Applications & Tools: UpdatedHarmony Procedures – Financial Eligibility

When a worker determines that a client is not financially eligible for SPPC services, but is financially eligible for ADvantage Waiver services.

Workers should deny the SPPC auth and place the ADvantage auth into “F” status. If client is not eligible for medical unless ADvantage is approved, worker will leave the D section in app status. Harmony will take the appropriate action on both the auth and the D section. If denied medically, Harmony will deny the auth and the D section. If approved for services, Harmony will certify the auth, certify the D section for the first of the month for the F200 date entered, code F199 & 200, MA the client if not already coded, and enter the appropriate F190 if null.

Note: This is the only time Harmony will take any action on the D section other than just a change.

When a worker determines that a client is not financially eligible for ADvantage Waiver services, but is financially eligible for SPPC services:

Workers should deny the ADvantage auth and place the SPPC auth into “F” status. If not already open, certify the D section since client is eligible for medical services at this point.

What to do if the status is updated to “F” on both ADvantage and SPPC authorizations and later it is determine that the client is not eligible for either type of service?

Worker should deny both authorizations and the D section, if not vending for other medical eligibility.

NOTE: If the worker realizes that the lines were incorrectly coded in “F” status the same day that the system certifies the authorizations, a ticket to the HelpDesk is required to back off the approval and notices before they generate. If the worker does not realize the lines were coded and certified in error until the day(s) following the certification actions the worker should notify the HCMN III of the need for closure including the reason.

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