MCO
Notes
Notes
are a chronological record of events and activities in a claim. Accurate notes
reflect the progress of the claim and provide a quick and easily accessible
summary of claim activity. As part of the New Business Model and Claims
Staffing process, all claims management services are going to be integrated on
Customer Care Teams. These integrated services include claims specialists,
employer management, injury management support and MCOs. As part of the
integration of services process, MCOs will submit their notes to BWC.
Initially, notes were be viewable to only BWC and MCO staff . Effective Jan. 18, 2005, MCO
notes became available for viewing by authorized providers and external parties to the
claim. Both MCO and BWC notes are currently subject to public records laws.
Submitting
Notes to BWC
Effective
Oct. 18, 2004, MCO notes created from that date forward will be shared with BWC
for BWC viewing through V3 notes. MCO notes created before Oct.18, 2004 will
not be sent to BWC. MCOs must have a daily process for submitting notes. MCO
notes must be submitted within one business day of creation. In the case of
new claims, notes must be submitted within one business day of claim number
receipt. Notes submitted with a creation date more than 10 calendar days prior
to the submission date will be rejected.
MCOs
should not send notes received from previous MCOs (i.e. notes from claims
transferred through open enrollment or policy number changes). Previous MCO
notes should have already been submitted and viewable via V3 and Dolphin.
Notes
related to Fraud should not be submitted in the MCO Notes file. The MCO should
follow established processes for reporting suspected Fraud.
MCOs
will continue to enter notes according to their medical
management policies and procedures as required by URAC with four notable exceptions:
1.
If an MCO or
BWC staff name is used in the notes, it should only contain first name and last
initial.
2.
Notes should
not contain the BWC servicing provider number as BWC sometimes assigns a servicing provider number to an individual
provider based on his/her social security number with a two digit (-00) suffix.
Care should be taken in documenting phone numbers and fax numbers.
3.
Existing
notes can not be appended after they have been submitted to BWC. A new note
will need to be created because each note will have a system assigned unique
identifier when it is submitted to BWC.
4.
Cutting/copying
and pasting content from e-mails into notes is quick and convenient. However,
to ensure consistency and easy understanding for all parties reading the note,
the following guidelines must be followed:
·
Identify the
author of the e-mail - be sure to only use first name and last initial;
·
Explain why
the e-mail is pasted in notes;
·
To avoid
duplicates, make sure the content from the e-mail is new information not
already available in V-3 notes (BWC entered) or imaging.
BWC
uses titles for the V3 notes, however, MCOs are not required to do so. The
title in V3 when a note is submitted without a title will be “MCO Note Sent
Without Title.”
Quality
Assurance
Accurate
notes reflect the progress of the claim and provide the reader with a quick and
easily accessible summary of claim activity. Notes should be written in a
professional manner and contain objective statements, such as
facts and actions and observable behaviors, without bias. Notes should not
contain subjective statements, such as opinions, perceptions or
drawn conclusions. MCO notes must provide evidence that the injured worker,
provider and employer have been contacted to create a RTW plan.
During the
transition period Oct – Dec. 2004, notes were reviewed by BWC for compliance
with policy related to appropriateness and 10 day submission period. MCO notes
became viewable to external parties to the claim via Dolphin on Jan. 18, 2005.
As a
general guideline, notes should:
·
Contain only
factual information. They will not include editorials or hearsay.
·
Be written in
a logical and sequential order.
·
Be direct and
to the point. The use of jargon and abbreviations should generally be avoided.
·
Only contain
information that is relevant to the claim.
·
Contain an
explanation of any decisions made by the MCO.
·
Be entered
the same day as the action being described.
·
Cite all
contacts. BWC contacts (e.g. team nurse) should be cited by first name and last
initial (e.g. John D. for John Doe). MCOs have the option of citing their
staff names by first name and last initial. External contacts should be cited
by first and last name along with their relationship to the IW or employer
(e.g. Called IW and spoke to John Doe, the IW’s brother.)
·
Not contain
BWC servicing provider numbers. Care should be taken in documenting phone
numbers and fax numbers.
·
Not duplicate
information from a previous note submitted to BWC.
·
Contain
proper English and grammar.
·
Each note
should be informative, accurate and easy to understand.
Viewing
MCO Notes
The MCO
notes are loaded intoV3 notes in BWC received date order. During the
transition period, after the MCO notes were loaded in V3, V3 users, BWC
Internal Dolphin users, the Industrial Commission and Attorney General’s office
had access to view MCO notes. The MCO also had access to view their notes
through Dolphin. Authorized providers and external parties gained access to
view MCO notes on Jan. 18, 2005. The MCO Notes appear in V3 and Dolphin as
text only. MCO notes do not necessarily display in the same format as it
appears on the MCO system. MCO notes are accessible on EDA.
Deleting
MCO Notes
After
the MCO notes have been successfully loaded in V3, all V3 users will have
access to view the note. Upon viewing the MCO’s notes, if the Customer Care
Team Manager (CCT) determines that the note(s) may be inappropriate, the issue
will be referred to the SOM for review. If the SOM review agrees that the note
is inappropriate, the V3 Support Team Manager will be contacted to review the
note(s) and determine if the note needs deleted.
Currently,
BWC does delete selected notes from V3, however, it is not a common
occurrence. The determination of an inappropriate note is not based on
spelling or grammar errors. Rather, it is deleted because it contains
references that are unprofessional, can be construed as inflammatory or harmful
to an individual, not related objectively to the management of the claim or
reflect personal feelings regarding a contact that has been made. The V3 Support Team Manager, the MCO
Business Council Representative and MCO Business and Reporting Unit
Representative will coordinate the determination
to delete a note.
Rejected
MCO Notes
If a
note is rejected because the MCO no longer manages the claim, the MCO must
ensure that substantive information is communicated to the new MCO. If a note
is rejected because the claim has been combined, the note under the surviving
claim should be resubmitted if it contains substantive information.
Notes
submitted with a creation day more than 10 calendar days prior to the
submission date will be rejected and should be resubmitted according to the
procedures detailed in the Information Systems Documentation.