Long Term Care (LTC): Nursing Facility (NF) Applications Processing Certifications

Placing Authorization Into Financial “F” Status

If the AFS worker determines the client to be financially eligible, the NF authorization needs to be updated from “A” application to “F” financially eligible.

  1. In IMS, type EKL <space> case number, and press enter.In IMS - ekl (space) H017762
  2. Tab down to the authorization in application status and type aul, and press enter.EKL screen - "aul" in Authorization in Application Status
  3. Enter the following items
    • Tab down to action block and enter “F” over the “A”
    • Tab down to VEND PAY and enter a vendor payment (this can be changed when opening the auth if needed)
      • If the vendor payment is $0, enter 0.
    • Enter effective date. This date will always match the begin date (these dates may also change once the medical approval from ELDERS is received when the auth is opened)
    • Press Enter to place authorization in “F” status

    Auth Financial screen - Action block = f, Vend Pay = 00520.00, and EFF DATE= 041217.

  4. Check EKL to verify the Auth is in “F” StatusEKL Screen - Authorization status = f

The AFS worker is responsible for the certification or denial of the NF case and authorization.

Communication with the area nurse is extremely important. If financial eligibility is delayed due to spending down of assets, transfer penalty, etc., an e-mail must be sent to the nurse and copied to the area nurse and AFS supervisor.

Once the area nurse has determined medical eligibility, the medical decision will be posted on the UCAT screen as to the NF Level of Care (LOC) eligibility. The AFS worker and his or her supervisor will be notified by an e-mail alert through ELDERS.

The Medical “D” section must be certified and in vending status prior to certifying the NF authorization.

Even when it is an open ongoing case, a new certification must be put on. The D section does not need to be closed, but a new application date and certification date is entered over the exisiting dates.

If the second months vendor payment is different than the first month, “Application Topics – Unfinished Issuance (Case)” must be used to “roll the D section up to current”

Updating Authorization from “F” Financially Eligible to “1” Certification

In IMS, type EKL <space> case number, and press enter.
Tab down to the authorization on “F” status and type aul, and press enter.Authorization update screen - action block=1, begin dt=041217, vend pay=0, eff dt=041217, vend pay=520, and eff dt=050117

Enter the following items on the aul screen in IMS

  • Tab down to the action block and enter “1” over the “F”
  • Update the Level Care only if different from IC
  • In the begin date field, enter effective date given from ELDERS or date of financial eligibility. If the dates are different, ALWAYS USE THE LATER DATE.
  • Code the VEND PAY with the first months vendor payment and EFF DATE (must match the BEGIN DT)
  • Code the VEND PAY with the second months vendor payment and EFF DATE( first day of the month following the BEGIN DT).
  • Up to four months of vendor payments may be entered on aul screen at a time.
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