Applications & Tools: Harmony Procedures – Annual Reviews

When ABD/QMBP/SLMB cases with LTC services are closed due to the client not completing their annual financial review:

    1. Worker should make every attempt to contact (i.e. ADM-92, phone call, home visit – contacting Case Manager (CM) listed in Harmony [Refer to article Locating ADvantage CM Assignments”], the client prior to closing the case. If closure is unavoidable for ADvantage and SPPC Members, notify the HCMN III of need for closure and include reason for closure and effective date. Worker must wait for the HCMN III to close the program in Harmony which will automatically close the authorization in IMS. An auto generated notice will be sent to the SSS/SSS Supervisor assigned to the case. Once the notice is received and authorization line is closed the worker may take closure action on the D section, if required.Note: NF cases do not require HCMN III closure action, and the worker will close the authorization line as appropriate. There may be a 30 minute to 1 hour delay from the time that the notice is received to the time that the authorization lines are updated in IMS.

When annual review is completed following closure less than 90 days and case needs to be reopened:

    1. Worker will reopen the B/D sections.Note: If client was only eligible for a medical benefit due to ADvantage approval, worker will need to M/O client rather than M/A at the time of reopen. When the new ADvantage authorization is approved through Harmony, the system will appropriately M/A the client.Worker will navigate to the Harmony Referral Form located on the InfoNet and complete the application for a re-open, which will auto generate an auth line in “A” status to the case in IMS.
    2. There may be a delay of a few hours from the time the application for reopen is submitted until the auth line appears in IMS.
      If the case was closed over 90 days the Online Assessment should be completed to generate a new application for the client.
    3. Once the auth line is available; the worker will code the auth line in “F”status as appropriate.

When an annual financial review is completed without involving a closure/reopen action:

    1. Worker will complete review per normal procedures for reviewing the medical or ABD benefit.
    2. No new application will need to be submitted as LTC services are ongoing and client does not need referral for new services.
    3. No change will made to authorizations as they are open and ongoing as well.
    4. When the medical review is due no action is required from the worker. The HCMN’s have a process they will follow in Harmony.
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