Approval and Scheduling System Features Sample Clauses
Approval and Scheduling System Features. A.5.10.1 Each transportation request processed by the CONTRACTOR shall be assigned a unique number, shall contain all pertinent information about the request, and shall be available to NEMT Call Center staff. This information shall include, but not be limited to the following:
A.5.10.1.1 Verification of member’s TennCare eligibility (e.g., member name, address, Medicaid ID number, and telephone number if available; eligibility start and end dates);
A.5.10.1.2 Determination that service is a TennCare covered service (e.g., category of service) (see Section A.4.2 of this Attachment);
A.5.10.1.3 Determination that the transportation is a covered NEMT service (see Section A.4.2 of this Attachment);
A.5.10.1.4 Determination of the appropriate mode of transportation (e.g., member’s requested mode of transportation, member’s special needs, availability and appropriateness of fixed route, the approved mode of transportation, justification for the approved mode of transportation);
A.5.10.1.5 Determination of the appropriate level of service (see Section A.4.4 of this Attachment);
A.5.10.1.6 Information regarding Standing Orders (if applicable) (see Section A.4.5 of this Attachment);
A.5.10.1.7 Information about whether the request was modified, approved or denied and how the member was notified; Amendment Number 3 (cont.)
A.5.10.1.8 Information about approved and scheduled transportation (e.g., elements required for the trip manifest; see Section A.5.5 of this Attachment);
A.5.10.1.9 Whether the request was validated;
A.5.10.1.10 Timeframes for the approval process (e.g., date and time of request, determination, scheduling, and notification of member); and
A.5.10.1.11 If applicable, reason for trip cancellation.
A.5.10.2 The CONTRACTOR’s approval and scheduling systems shall be coded such that policies and procedures are applied consistently.
A.5.10.3 Based on approval of previous NEMT services, the CONTRACTOR shall display members’ permanent and temporary special needs, appropriate mode of transportation, and any other information necessary to ensure that appropriate transportation is approved and provided. All of this information shall be easily accessible by all NEMT Call Center staff.
A.5.10.4 The CONTRACTOR’s approval and scheduling systems shall also support the following:
A.5.10.4.1 A database of NEMT providers that includes information needed to determine trip assignments such as but not limited to: types of vehicles, number of vehicles by type, lift capaci...