Transportation, mileage reimbursement per RPM, billed charges, or negotiated rate If consumer has verified comparable benefits, create service records the consumer portion not covered by the comparable benefit as the cost for the service. The consumer portion amount cannot exceed the hospital contract rate or the MAPS rate for the ancillary service whichever one applies. If consumer comparable benefits cannot be verified, create service records as if the consumer does not have any comparable benefits. If hospital cost is estimated to be $30,000 or above, follow encumbrance guidelines in the SERVICE COORDINATION BUDGET BUSTERS. – Contact counselor Provide estimate for requested service(s) and anticipated ancillary services. total Discuss Budget Busters if hospital cost is estimated to be $30,000 or greater and inform counselor that only $30,000 will be encumbered from the counselor’s budget and the remaining estimated cost will be requested from Budget Busters. Obtain counselor approval of encumbrance. Document contact and approval in a case note. Contact surgeon or surgeon’s representative. Obtain surgery date. Note: In some the consumer schedules the surgery date. Advise that purchase order(s) will be mailed or faxed. Issue purchase order(s) and send copy to surgeon, hospital, and ancillary service providers. Review the service records to confirm information is correct and ensure accurate purchase will be generated. Issue purchase order(s) for planned service and all anticipated ancillary services. If comparable benefits are verified, or reported but not verified, note the specific comparable benefit in the Payment or Special Instructions section of the purchase order and request a copy of the Explanation of Benefits with the invoice for payment. Fax or mail purchase order(s) to surgeon, hospital and any ancillary service providers. Document the specific surgery, name of surgeon, hospital, and date of scheduled surgery in a case note. Also, include a list of ancillary providers and services purchased. Coordinate surgery date and pre-operative instructions with consumer. Contact the consumer by phone or letter to either notify the consumer of the scheduled surgery date or request that the consumer schedule the surgery date and notify the MSC. Verify if consumer has received any special pre-operative medical instructions from the surgeon’s office. Notify counselor of consumer’s surgery date. Contact hospital. Contact hospital to confirm consumer’s discharge date.
Transportation, mileage reimbursement per RPM, billed charges, or negotiated rate If consumer has verified comparable benefits, create service records the consumer portion not covered by the comparable benefit as the cost for the service. The consumer portion amount cannot exceed the hospital contract rate or the MAPS rate for the ancillary service whichever one applies. If consumer comparable benefits cannot be verified, create service records as if the consumer does not have any comparable benefits. If hospital cost is estimated to be $30,000 or above, follow encumbrance guidelines in the SERVICE COORDINATION – BUDGET BUSTERS. Contact counselor Provide total estimate for requested service(s) and anticipated ancillary services. Discuss Budget Busters if hospital cost is estimated to be $30,000 or greater and inform counselor that only $30,000 will be encumbered from the counselor’s budget and the remaining estimated cost will be requested from Budget Busters. Obtain counselor approval of encumbrance. Document contact and approval in a case note. Contact surgeon or surgeon’s representative. Obtain surgery date. Note: In some the consumer schedules the surgery date. Advise that purchase order(s) will be mailed or faxed. Issue purchase order(s) and send copy to surgeon, hospital, and ancillary service providers. Review the service records to confirm information is correct and ensure accurate purchase will be generated. Issue purchase order(s) for planned service and all anticipated ancillary services. If comparable benefits are verified, or reported but not verified, note the specific comparable benefit in the Payment or Special Instructions section of the purchase order and request a copy of the Explanation of Benefits with the invoice for payment. Fax or mail purchase order(s) to surgeon, hospital and any ancillary service providers. Document the specific surgery, name of surgeon, hospital, and date of scheduled surgery in a case note. Also, include a list of ancillary providers and services purchased. Coordinate surgery date and pre-operative instructions with consumer. Contact the consumer by phone or letter to either notify the consumer of the scheduled surgery date or request that the consumer schedule the surgery date and notify the MSC. Verify if consumer has received any special pre-operative medical instructions from the surgeon’s office. Notify counselor of consumer’s surgery date. Contact hospital. Contact hospital to confirm consumer’s discharge date.