When taking an action on an Institutional Care program, it is necessary to inform both the consumer and the Institutional Care provider of eligibility and patient liability amounts. In these instances, the NOA is generated for the consumer and a form must be sent to the Institutional Care provider.
Select Document Control from Global Navigation. Select Templates from Local Navigation.
On the Template Repository Search page, enter available search criteria. If unsure of specific search criteria, proceed to STEP 3. The Document Parameters page displays.
NOTE: Keywords can be used as search criteria.
Click the Select button found under the Resource/Provider field. The Select Resource page displays.
Enter search criteria to locate the appropriate Resource/Provider.
Click the Search button. The Search Results Summary displays.
Click the radio button for the correct resource.
Click the Select button. The Document Parameters page displays with the Resource/Provider number.
Enter the Case Number and click the Go button.
Select the appropriate Consumer Name and Program and additional drop-down fields.
NOTE: Depending on the Facility Notice selected there may be other required dynamic fields to complete.
Month 1 = Month change takes place
Month 2 = Month of the next change
Month 3 = Third month of change
Click the Generate Form button.
Review the form for accuracy. Modify or add information in the enterable shaded areas.
Click the Save and Print Locally, or Save and Print Centrally button.