CPI Other

Accomplishments

Hard work and dedication paid off by completing and rolling out:

Provider Enrollment

• Rollout of Delegated Roster
  • Each Delegated Entity and CMO have implemented a unified delegated roster for monthly submissions. As of the date of posting, there have been no complaints and quite a bit of high praise for ease of use, submission and returns.
  • There will be a 90-day, 180-day and 1-year check-in with staged rollouts of any identified bugs to be fixed.

Claims and Billing

• Standardized appeals and grievance process across all three CMOs. CareSource has isolated, updated and promoted language around a reconsideration phase. 
• This will bring this same step in line for all three CMOs.

Prior Authorizations

• Rollout of Universal Psychiatric Residential Treatment Facility (PRTF) Form.
  • The form went live on GaMMIS on Feb 13, 2023, and, as of the date of posting, has not garnered any complaints or pushback from the PRTFs or CMOs.