Southeast PA CHC SC/SCE Training

Southeast PA CHC SCSCE Training

Hosted by

Wednesday December 5th 2018

1

The purpose of this presentation is to provide information and

process updates to ALL SCSCE managing to the implementation

of CHC in the Southwest Region of Pennsylvania

Southeast Region MCOs are

Note AmeriHealth Caritas PA Community HealthChoices (SW Region) and Keystone First Community HealthChoices

(SE Region) are sister companies and have different names in different zones

2

Housekeeping

bull Attendee phones will be muted during the session

bull Question and Answer time at end of each section

bull Additional questions please submit them to your PPL Regional Enrollment Manager

bull FAQ will be distributed after this presentation through the PPL Regional Enrollment Managers

PPL will be recording this presentation It will be posted to our website publicpartnershipscom

3

AGENDA

bull General Information

bull Roles and Responsibilities

bull Enrollment Processes

bull New PDS Initiatives

Authorization Creation Modifications and Troubleshooting

bull MCO Switches

bull File Error Report Automation

bull Assisting Participants as they Manage their Services in CHC

bull Advance Funding

bull Tools to Assist Participants Service Coordinators and MCOrsquos

bull MCO Contacts and Portal Access

4

GENERAL INFORMATION

Pennsylvania PPL Staff

bull PPL maintains two offices in Pennsylvania

bull Harrisburg

bull Philadelphia

bull PPL Regional Enrollment Managers assist with participant concerns and

enrollment Educate Service Coordination Entity staff on using PPLrsquos

BetterOnlinetrade Web Portal program processes and program rules

bull PPL Enrollment Specialists and Supports Brokers are located throughout

PA They provide in-home and telephone visits to new participants to

assist with the initial enrollment paperwork and provide orientation and

training to the CLE

Office hours by appointment

6

Roles and Responsibilities

PPL Roles and Responsibilities

bull Provide and assist Common Law Employer (CLE) and Direct Care Worker (DCW) with new hire forms

bull Provide over-the-phone enrollment for DCWs

bull Process and review completed CLE and DCW paperwork including perform all necessary record checks on prospective DCWrsquos

bull Issue payments to DCWrsquos bi-weekly following the receipt of properly submitted timesheets

bull Provide payments to vendors through Services My Way program

bull Complete CLE tax responsibilities including withholding and depositing payroll taxes and filing payroll tax returns

bull Issue w-2 year-end statements

bull Provide customer service support for Participants and DCWs

8

Enrollment Manager Roles and Responsibilities

bull Main point of contact for Service CoordinatorsEntities (SCSCE) and MCOrsquos

bull Main point of contact for DCWrsquos and CLErsquos is PPLrsquos Customer Service

bull Respond to day to day participant direction issues identified by SCs

bull Support training and education

bull Work with SC Administrators to maintain web portal access for SCs

bull Communicate significant changes and updates

bull Work with SCs on errors which may cause participants to not receive services

bull Missing authorizations

bull Gap in Service Issues

bull Mandatory Reporter

9

10

Enrollment Manager Assignments by County

bull Enrollment Managers are the primary contact for Service Coordinators

bull Participants CLEs and DCWs should continue to call PPL Customer Service for assistance

A copy of the crosswalk is included as a hand-out with this presentation

Service Coordinator Roles and Responsibilities

bull Introduce the choice for Participant Directed Services to Participants

bull Assist with the designation of an alternate CLE where necessary and allowed

bull Make referrals to PPL using the PPL Better Online web portal

bull Develop and update Individual Service Plans

bull Initiate informal supports or agency services until the participant is ready to

receive services through PPL and DCW is good to go

bull Help participants develop and implement a backup plan

bull Monitor the delivery of services and supports

bull Review PPL utilization reports and the Service Plan with participant to ensure

services are being provided in accordance with the Service Plan

bull Provide PPL with any temporary gaps in service in a timely fashion

bull Keep participant demographics up to date in OLTL Systems or MCO Plan Portals

bull May assist participants with completing enrollment forms


11

MCO Plan Role in PDS

bull Train Service Coordinators on program requirements and MCO system entry and utilization

bull Provide support to Service Coordinators in the management of the Participantsrsquo services

bull Provide authorizations to Public Partnerships for participants choosing PDS

bull Approve Service Plans submitted by Service Coordinators

bull Provide Service Coordination Supervision

bull Receive and Review Reports from PPL

bull Confirm the correct Waiver Authorization and service codes are being entered to ensure payment to DCW


12

Common Law Employer Roles and Responsibilities

bull Recruit hire train schedule manage and dismiss DCWs

bull Verify DCW and vendor qualifications

bull Ensure that DCWs complete the enrollment requirements

bull Train DCWs in providing services described in the ISP

bull Decide how much to pay DCW within state guidelines

bull Monitor adherence to Service Plan and budget

bull Develop and implement a backup plan

bull Approve and submit all timesheets to PPL

bull Report suspicions of Medicaid fraud or financial abuse

bull Designate a representative to assist with CLE duties as

necessary


13

Alternate Common Law Employer Option

bull CHC Aging Independence and OBRA Waivers allow a participant to assign another to act as CLE

bull An alternate CLE can be used to assist an individual tobull Understand personal assistant needsbull Make decisions about carebull Manage lifestyle and environment by making these

choicesbull Understand or have the ability to learn how to

recruit hire train and supervise providers of carebull Understand the impact of decisions and assume

responsibility for the results

14

Direct Care Worker Roles amp Responsibilities

bull Complete DCW enrollment paperwork and required background checks for each participant-employer they provide services to

bull Complete the required DCW Orientation and obtain a Unique ID

bull Alert PPL to any address changes

bull Complete a Live-In Exemption form if moving into or out of the home of the participant to whom services are provided

bull Provide services to participant as described in ISP

bull Meet all qualification requirements and complete training as identified in the ISP

bull Be aware of guidelines related to their own withholdings

bull A DCW may not be a spouse Power of Attorney person under 18 years of age Designated Rep or Rep Payee of the person receiving services


15

Enrollment

The Enrollment Process Post CHC

17

On 112019 in the SE Region

1 The Enrollment Broker will refer new participants to the MCO Plan of choice

2 The MCO Plan offers choice of Service Coordination Entity to the Participant

The Enrollment Process Flow is included with the materials for this presentation

Participant Referral Process

bull SC works with the participant to determine the Common Law Employer (CLE)

bull The CLE is the legal Employer of Record and is responsible for managing DCWs CLE must agree to be responsible for key employer related tasks

bull SC enters in new participant referral through the PPL Web Portal

bull Participants who re-enroll or transfer from Options should be submitted via paper referral form

bull SC should be adding Service Coordinator Entity and Service Coordinator name to Participant Profile

bull SC submits service plans to MCO Plan (via MCO Plan Portal) after entering the new participant referral

18

Referral Entry New Feature Service Coordinators should enter the MCO Plan information into BetterOnlinetrade during referral entry

The example below shows the drop down feature which allows you to accept the Plan the participant is associated to Select OLTL for non-CHC Waiver Participants in OBRA and ACT150 and for participants you are referring in a non SWSE Region)

19

Updates in PPLrsquos BetterOnlinetrade Web Portal

Enrollment Assistance

The following resources are available to help CLEs and DCWs complete their paperwork

bull Customer Service

bull Enrollment Specialist and Supports Brokers

bull For new CLEs and their 1st DCW

bull PPL Website

httpwwwpublicpartnershipscomprogramsPennsylvaniaPADPWOLTLindexasp

bull Informational Packets

bull Video Recorded Trainings

20

Enrollment Specialists

Conduct in-home and telephonic visits with new Participants to

bull Assist with the initial participant CLE enrollment paperwork

bull Explain the enrollment process and timeframes for completion

bull Support the CLE with the initial DCW enrollment paperwork with their DCW

bull Provide orientation and training to the CLE

bull Follow-up on good-to-go (G2G) and good-to-serve status

bull Post-visit will refer any concerns or issues identified by the participant to the Enrollment Manager

21

Processing Enrollment Forms

1 For in-home appointments the ES returns the completed CLE

and DCW enrollment documents to PPL for processing

a For phone appointments the CLE faxes or mails the

completed CLE and DCW packets to PPL for processing

2 PPL reviews documents for completion and accuracy

3 If documents are incomplete PPL calls the CLE andor re-sends

documents to complete

4 Completes all required background checks

a Criminal history results of a background check may require

sign-off by the CLE

5 When all forms have been completed Orientation attended

Unique ID acquired background checks processed and

authorizations have been received PPL will issue Good to Go

date

wwwpublicpartnershipscom 22

Good to Go Notification

Being ldquoGood-to-Gordquo means all of the following

bull PPL received and processed all required CLE documents and obtained an Employer Identification Number (EIN) for CLE

bull DCW has passed the mandatory background checks and completed all enrollment paperwork and program requirements

bull Including DCW Orientation and Unique ID

bull Participant has a current authorization in place for services

bull When a DCW is able to start providing services when they are notified in writing by receiving a Welcome Packet with the good-to-go date

bull A DCW is not qualified to work before receiving the good to go date hence the DCW will not be paid for any services provided prior to being notified of the good-to-go date

23

Enrollment Activity Updates

Key Service Coordinator Activity OLTL

AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW

Referral to SCE is provided by Enrollment

BrokerMCO Plan MCO Plan MCO Plan

Referral is entered into PPL

BetterOnlinetradeSCE SC SCE SC SCE SC SCE SC

Service Plans are createdreviewed

with Participants by theSCE SC SCE SC SCE SC SCE SC

Service Plans are submitted by SCE SC SCE SC SCE SC SCE SC

Service Plans are submitted through OLTL SystemsMCO Plan

Portal

MCO Plan

Portal

MCO Plan

Portal

Service Plans are approved by OLTLPlan

Leadership

Plan

Leadership

Utilization

Management

for Plan

Plan Authorizations are submitted to

PPL byOLTL MCO Plan MCO Plan MCO Plan

24

New PDS Initiatives

DCW Pre-Service Orientation

bull Effective December 1 2018 the Office of Long Term Living will require that all new DCWs with a PPL intake date on or after 1201 will be required to attend a pre-service Orientation prior to providing services

bull The Orientation will provide a basic understanding of the functioning and requirements of participant directed services

bull DCWrsquos will be contacted by PA Frontline to schedule an Orientation in their area

bull Additional information regarding DCW Pre-Service Orientation is available on PPLrsquos Website


26

Unique Identifier and Opt InOut Selection

bull All DCWs providing services in OLTL PDS programs will be required to register for a Unique Identification (ID) Number

bull This Unique ID Number will serve as a reference number in the Unique ID Registry

bull DCWs may elect during registration to be excluded from the public registry through the ldquoOpt-Outrdquo selection

bull New DCWs starting after December 1 2018 will be required to obtain a Unique ID Number before they receive Good to Go status

bull For DCWs providing services to participants before December 1 2018 a Unique ID Number must be provided to PPL by March 31 2019

bull Link to register for Unique ID can be found on PPLrsquos website

httpwwwpublicpartnershipscomprogramsPennsylvaniaPADPWOLTLindexhtml

27


Migrating current SE PDS Participants from Annual Authorizations to Monthly Authorizations for CHC Waiver

29

Effective 112019 all CHC Participants utilizing PDS will have

MONTHLY authorizations

bull Participants in Waivers other than OBRA and ACT150 will migrate to the

CHC Waiver effective 112019 in the Southeast Region

bull Authorizations for Participants in the Southeast Region will be end-

dated 12312018 by OLTL

bull MCO Plans will provide new authorizations to PPL for Southeast Region

CHC Participants currently utilizing PDS with an effective date of

112019

bull MCO Plans will transition all plans to a monthly authorization

bull NOTE 62 of participants in SE will be transitioning from yearly

to monthly authorization

Authorization Creation MCO PLAN

MCO PLAN Portal

Authorizations are received from MCO Plans at minimum daily

bull Authorizations are loaded through an automation process when received daily

bull Authorization start and end dates for W1792 W1792TU W1900 W1901 S5150 and S5150TU service codes should span the entire month

bull Exception in a first month of service for a newly referred participant

bull Ideally service authorizations should start 30 days from the date the participant was referred to PPL however sometimes the PPL Enrollment Process takes less than 30 days At your discretion the service plan can be modified to allow an earlier start date Additional information on plan submission timing will be provided to you during your MCO Training

bull W7341 and W7341 U4 are not a required entry for MCO Plan Portals

bull Authorization quantities for all service codes must be a whole number

Example 100 instead of 1015

30

Authorization Modifications Addition or Subtraction of units

bull Date Range Adding or subtracting units must be modified for the entire

authorization period not a shorterlonger date range

bull Units should be added or subtracted from the total amount of units on the original

authorization

bull The start or end date of an authorization should only be modified if PPL has not

paid for services prior to or after the new date

bull Before modifying a date please review the participantrsquos authorization in

Portal to see if services have been paid out

bull To review this click on the Authorization button at the bottom of the

participantrsquos profile page

bull Then select the Display Detail button under the Actions column for the

month in question

31

Authorization Modifications Contrsquod

Change in Waiver or County

bull If a participant moves to a new county within the SE CHC Region please

provide the participantrsquos updated address through the demographic file

The enrollment begin date should remain the same as long as they are

staying with the same MCO

bull Alert your Regional Enrollment Manager as soon as possible of the change

in address via a(n) Address Change Form

Termination

bull Service Plan must be end-dated so the modified authorization will load into

the PPL Portal before services are paid out past the last date that the

participant was eligible

32

Managing to MCO Switches

MCO Switches during the first months of CHC Implementation

34

Participants can choose to switch their MCO at any time

bull The last day a Participant can choose their MCO for a 1119 start is 12212018

bull A Participant who changes their MCO on or before the 15th

of the month will receive services from the new MCO on the 1st of the following month

bull A Participant who changes their MCO after the 15th of the month will receive services from the new MCO on the 1st of the 2nd month following the choice change

bull Switches if not identified and resolved quickly put workers at risk of delay of payment

bull We anticipate a potentially high volume of switches in the month of February 2019

What MCOrsquos Can Do to Assist Participants

35

bull MCOrsquos should work in collaboration to ensure that the Plan the Participant is eligible with for the month also has an authorization in PPLrsquos BetterOnline Web Portal

bull End date authorizations upon notification of switch to ensure authorizations for new MCO can be entered quickly and efficiently in order to avoid delayrsquos in payments

1 Review correction files daily and take appropriate action

bull Check Eligibility for Potential Issues

1 Eligibility may show ldquoMCO NEWrdquo and ldquoMCO OLDrdquo because

the old has not been end dated in PPLrsquos system

2 Eligibility shows with ldquoMCO NEWrdquo but ldquoMCO NEWrdquo hasnrsquot

provided an authorization

3 Both1amp2 can and HAVE occurred

File Error Report Automation

Authorization File Error Automation

bull Released to Production

bull No Reply Emails

bull Automated File Error Report

bull In Development

bull Automated Resolution Path of Authorization File Error Report

bull Manual Reports will continue to be provided in interim

bull Automated Participant File Error Reports

bull Timeline - TBD


File Error Messaging and Resolution Path


MCO Authorization Error Messages and Resolution Path

Error Messages Actions Resolution Paths

Error - Auth Qty cannot be smaller than 1 Service units must be greater than or equal to

one

Revise the service unit to reflect a whole number equal or greater than one

Error - Consumer Medicaid ID []

not in correct format

Medicaid ID must be ten digits Revise the Medicaid ID to reflect ten digits including preceding zeros if applicable

Error - Overlap Auth Found in this plan

rejecting

Authorization exists in Portal with a different

AuthRefID

Check Portal to obtain the initial authorization ID and use that authorization ID as the external reference ID on the authorization

file to update the authorization

Action Code not N but Auth does not exist 1 If the action code is M then it should be

changed to N

2 If the action code is I the auth ref ID does not

exist in Portal

1 AuthRefID does not exist in Portal Resubmit with action code N

2 This authorization was previously inactivated or it does not exist in Portal Do not resubmit

Error - Overlap with MCO Change Participant is enrolled with another MCO or

OLTL

The MCOs should check PROMISe to identify which MCO has eligibility for these months the MCOs should work together to

inactivate and resubmit authorizations accordingly

Action Code is N but Auth already exists Authorization exists in Portal Resubmit with

action code M

Change the action code to M on the authorization file and resubmit

End date not in Fiscal year Authorizations should be generated in monthly

increments

Modify the authorization start and end dates to reflect a monthly plan

Service code does not exist in system Invalid service code Change the service code to either W1792 W1792TU S5150 S5150TU W1900 or W1901

Cannot change Service Code after Payroll

Journal Lines or Payroll Ledger Entries have

been authorized

The service code on this file does not match the

initial service code that is linked with this

external reference ID in Portal

Check the reference ID and corresponding service code in Portal and update the service code on the authorization file

accordingly

Error - Consumer Medicaid ID not found in

system

No matching participant in Portal Verify that participant record cannot be found in Portal If record does not exist (based on a search by MA FirstLast Name

and SSN) the MCO should submit the new participant referral electronically for the missing participant record

Error - Cannot realign paid entries to an

alternate Authorization Line

Service start date cannot be modified to a new

date PPL has already paid for services prior to

the new start date

Check the authorization budget detail screen in Portal to confirm payment start date and update authorization start date and

resubmit

Assisting Participants as they Manage their Services in CHC

ParticipantCLE Changes

bull Common Law Employer and Participant Services Change Form

bull Request a change in Common Law Employer

bull Notify PPL of a temporary halt of services

bull Notify PPL of a participant termination

bull Common Law AddressPhone Change Form

bull New Participant FMS Referral Form

bull For Participant re-enroll ONLY

bull All new should be referred via BetterOnlinetrade Web Portal

bull Participant wants to change Service Coordination Entity

bull Service Plan including PPL Service Authorization moves with the participant

bull No execution is necessary at the Plan Level

bull Do not end date Service Plan or PPL services

bull Only change Service Coordination services

Refer Participants who wish to change their MCO Plan to the Independent Enrollment Broker who will assist them

40

Reporting Terminations and GAPrsquos in Service

Modifying the Start or End Date due to a Termination or GAP in Service

bull If a participant is no longer eligible for services please complete the Termination Section of the change form

bull Be sure to include the date of termination

bull If a participant services are temporarily on hold enter Service Hold information

bull Please notify your Regional Enrollment Manager of any terminations or gaps in services by e-mailing them the change form

41

CHC Payroll Related Assisting Participants with Pended Timesheets

42

Service Coordinator Action

Pend Message OLTL MCO Plan Pend Message Explanation

Consumer is not authorized for this service or

Date Worked is not within authorized date

range

SCE SC SCE SC

Explanation PPL does not have an authorization the authorization

does not span dos for the submitted timesheet dates the auth

has been inactivated

Eligibility Plan Not Matching Authorization

PlanNA

SCE SC

discussion with

MCO Plan

Explanation Promise (270271 eligibility process) shows part

assoc to a Plan that is different than the authorization we have in

portal Portal is showing auth with OLTL or another plan

Medicaid not eligible SCE SCCAO

SCE SC

discussion with

CAO

Explanation Promise shows participant is not Medicaid Eligible

Verifying eligibility

PPL Messaging

turnaround

expectation 48

hours

SCE SC

Explanation Normal processing pend Timesheet is submitted

and approved by CLE waiting on 270271 response to complete

processing of timesheet

Waiver not eligible SCE SCCAO

SCE SC

discussion with

CAO

Explanation CHC Waiver not showing (requires discussions with

CAO)

Providing continuity of care for Participants receiving PDS

43

bull Encourage participant-CLEs to approve and submit DCWsrsquo timesheets as soon as possible to allow ample time to correct pending timesheet errors

bull Encourage Time4Care trade and PPL BetterOnlinetrade timesheet submission The sooner timesheets are submitted the more time is available to resolve any issues particularly during the first month of implementation

bull Continue to work with CAOs to address any eligibility items

bull Assist MCOs with any eligibility and authorization items that may impact on-time payments

bull Encourage participants to use and to encourage their DCWs to use PPL BetterOnlinetrade

Providing continuity of care for Participants receiving PDScontrsquod

44

Verifying Eligibility is a normal processing Pend Message on a submitted timesheet when it occurs for 2 to 3 days The PPL System is confirming Eligibility after the timesheet has been submitted processing time is usually 2 days However if this message remained after 3 days alert PPL

Example The below timesheet is in a pend status with a message lsquoVerifying Eligibilityrsquo on 81518 It was submitted with CLE approval on 81518 so it has not completed processing

Participant Eligibility

bull Service coordinators monitor and assist with participant issues related to Medicaid and Waiver eligibility

bull County Assistance Office (CAO)bull SCs assist participants during recertification process as needed and

bull Coordinate county changes or waiver changes with CAO

bull Notify your PPL Enrollment Manager as soon as you become aware of a county or waiver change to coordinate continuation of services


45

TOOLS TO ASSIST PARTICIPANTS amp SERVICE COORDINATORS

PPL Tools

bull PPL BetterOnlinetrade web portal

bull Reports


bull Program website resources

bull DCW over-the-phone-enrollment

bull CLE Orientation amp Skills Training Handbook

bull Program Management Staff specifically Regional Enrollment Managers and Enrollment Specialists

47

PPL BetterOnlinetrade web portal

bull Provides real-time access to participant information

bull Functions of the web portal for SCs include the followingbull Entering New Participant Referrals

bull Accessing participant information budgets and utilization details

bull Information available on the portalbull ParticipantCLE demographic information

bull Associated Direct Care Workers and currentmax pay rate

bull Good to Go status for participant and DCW

bull Timesheets and pend messages

bull Gaps in service

bull Participant reports

bull SCs can work with their Enrollment Manager (EM) to receive training on the BetterOnlinetrade web portal Each SC can receive a portal ID and password by requesting one from their EM

48

PPL Reports

bull PPL provides Participant reports detailing how services are being utilized when timesheetsinvoices are missing when timesheets are pending and why and on direct care worker qualification and payment information

bull Monthly Utilization DCW Summary Over and Under Utilization and DCW 16+ Hours Shift

bull PPL Reports are available to SCs in web portal

bull Reports also available to CLEs in Portal

49

PPL Customer Service

bull Provides toll-free customer service via phone fax and e-mail

bull Provides translation and interpreter services

bull Can provide assistance with completing CLE and DCW paperwork

bull Notifies CLE of missing or incorrect paperwork or issues that may delay payroll to DCWs via Blaze calls

bull Provides program materials in alternate formats

IMPORTANT

Only PPL staff CLEs Designated Representatives SCs and SC supervisors will be able to speak with PPL Customer Service staff about a participantrsquos services

50

Contact PPL

Customer Service Hours

830 am - 800 pm (Monday-Friday)

900 am - 100 pm (Saturday)

Closed State Observed Holidays

Toll Free 877-908-1750

TTYTDD 800-360-5899

E-mail cs-oltlpcguscom

Mail to PO Box 1108

Wilkes-Barre PA 18773-9905

51

Website Resources

PPL website

bull CLE and DCW forms

bull Portal How-to Guides

bull Payroll Schedules and timesheets

bull Workers Compensation Information

bull WebEx Recordings

bull Frequently Asked Questions

bull URL httpwwwpublicpartnershipscomprogramsPennsylvaniaPADPWOLTLindexasp

52

MCO Contact Information

53

PA Health amp Wellness

Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW

wwwpahealthwellnesscom wwwupmccom wwwkeystonefirstchccom wwwAmeriHealthcom

Participant_Directed_Option_PAPaH

ealthWellnesscom

E-mail inquiries available E-mail inquiries available E-mail inquiries available

1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments

Questions not answered today will be used to compile a FAQ

document to be posted on the PPL PA OLTL program websitepublicpartnershipscom

54

wwwpublicconsultinggroupcom

The purpose of this presentation is to provide information and

process updates to ALL SCSCE managing to the implementation

of CHC in the Southwest Region of Pennsylvania

Southeast Region MCOs are

Note AmeriHealth Caritas PA Community HealthChoices (SW Region) and Keystone First Community HealthChoices

(SE Region) are sister companies and have different names in different zones

2

Housekeeping






3

AGENDA






bull MCO Switches






4

GENERAL INFORMATION



bull Harrisburg

bull Philadelphia







training to the CLE


6











8












9

10




















11










12












necessary


13







14











15

Enrollment


17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54


Housekeeping






3

AGENDA






bull MCO Switches






4

GENERAL INFORMATION



bull Harrisburg

bull Philadelphia







training to the CLE


6











8












9

10




















11










12












necessary


13







14











15

Enrollment


17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54


AGENDA






bull MCO Switches






4

GENERAL INFORMATION



bull Harrisburg

bull Philadelphia







training to the CLE


6











8












9

10




















11










12












necessary


13







14











15

Enrollment


17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54


GENERAL INFORMATION



bull Harrisburg

bull Philadelphia







training to the CLE


6











8












9

10




















11










12












necessary


13







14











15

Enrollment


17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54




bull Harrisburg

bull Philadelphia







training to the CLE


6











8












9

10




















11










12












necessary


13







14











15

Enrollment


17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54












8












9

10




















11










12












necessary


13







14











15

Enrollment


17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54











8












9

10




















11










12












necessary


13







14











15

Enrollment


17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54













9

10




















11










12












necessary


13







14











15

Enrollment


17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54


10




















11










12












necessary


13







14











15

Enrollment


17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54

















11










12












necessary


13







14











15

Enrollment


17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54











12












necessary


13







14











15

Enrollment


17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54













necessary


13







14











15

Enrollment


17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54








14











15

Enrollment


17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54












15

Enrollment


17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54


Enrollment


17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54



17












18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54









18



19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54




19







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54







bull PPL Website




20









21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54










21











sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54












sign-off by the CLE




date










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54










23



AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54




AmeriHealth

(SW)

Keystone (SE)

UPMC PAHW









Portal

MCO Plan

Portal

MCO Plan

Portal


Leadership

Plan

Leadership

Utilization

Management

for Plan



24

New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54


New PDS Initiatives







26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54








26









27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54










27



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54




29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54



29









112019





MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54



MCO PLAN Portal









30





authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54






authorization








month in question

31









Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54










Termination




32



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54




34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54



34









35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54



35















bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54







bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54






bull In Development




bull Timeline - TBD







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54







one






rejecting


AuthRefID




changed to N


exist in Portal




OLTL




action code M



increments





been authorized





accordingly


system







the new start date


resubmit

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54


















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54

















40







41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54








41


42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54



42





range

SCE SC SCE SC





PlanNA

SCE SC

discussion with

MCO Plan





SCE SC

discussion with

CAO



PPL Messaging

turnaround

expectation 48

hours

SCE SC





SCE SC

discussion with

CAO


CAO)


43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54



43







44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54



44









45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54








45


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54



PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54


PPL Tools


bull Reports






47












48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54













48

PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54


PPL Reports





49







IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54








IMPORTANT


50

Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54


Contact PPL





Toll Free 877-908-1750

TTYTDD 800-360-5899


Mail to PO Box 1108


51

Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54


Website Resources

PPL website








52


53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54



53


Regions

1012018 SW

1012019 SE amp SW

UPMC Community

Health Choices

Regions

1012018 SW

1012019 SE amp SW

Keystone First

Region

1012019 SE

AmeriHealth Caritas

Region

1012018 SW



ealthWellnesscom


1-844-626-6813 1-800-533-UPMC (8762) 1-800-521-6007 1-877-219-5453

(TTY 1-844-349-8916)

Questions Comments



54


Questions Comments



54



Documents

Southeast PA CHC SC/SCE Training