New Centralized Eligibility Process (ODH Form 1341/1341A) for Take Charge!

Learn about the new centralized eligibility process for Take Charge! training, including who is required to take it, the goals and objectives, overview, general eligibility criteria, and options for determining Take Charge! eligibility.

• Healthcare
• Training
• Eligibility process
• Take Charge!
• Oklahoma

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1. New Centralized Eligibility Process (ODH Form 1341/1341A) for Take Charge!

2. Before Proceeding with Training Have the Take Charge! Eligibility Form ODH No: 1341 and Take Charge! Eligibility Form ODH No: 1341A (Spanish) in front of you for easy reference Plan on completing the skill assessment at the end of the training Allow approximately 20 minutes for training (including completion of the skill assessment) Please do not work as a group 2

3. Who is Required to Take the New Centralized Eligibility Process Training? Patient Navigator Receptionist Administrative Assistant Medical Assistant Billing/Invoice Personnel Licensed healthcare provider (DO, MD, PA, Nurse Practitioner, RN, LPN, etc.) who provides Take Charge! services for Take Charge! eligible women All individuals who assist with Take Charge! related clients and services

4. Goal and Objectives Goal Provide an opportunity to gain knowledge and skill in completion of the Take Charge! Eligibility Form ODH No. 1341 and Take Charge! Eligibility Form ODH No. 1341A Objectives Upon completion of this self-study training participants will be able to: Describe the process of utilizing the Take Charge! Eligibility Form Correctly complete the ODH Form No. 1341 or ODH No. 1341A 4

5. Overview The new Centralized Eligibility Process for Take Charge! will: Allow multiple opportunities to establish Take Charge! eligibility Maintain requirement to follow Federal Office of Management and Budget (OMB) 5

6. Take Charge! Centralized Eligibility General Eligibility Oklahoma resident Age 21 - 65 years old (under 50 must have a tubal litigation or hysterectomy) No insurance No Medicaid/Medicare Underinsured with unmet deductible of $150 or higher Meet the income guidelines Women served in County Health Departments may qualify for dysplasia services 6

7. Take Charge! Centralized Eligibility Options Pick one of the three options to determine Take Charge! Eligibility: 1. Call Take Charge! Patient Navigator toll free at 1 - 888 - 669 - 5934 2. Mail Take Charge! Eligibility Form ODH No: 1341 or Take Charge! Eligibility Form ODH No: 1341A (Spanish version) to Take Charge! Program, 1000 NE 10th Street, Oklahoma City, OK 73117-1299, Attention: Take Charge! Eligibility Unit 3. Submit Fax ODH Form No. 1341 or ODH Form No. 1341A via fax (405-271- 6315) or upload through Take Charge! s BOX account* If you are requesting a quick turn around, it may be helpful to send an email or call Take Charge! administrative staff to advise that a fax was sent. This option should be used while the woman is in the healthcare provider s office prior to receiving Take Charge! funded breast and cervical cancer screening services *Contact Take Charge! administrative office at 405 - 271 - 3619 for assistance 7

8. Take Charge! Centralized Eligibility Notification Process Faxed eligibility requests will receive a fax response back Regardless of which option used to apply for Take Charge! services, all eligible clients will receive a Take Charge! Eligibility Packet mailed to the address provided 8

9. Take Charge! Centralized Eligibility Packet Eligible clients will receive a Take Charge! eligibility letter in their Take Charge! packet Eligibility letter expires 60 days post issuance Packet contains list of available Take Charge! facilities Approved women should receive the Take Charge! packet within 7-10 business days 9

10. Take Charge! Eligibility Established Prior to Funded Services Being Rendered Take Charge! eligibility must be determined before receiving Take Charge! funded services Take Charge! will not pay for services provided without proof of Take Charge! letter or approved Centralized Eligibility Form at time of service Eligibility must be re-established if letter has expired 10

11. Completing ODH Form No. 1341 or ODH Form No. 1341A Take Charge! Eligibility Forms are available in English and Spanish Forms can be ordered on the Take Charge! supply order list Forms can be completed online or printed Forms can be faxed or mailed The form is comprised of multiple sections: Facility information Patient information Take Charge! Administrative Office Use 11

12. New Centralized Eligibility Form (ODH Form No. 1341) 12

13. New Centralized Eligibility Form (ODH Form No. 1341A) 13

14. Facility Information Take Charge! contractor and/or County Health Department staff must complete all of the fields in the facility information section o Form will be returned if it is incomplete Information provided in the facility information section will be utilized if additional information is needed to determine eligibility 14

15. Facility Information If the client indicates they heard about Take Charge! through a postcard with an identification number, write the number on the form in the Postcard identification number section 15

16. Patient Information Section Take Charge! contractor and/or the County Health Department staff may assist the client in completing fields in this area Have client provide their legal name as listed on photo/identification cards Have client review the description of household income to facilitate accurate reporting 16

17. Patient Information Section If client has an abnormal finding, such as an abnormal Pap report, it is required to be submitted with the eligibility form 17

18. Take Charge! Administrative Office Section Take Charge! Administrative Office will review the ODH Form No. 1341 or ODH Form No. 1341A along with abnormal results Take Charge! will determined eligibility based on the information provided on the form oIt is possible that a follow-up call will be made if the information is incomplete or unclear 18

19. Take Charge! Administrative Office Section Take Charge! will determine which services the client is eligible to receive Take Charge! will indicate the date eligibility expires Take Charge! will return the form with eligibility indicated 19

20. Take Charge! Contractor Roles and Responsibilities A current Take Charge! letter or ODH Form No. 1341/ODH Form No. 1341A is required prior to providing breast/cervical cancer screening services A copy of Take Charge! letter or ODH Form No. 1341/ODH Form No. 1341A is required to be submitted with invoice as indicated in Take Charge! contract 20

21. Take Charge! Patient Navigator Role and Responsibilities Provide timely and professional customer service Determine eligibility Facilitate timely access to quality breast and cervical screening, diagnostics and initiation of treatment services 21

22. Skill Assessment Please complete the electronic skill assessment located at the Take Charge! website at Take Charge! Centralized Eligibility Training For issues with the skill assessment, contact: Take Charge! administrative staff at 405-271-3619. 22

23. Take Charge! Contact Information Take Charge! toll free number 1-888-669-5934 Center for Chronic Disease Prevention and Health Promotion 405-271-3619 Email CancerPCP@health.ok.gov (Please do not email protected health/confidential information) Fax Number 405-271-6315 Take Charge! website Take Charge! (oklahoma.gov) 23