Centralized Eligibility

For Take Charge! program contracted healthcare

providers

Before proceeding with training

• This is a self-directed training with no audio

• Plan on completing and returning the post assessment

• Allow approximately 20 minutes for training and post test

2

Who should take the Centralized Eligibility Training?

• The following types of individuals (that work with the Take Charge! program) must receive and complete the training and post test.– Receptionist– Billing– Administrative Assistant– Medical Assistant– Any individual that assists with scheduling

appointments or preparation of billing/invoicing

3

Training Topics

• Goal and Objective• Background Information• Roles and Responsibilities• Implementation Information• Step by Step Instructions• Post Test

4

Goal and Objectives

Goal– Provide an opportunity to gain knowledge and skill

in centralized eligibility with the Take Charge! program

Objectives- Upon completion of this self-study training

participants will be able to:- Understand the role of the contracted healthcare

provider in the centralized eligibility process- Understand the role of the Take Charge! patient

navigator

5

Background Information

• Centralized eligibility was designed to:– decrease confusion about age related

eligibility guidelines within the Take Charge! program

– decrease workload on contracted health care facilities

– follow Federal Office of Management and Budget (OMB) circular A-133 definitions and characteristics of vendor contracts 6

Take Charge! Contractor Roles and Responsibilities

– No longer determines women’s eligibility for Take Charge! effective September 15, 2014

– Assures women screened through Take Charge! program have a current Take Charge! card prior to providing services

– Attaches copy of Take Charge! card to program form for each woman served

– Continues to follow Take Charge! guidelines for services provided, form completion, tracking and follow-up, and timely invoicing

7

Take Charge! Patient Navigator Roles and Responsibilities

• Answers toll free phone number to assist with Take Charge! eligibility

• Asks demographic and eligibility information and records it in CaST program (Take Charge! database)

• Determines if the woman is eligible to receive Take Charge! funded services

• Advises the type of services the woman is eligible to receive based on age

8

Take Charge! Patient Navigator Roles and Responsibilities

• Educates eligible women on Take Charge! program• Mails enrollment packet and Take Charge! card to

eligible woman with list of Take Charge! contractors

• Provides community resources for women not eligible for the Take Charge! Program

• Calls eligible women if screening services have not been documented in CaST program

• Calls eligible women with abnormal results if diagnostic services have not been documented into CaST program

9

General Take Charge! Eligibility

• Age– Between the age of 21-65

• Income– Must be less than 185% of current Federal

Poverty Guidelines

• Insurance– No Medicaid/Medicare– Unmet deductible of $150.00

10

Take Charge! Funded ServicesAge and Services

Age Service21-49 Clinical Breast Exam (CBE), Pelvic Exam, Pap Test, HPV Test*

*Note: (Women who are eligible for Family Planning services should be referred to the OSDH Family Planning Program at the nearest County Health Department.)

40-49 *IMPORTANT*Mammograms restricted to symptomatic women only. 

Clinical Breast Exam (CBE), no screening mammogram*, Pelvic Exam, Pap Test, HPV Test* To refer for a diagnostic mammogram, an abnormal breast finding must be identified by the healthcare provider through a clinical breast exam. Abnormal breast findings may include: bloody or serous nipple discharge, discrete palpable mass-suspicious for cancer, nipple or areolar scaliness, skin dimpling or retraction.

50-65  PRIORITY POPULATION 

CBE, Screening/Diagnostic Mammogram, Pelvic Exam, Pap Test, HPV Test

Over 65 CBE, Screening/Diagnostic Mammogram, Pelvic Exam, Pap Test, HPV Test* Note: *Please use current clinical guidance from USPTF to determine if screening is clinically necessary. Women in this age group should be encouraged to sign-up for Medicare Benefits.

11

Implementation

• Centralized eligibility goes into effect September 15, 2014

• Allow at least 7-10 business days for the Take Charge! card to arrive at eligible women’s addresses.

• Services provided without a current Take Charge! card will not be reimbursed

12

• Take Charge! card will expire within 90 days from the date of issue

• Previous Take Charge! clients must have a Take Charge! card before scheduling an appointment

Implementation

13

Instructionsfor women with appointments

scheduled after September 15, 2014Option 1

1. Contact the women you have already scheduled to let them know they must contact the Take Charge! patient navigator(s) and receive a Take Charge! card prior to receiving services.

2. Ask the women to call you back with their Take Charge! card.

3. Instruct the woman that her appointment will be cancelled two business days prior to the appointment if her Take Charge! card number has not been provided.

Option 2

1. Generate a list of the women’s full name, phone numbers and appointment dates

2. Fax the list to the Take Charge! patient navigator(s) at 405-271-6315.

3. The clients will be contacted by the Take Charge! patient navigator(s) to determine eligibility and issue a Take Charge! card.

4. At least a week prior to the women’s schedule appointment, please call the client to obtain her Take Charge! number.

Please note: This option is only available for appointments from September 15, 2014 through October 15, 2014.

14

Take Charge! Card

The Take Charge! card looks like similar to the one below

15

Scheduling Appointment

• Scheduling Appointment– Ask for the number on the Take Charge! card

• If the woman is unable to provide the number, refer her to the Take Charge! Patient Navigator to obtain her number

– Ask the woman for the expiration date on the Take Charge! card• The Take Charge! card will expire 90 days from the date it was

issued.– If the Take Charge! card is expired, refer her to the Take Charge! patient

navigator(s).– Services provided without a current copy of a Take Charge! card will not

be reimbursed by the program.

– Advise the woman that she must bring the Take Charge! card with her to receive services

– If the woman doesn’t have a Take Charge! card, she must be referred to the Take Charge! patient navigator.

16

Day of Appointment Instructions

• Make a copy of the Take Charge! card

• Review card to ensure that the card has not expired– If the card has expired, advise the client that the

card has expired and that any services provided will not be reimbursed by the Take Charge! program.

17

Invoice Preparation Instructions

• Attach a copy of the Take Charge! card to each completed program forms (ODH Form No. 274A, ODH Form No. 274CD, ODH Form No. 833)– If a completed program form is received

without a copy of the card, the services will not be reimbursed by Take Charge! program

18

Post Test

Answer the centralized eligibility post test assessment located on the current

provider training tab and fax the answers to

Take Charge! Program at 405-271-6315

19