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The purpose of this memo is to notify providers that Chapter 6 of the developmental disability waiver manual has been updated. The changes include incorporating boilerplate text related to Utilization Review, Compliance Reviews, Medical Records, Fraudulent Claims and updating the text specific to DD Waiver services with the following changes:

• Updates and clarifications to QMR and compliance review processes.     

• Added statements regarding providers rendering services under the appropriate license for the service.

• Added clarifications regarding the use of electronic signatures date stamp. 

• Added information on Mandatory Provider Remediation process. 

• Updated information on individual support plan (ISP) format and assessments and forms completed by support coordination.

• Added information on EVV requirement for applicable Consumer and Agency Directed services. 

• Added information on payment suspension for providers with provisional license. 

• Minor updates to notification of appeal rights.  

• Added minor clarifying language to several sections, grammar and format updates and removed outdated or duplicated language.

To avoid disruption to claims payment through FFS and the MCOs providers must periodically check the DMAS provider portal, also known as the Provider Services Solution (PRSS), to ensure that the provider's enrollment, contact information, and license information is up to date, for all of the provider's respective service locations. Under federal rules, MCOs and DMAS are prohibited from paying claims to network providers who are not enrolled in PRSS. Additional information is provided on the MCO Provider Network Resources webpage and includes links to resources, tutorials and contact information to reach Gainwell with any provider enrollment or revalidation related questions.  Dental providers should continue to enroll directly through the DMAS Dental Benefits Administrator, DentaQuest.