§3 ch5: Working with Contracted Treatment Providers
Attachment F: Individual Duties Related to the SEAS System
Procedures for the SEAS system require the identification of three individuals who have different and specific roles within the operation of the system. They are the authorizing designee, the payment designee, and the authorizing worker.
Within each office it will be necessary to assign the roles of authorizing designee, and payment designee. These roles should be performed by separate individuals, whenever possible, to assure the separation of the duties involved.
The authorizing designee is the individual(s) who has the responsibility of maintaining local control over the number of services authorized. This will ensure that the spending by a county does not exceed the funding allocated within a particular program area.
The authorizing designee’s approval and signature is mandatory and shall appear on all CS-67A’s prior to data entry.
The duties of the authorizing designee will include:
- Assuring that the services authorized appropriately meet the needs of the client, in a fair and equitable manner;
- Coordination with the payment designee to ensure that allocated funds are neither being overspent nor under-utilized;
- Checking that funds for the program area being authorized are available;
- Checking the correctness of the form submitted for data entry;
- Communicating with a provider if problem exists with a specific authorization that cannot be resolved by the worker involved; and
- Reviewing copies of notices to providers, appropriate inquiry screens, system reports, and taking any action necessary to ensure that the services and funds available are being utilized appropriately.
The payment designee is the individual(s) responsible for assuring that correct payment is made for all services authorized and delivered. The payment designee will review each invoice, CS-65A, submitted for payment each month for completeness, reasonableness of service delivery, and accuracy.
The signature of the payment designee is mandatory and will be required prior to data entry of any CS-65A.
Duties of the payment designee include:
- Checking the payment requested on the CS-65A to ensure accuracy and completeness;
- Processing all invoices submitted for payment in an expedient manner to ensure prompt payment, avoiding any unnecessary delays. If providers do not receive their payment within 45 days from the date of receipt of a complete and accurate invoice, they may claim interest at the rate of 12% for any unpaid balance;
- Contacting the provider immediately to resolve any incompleteness or inaccuracies identified on submitted invoices. A decision must be made regarding the following items:
- Can a specific invoice be corrected at the office level after receiving clarification from the provider, entered for payment, and the "correction copy" returned to the provider for their record;
- Must the entire invoice be returned to the provider for correction and resubmission for payment; and
- Can payment be processed for correct line items, with return of the partially paid invoice to the provider for correction and resubmission for payment of the remainder of these items.
- Reviewing system generated reports to ensure that payments have been made correctly.
Children’s Service Worker Roles
SEAS allows three different workers to be identified when necessary. The first, the authorizing worker, is the worker who must complete and update all forms and information for SEAS through the use of the CS-67 and CS-67A. The system requires that the worker I.D. number always be entered for the authorizing worker. Additionally, the system can identify a case manager and direct service worker. The case manager and direct service worker I.D. numbers are to be entered only when required, as explained below.
In the majority of cases the authorizing worker will be the case manager. The authorizing worker will receive copies of all letters sent by the system to clients.
- For Family Support Division (FSD) and IE child care, the authorizing worker will be responsible for taking applications, determining client eligibility for services, authorizing clients for services and maintaining and updating case records.
- For all children’s treatment services and protective services child care, the authorizing worker will maintain case records that will indicate the need for these services as part of the case plan. This worker will be responsible for completing and updating all eligibility and authorization information.
RCST becomes the "authorization worker" for a child placed in residential treatment (excluding emergency residential treatment), and handles all invoices resulting from this placement. RCST will also be the "authorization worker" for all other contracted services while the child is in the residential facility.
NOTE: A household that has both a protective service case and an FSD or IE child care case, may have two authorizing workers. This will occur only when the family is receiving IM or IE child care, and also receives children’s treatment service through the protective service case.
In some cases it will be necessary to identify, and enter into the system, a different worker I.D. number for the case manager. This will occur, for example, when a family, receiving protective services, requests and/or also receives IM or IE child care. Identification of a separate case manager will also occur in alternative care cases where a child is not residing in the county of court jurisdiction, and is receiving a purchased service, such as PS child care. The case manager will receive reports regarding eligibility and authorization information on their cases. In cases where a family is receiving both protective services and IM or IE child care, the case manager has the responsibility of immediately informing the authorizing worker of any changes within the household which may affect a family’s eligibility. This is necessary since the authorizing worker, as identified in the system, is the only worker able to update information in the system.
Direct Service Worker
In a limited number of cases it will also be necessary to identify a direct service worker. This would occur when a family with court involvement moves from the county of court jurisdiction, and continues to receive protective services and IM or IE child care in the county of residence. In these cases, the authorizing worker for the FSD or IE child care, when different, will identify both the case manager, and the direct service worker, so both will receive reports concerning activities related to this household’s authorizations for services.