MEMORANDUM

DISCUSSION:

The purpose of this memorandum is to introduce the Report of MHN Quality Control Review (IM-210MHN) form. The goal of using the Report of MHN Quality Control Review is to ensure proper levels of coverage are available to the citizens of Missouri while improving the error rate.

The IM-210MHN provides a uniform method of reporting Quality Assurance / Quality Control (QA/QC) findings to offices, and provides offices the opportunity to challenge QA/QC error decisions. This form will be used by the offices and QA/QC as a tracking tool to ensure appropriate updates and actions are taken timely on error cases as well as on correct cases that have technical errors.

The IM-210MHN is divided into Sections A through C. Sections A and B (QA/QC Findings and MO HealthNet Level of Coverage) are completed by the QA/QC Unit. QA/QC will submit the Report of MHN Quality Control Review to the office for review and response.

QA/QC will distribute the IM-210MHN to the eligibility specialist (ES), eligibility specialist supervisor (ESS), and county manager, as well as the regional administrator. For all error cases, the county manager or ESS must respond to the information provided on the IM-210MHN no later than close of business on the third working day after receipt.

Section C #1 - #7, and required signatures will be completed by the local office. It will be the local office’s responsibility to establish procedures to ensure the form is completed, the case is updated and/or corrected, and the IM-210MHN is returned to the QA/QC Unit within three working days from the date received.

If the local office disagrees with an error case determination by QA/QC the office has the opportunity to challenge the QA/QC decision in Section C. If the office disagrees with the case review decision, the ESS or county manager must contact the Quality Assurance Manager immediately to discuss. If the ESS and Quality Assurance Manager cannot resolve the issue, the determination is forwarded to the QA/QC Unit Manager who will make the final decision.

NECESSARY ACTION:

• Review this memorandum with appropriate staff

ATTACHMENT:

• Report of MHN Quality Control Review (IM-210MHN) form

AC/gb