DD ISP/Budget Reviews Sample Clauses

DD ISP/Budget Reviews. Initial, Annual, Initial Residential and Revision, and Professional Services: i. A case manager initiates the ISP/budget request using the MAD 046 form or DDW budget worksheet, as applicable, and supporting documentation. The MAD 046 or budget worksheet specifies the request for services and is submitted to the Contractor. ii. Other than annual reviews, the instances in which the case manager’s ISPs need to be reviewed for medical necessity are: 1) the case manager has requested residential services for the first time or after a break in residential services or 2) there is a request for professional services. Additionally, Outlier Services must be accompanied by a DDSD RO Approval Form, and a MAD 046 or budget worksheet, with Outlier Services indicated as well as staff signature. iii. The Contractor will conduct independent clinical reviews of individual service plans, associated budgets and revisions to service plans. iv. The Contractor will enter the approved services from the MAD 046 or budget worksheet into the MMIS/Omnicaid system system and assign a prior authorization number. The Contractor will document authorization, denial, pending or modification of the request on the MAD 046 form or budget worksheet, as applicable, along with the certification period. The approved services, including any changes due to reconsiderations or revisions, are then entered into the MMIS/Omnicaid system . v. The Contactor will send the MMIS/Omnicaid system-entered budgets with the prior authorization number to the case manager. vi. The Contractor will also send the initial and annual budgets to the member. Revised budgets do not need to be mailed to the members.