Updating Authorization to Denial “2”
If found financially ineligible the AFS worker must code the ACTION BLOCK in the ADvantage Waiver authorization and notify the nurse, copied to the area nurse.
In IMS, type EKL case number and press enter.
Tab down to the ADvantage Waiver authorization in application status, type ausw and press enter.
Enter the following
- Tab to the action block and enter a 2 (denial) over the “A”
- Enter the reason code for denial in the reason block and press enter. Refer to article IMS: IMS Codes for LTC Authorization Actions.
Communication with the area nurse is extremely important. If financial eligibility is delayed due to spending down of assets etc., an email must be sent to the nurse and copied to the area nurse and AFS supervisor.
Once the ADvantage Waiver authorization is denied, certify or deny the Medical “D” section appropriately.
If found financially eligible but medically ineligible, the authorization will be denied by the nurse. In this scenario the AFS worker will code the authorization as financially eligible as instructed in the LTC Help & How To’s entitled: “ADvantage Waiver Application Processing Certifications”
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