged, then another discharge request will be created the next day.

Update Screen (TOP)

Required but Empty Fields

All fields marked with a red asterisk are required to successfully submit to CDW. At times, AlphaMCS generated discharges will be created w/out this required information. It is the MCO’s responsibility to retrieve this information and record it in the discharge form prior to submitting to CDW.

Update Screen Cont. – Status and Types(TOP)

Status: chosen accordingly to identify the current state of the process
Saved: the initial status before any action is taken
Submitted: discharge requests that are assigned to you for acknowledgement. Both manually created (after submission) and system generated discharges begin with this status.
Sent back: a provider submitted request that was sent back for discrepancies. Discharges currently sent back will be indicated in this status.
Discharged: identifies that the consumer was discharged in CDW. This will also need to be selected prior to Submitting the Discharge to CDW, after review.
SA Move: identifies that this type was submitted and used to put the consumer on “hold.” This means that you acknowledge the consumer has not received services but as an MCO you are unsure if they completed treatment and should be officially discharged at the time of review.
Discharge Type: Determines what will be discontinued and end-dated.
Full Discharge: When a consumer is fully discharged their STATE, insurance will be end-dated with the recorded discharge date and all open STATE authorizations will be discontinued with the discharge date (not end dated).
Service Only: This will be chosen if the consumer has completed treatment for aSTATE covered service but may still be receiving anotherSTATE covered MH services (for example). Selecting this and Discharge status will leave Auths and Insurance records as is.

**Staff will need to amend affected Authorizations

Involving CDW

When a Discharge request, Full or SO. This data will be queued up in the CDW Out SQL tables to be created on Sunday to have ready to submit to \\ alphaMCS_ftp\Out\cdw_test folder. MCS will generate the appropriate CDW type records to include in the file (12 Record)

SA Move(TOP)

When the SA Move check box is selected, choose Update; an additional screen will pop-up to record required data to be completed and send to CDW.

SA Move information screen:

Working Multiple SA Moves

If multiple SA Move checkboxes are selected and Update is chosen, then after the first is submitted, then the next SA Move marked discharge request will automatically open so MCO staff can quickly complete the data entry for the SA Move request. If any SA Moves were completed then the checkbox will remain checked but grayed out.

Involving CDW

Submitted SA Move requests are queued to be created Sunday for you to have ready Monday morning to copy to your \\alphaMCS_ftp\Out\cdw_test folder. When the Substance Abuse Treatment (Movement) Details record is sent, the system will auto-generate a Diagnosis Details (13 Record), Substance Abuse (Drug of Choice) Details (17 record).
Authorizations Tile(TOP)

The Auth Tile will provide you with a list of ALL Authorizations by Provider, Site, benefit plan and Service. You can also review the effective and end dates and number of consumed units.

Claims Tile

The Claims Tile is used to review the most recent history of claims by Provider, Service, submitted date and claim amount vs. adjudicated amounts. Remember you can sort by column headings.

Patient Notes Tile(TOP)

The Patient Notes Tile is to record any current clinical notes about the consumer.

Others Tab

The Others Tab will hold addtinal information such as the reviewer comments from the corresponding field in the discharge form. As well as SA Move information if that was the type of discharge submitted to CDW.

Reviewer Comments Tile

To review comments recorded on the discharge claim, drag over your reviewer comments tile, maximize and choose “View Comments.”

Discharge Flowchart(TOP)

Tech Notes(TOP)

System Generated Discharges: Asp_process_batch_data_wrapper runs at 4:45 AM every day and calls asp_cre_disch_req to create the requests.

Stat IDs and DC Types

--Discharge Status--Discharge Type

stat_id = 0 Saved0 =nooption given

stat_id = 1 Submitted1 =full

stat_id = 2 Sent back to Provider2 =Service only

stat_id = 3 Discharge -Full

stat_id = 4 Discharge -Service Only

stat_id = 6 Deleted

Sample Reports

--Total unworked Discharges

SELECTCOUNT(disch_req_id)

FROM tb_pat_disch_requests

WHERE submitted = 1 and stat_id = 1and active = 1

--Number of discharges per patient, one for each service

SELECTDISTINCT pat_id,COUNT(disch_req_id)as ttl_dischgs

FROM tb_pat_disch_requests

WHERE active = 1 GROUPby pat_id ORDERbyCOUNT(disch_req_id)desc

--Report of DR where at least 4 pieces of data are missing

SELECT dr.disch_req_id, dr.prv_id, dr.pat_id, dr.pc_id, dr.disch_dt, dr.disch_rsn, dr.final_loc, dr.disch_ref, dr.disch_lvg_argmt,dr.disch_emplymt, dr.disch_emplymt

FROM tb_pat_disch_requests dr

WHERE dr.insrt_usr_id = 1000 and dr.last_upd_usr_id = 1000 and dr.active = 1

and dr.final_loc = 0

and dr.disch_ref = 0

and dr.disch_lvg_argmt ='-1'

and dr.disch_emplymt ='-1'

--Above Report with missing 4 missing pieces of data with availabe patient record data

SELECT dr.disch_req_id, dr.prv_id, dr.pat_id, dr.pc_id, dr.disch_dt, dr.disch_rsn,

p.pat_emplymt_id as pr_emp_id, p.locus_score as pr_locus_score, p.calocus_score as pr_calocus_score, p.lvg_argmt as pr_lvg_argmt, p.pat_loc_id as pr_loc_id