ASAP Resources

Tufts Health Plan Senior Care Options

GSSC Care Manager Manual

Benefits

• Evidence of Coverage
• Prescription Claim Form
• Member Reimbursement Form
• Out of Network Vision Services Claim Form
• Wellness Allowance Reimbursement Form
• Weight Management Program Reimbursement Form
• OTC Savings Guide
• SCO Find a Doctor – Includes PCPs, Specialists, Dentists (through DentaQuest), Vision Care (through EyeMed), and CVS/Caremark Pharmacies
• SCO Plan Guide Overview

Case Trakker V.6

• Icons and Menus Quick Reference
• Printing from Case Trakker
• Searching Date/Times
• Assessment Summary - CTD 6 - April 11 2022
• Authorization Summary Screen - CTD 6 - April 13 2022
• Care Team Screen - CTD 6 - April 12 2022
• Course Handout - Creating Items and Using Standard Text - June 2022
• GSSC Clinical Note Requirements - CTD 6 - April 11 2022
• Letters & Attachments - CTD 6 - June 6 2022
• Medications & Medical History - CTD 6 - June 6 2022
• New Item Menu Options - CTD 6 - April 6 2022

HCBS Outpatient Events and Notifications

• Guidelines for GSSC Requesting HCBS for Level 2 Members
• Home and Community-Based Services (HCBS) Guidelines and Resources for Massachusetts
• Home Care Cheat Sheet
• Outpatient Event (OPE) for New Effectives
• Outpatient Event (OPE) Process Overview

Plan of Care

• The Plan of Care Screen V6
• Most Prescribed Medications Job Aid
• Care Management File and Plan of Care Maintenance Reminders/Checklist

Organization Determinations

• Inquiries, Treatment Decisions and Organization Determinations

Appeals and Grievances

• The Who, What, Where and When of Appeals and Grievances
• SCO Care Manager Grievance Process Job Aid

Advance Directives

• Identifying a Health Care Agent

Documentation Templates

• GSSC Clinical Note Guidelines
• Grievance Note Guidelines

Acronyms

• Member Document Naming Conventions
• Acronyms

Transportation

• TripCare Job Aid
• ModivCare Job Aid
• ModivCare Single Trip Request
• ModivCare Standing Order Form
• ModivCare Overview
• ModivCare Transportation Issue Resolution
• ModivCare SCO Transportation Flyer

Durable Medical Equipment - Byram

• Email Template
• Order Guide

Quick Reference

• GSSC Documentation Checklist
• ICD-10 Coding Help Sheet
• Tufts Health Plan Senior Care Options Contact Information
• Mini Cog Help Sheet
• Vaccination and Screening Schedule Job Aid

SCO Overview

• Tufts Health Plan Senior Care Options Overview

Member Assessments

• Member Assessments - September 2022
• Comprehensive 3.0
• Functional Assessment
• CA Highlights for GSSCs Job Aids

MassHealth Redetermination

• MassHealth Eligibility Review
• MassHealth Redeterminations Workflow
• MassHealth Redetermination – Eligibility Review Form Guide
• Authorized Representative Designation Form
• Permission to Share Information (PSI) Form
• Screening Questionnaire
• MassHealth Cheat Sheet
• MassHealth PCA Supplement

Forms

• Alzheimer's Association Referral Form
• Incident Report Form
• Mom's Meals Referral Form
• Mom's Meals Referral Process
• Safe Disposal of Medication Form
• OTC Reimbursement Form

Workflows

• Closing a Member Record
• Communication of Demographic Changes
• MassHealth Redetermination
• Quality Improvement Occurrence
• Elder Abuse and Protective Services
• Senior Products Specialist Guide
• SCO Touchpoint Frequency

Job Aids

• Invoice Submission Portal User Guide
• SCO Care Managers Job Aid Requests to the Enrollment Dept.
• Commonly Prescribed Medications Listed by Use
• Commonly Prescribed Medications Listed by Generic Name
• Commonly Prescribed Medications Listed by Brand Name
• Member File Screen Job Aid
• Masshealth OTC Drug List

Sales and Enrollment

• Sales and Enrollment Process
• Voluntary Disenrollment Process
• Dual Disenrollment Form
• Requests to Enrollment Job Aid
• Welcome to SCO
• My Ombudsman Program
• Sales and Enrollment Presentation Handout
• Connecting Seniors to Coverage: Referral Workflow
• SCO Welcome Guide