Chart Audit Prepayment Audit for Anthem Medicaid In-house audit Provider Name First Last Provider Email Client Name First Last A CASII OR LOCUS OR ESCII IS REQUIRED FOR THIS AUDIT TO PROVIDE PROOF OF MEDICAL NECESSITY. Is client 18 or older? Yes No Documentation ReviewBiopsychosocial within last 12 months Yes No Due date for next Biopsychosocial update CommentsIs Client receiving Intensive Services? Yes No Definition of Intensive Services: Intensive Services include any  psychotherapy session that extends beyond 1 hour or more than 1 session per week.  A 75 plus minute session applies.  Two or more psychotherapy sessions of any length per week apply.  Two or more psychotherapy services provided per week by different therapists also applies.  (This does not include psychiatry.) Any provider use of the add on code H0004 is considered an intensive service. And any use of Targeted Case Management Services and/or Community Support Services are considered an intensive service. Is an SED or SMI form present in the chart. Yes No, this documentation must be provided by the BHP No, client does not qualify Where is the SED/SMI located? Clients receiving intensive services must qualify for SED or SMI. Without it intensive services are not eligible for reimbursement for servicesTreatment Plan within the last 3 months? Yes No Treatment Plan with in the last 6 months? Yes No Date Treatment Plan Completed MM slash DD slash YYYY Level of Care Assessment in the last 3 months Yes No Level of Care Assessment in the last 6 months Yes No Date Level of Care Assessment Completed MM slash DD slash YYYY Level of Care Score 0-No services are medically necessary 1-Brief therapy (6 sessions or less) 2- Traditional Outpatient Therapy 1 x per week or less and up to 60 minutes per session 3- Intensive Home and Community Based Services 4 or more - group home, residential or hospitalization Is the level of care provided consistent with the level identified in the level of care assessment tool(CASII/LOCUS/ESCII? Yes No comments Which assessment tools were used to support the diagnosis and problems and show medical necessity for treatment? PHQ-9 GAD-7 AUDIT ADHD No assessment tools were found in the chart Other? Other tool Assessment tools should be documented in the biopsychosocial, the treatment plan, and on the progress note to help show measurable progress. These tools may be added to the addendum in the chart. Recommendations to improve progress note documentation Problems on the note should be copied from the latest treatment plan Measurable outcomes should be measured and updated each session Intervention should include a theory of therapy or a definition of psychotherapy Plan should include planned frequency of sessions and date for treatment plan update Response section should describe client's response to your interventions Length of note should reflect the length of the session with at least one paragraph per hour spent in the session Awesome progress note! Other Other The chart is missing the following updated enrollment forms Permission to Treat Emergency Release Form Authorization to Share Information with Primary Care Physician (PCP) Treatment Plan Signature Page Treatment Plan Level of Care Assessment (required on all clients for the purposes of the Anthem audit) Biopsychosocial Authorization to share Information with TCM Authorization to share information with Psychiatrist Credentials of rendering provider on evident on all documents? Yes No Which documents are missing the credentials? Chart is approved for claims submission Yes No, not until missing documentation is updated For what level of care is client approved? Intensive Home and Community Based Services One hour or less of psychotherapy per week but no intensive services Chart is approved for claims submission through the following date MM slash DD slash YYYY CommentsPlease note that this audit applies to all Anthem Medicaid clients billed on or before 10/14/2024. Update your chart to meet requirements and then notify Teri Lloyd when this is completed.Auditor Email Progress NoteMax. file size: 32 MB.One Note Only. do not send multiple notes or multiple dates of serviceDate of attached session note MM slash DD slash YYYY BiopsychosocialMax. file size: 32 MB.Treatment PlanMax. file size: 32 MB.Level of Care AssessmentMax. file size: 32 MB.SED/SMI formMax. file size: 32 MB.Assessment ToolMax. file size: 32 MB.Treatment Plan Signature PageMax. file size: 32 MB.OtherMax. file size: 32 MB.CommentsThis field is for validation purposes and should be left unchanged.
