PIQA: Process a Field Review Work Item Job Aid

The purpose of the PIQA Field Review Job Aid is to assist BCCD/PIQA staff with scheduling, conducting and processing Field Reviews.

Processing a Field Review

Once BCCD determines that a field review is needed, the PIQA supervisor creates a Field Review work item for a Field Monitor, selecting a specific review period, provider and sample size. CCMS generates a task for the monitor. The Field Monitor then searches records and generates a list of clients who were provided service during the review period. The field review is scheduled and the Site or CCR&R are then notified of the impending review. After the review is conducted, a report is prepared and sent to the PIQA supervisor and to the Site or CCR&R. Depending on the outcome of the field review, additional measures may be required.

The Work Flow Status of the Field Review work item will be constantly updated by the PIQA Supervisor and the Field Monitor depending on the steps being completed. Refer to the Field Request: Work Flow Status chart on page 12 for additional information.

Create a Field Review Work Item - Process Steps:

The following steps are completed by the PIQA Supervisor to create the Field Review Work Item.

  1. Navigate to the Work Item Search page to conduct a search and confirm the desired Work Item does not exist in CCMS.
  2. Click [Create New] at the bottom of the Work Item Search page.
  3. The Work Item Details page displays
  4. Scroll to the Work Item Details section of the page.
  5. Select Field Review from the Work Item Type drop-down list.
  6. Select the correct Source from the drop-down list.
    • Fax
    • Scan
    • Email
    • Mail
    • Phone
    • Other
    • No Contact
  7. Select the BCCD from the Assigned Org drop-down list.
  8. Select the Assigned Team and Assigned Worker from the drop-down list.
  9. Select Schedule Field Review in the Work Flow Status drop-down list.
  10. The Work Item Status will default to new when creating a new Work Item.
  11. If field review is for a CCR&R, select the correct CCR&R from the Assigned R&R drop-down list.
  12. Select the correct Fiscal Year for the field review from the drop-down list.
  13. If the field review is for a provider: Select a provider to associate with the Field Review.
    • Next to the Provider # field there is a icon. Click on the icon to access a search page to search for the correct provider to associate to the Work Item.
  14. Scroll to the Review Period section of the page.
  15. Record a begin and end date for the Field Review in the From and To fields, in the following format: MM/DD/YYYY.
  16. Type the Sample Size for the Field Review in the Sample Size field. This is the number of cases to be reviewed for the field review.
  17. Type information regarding the appeal in the Description field. This field has a 500 character limit.
  18. Click [Save].
    • Clicking [Save] triggers the following task "Schedule Field Review" to the monitor in the Assigned Worker field.

Process a Field Review Work Item - Process Steps:

The following steps are completed by the PIQA Monitor.

  1. Receive the Schedule Field Review task, and click on the task hyperlink to view the Work Item Details page to review the Field Review information. You are now in the context of the Field Review Work Item.
    • If the Field Monitor fails to schedule the required Field Review within the days documented on the Manage Alerts page, CCMS will send a reminder.
  2. Navigate to the Select Cases page on the Work Item tab to view the list of cases to review for the Field Review.
  3. CCMS automatically generates the case sample size based on the Sample Size, Fiscal Year, and Review Period fields on the Work Item Details page. All CCMS cases that were eligible during the review period of the specified Fiscal Year are eligible to be in the sample size. CCMS randomly selects the number of cases requested in the sample size to assign to the Field Review.
  4. On the Select Cases tab, the cases selected by CCMS to be reviewed display. You can use the fields in the Case Search section of the page to search the sample size. Export the selected cases into an Excel document by clicking [Export to Excel].
  5. Cases assigned to the field review display in a new Excel document in the below format:
    PROVIDER NAME:
    PIQA PROVIDER:
    CLIENT'S NAME 
    CASE ID or CLIENT SS#
    LAST NAME, FIRST NAME 
  6. Copy and paste information into a blank Field Review Worksheet.
  7. Navigate to the Generate Documents page.
  8. Select Confirmation Letter from the drop-down list and then click [Add].
  9. Complete the fields in the Confirmation Letter and click [Submit].
  10. CCMS will generate a confirmation letter with details about the upcoming field review. Send this letter (via mail/email/fax) to the Site or CCR&R.
  11. Navigate Work Item Details page to update the Work Flow Status to Draft Field Review Report.
  12. Click [Save].
  13. Clicking [Save] triggers the following task "Draft Field Review Report" to the monitor in the Assigned Worker field.
  14. Conduct the Field Review.
  15. Complete the draft Field Review Report and add the form to CCMS using scan, fax, email, or the Upload Documents page.
    • CCMS will only accept documents in the following formats: PDF, JPG and TIFF.
  16. Navigate to the Work Item Details page, and change the Work Flow Status field to Approve Field Review.
  17. Click [Save].
  18. Clicking [Save] triggers the following task "Approve Field Review" to the PIQA Supervisor.
    • If the PIQA Supervisor does not approve the Field Review Report within the days documented on the Manage Alerts page, CCMS will send a reminder.

The following steps are completed by the PIQA Supervisor:

  1. Receive the Approve Field Review task.
  2. Review the Field Review Report.
  3. If the draft field Report requires revision, navigate to the Work Item Details page, and select Revise Field Review Report in the Work Flow Status field.
  4. Click [Save].
  5. Clicking [Save] triggers the following task "Revise Field Review Report" to the PIQA Monitor.
  6. PIQA Monitor: update the report and proceed with step 32. Repeat this process until the PIQA Supervisor deems the draft Field Review Report is ready to be sent to the CCR&R/Site or provider.
  7. When the PIQA Supervisor deems the draft Field Review Report is ready to be sent to the CCR&R/Site or provider, complete the following steps:
    • If the Field Review is for a CCR&R/Site with access to CCMS, proceed to step 41.
    • If the Field Review is for a CCR&R/Site without access to CCMS, proceed to step X.

Field Review for CCR&R/Sites/Providers with access to CCMS

The PIQA Supervisor completes the below steps:

  1. When the Draft Field Review Report is ready to be shared with CCR&R/Site/Provider, convert the Field Review Report into PDF and navigate to the Upload Documents page.
  2. Upload the document to CCMS and associate the document to the corresponding Work Item number.
  3. Navigate to the Generate Documents page and select Outcome Letter from the Document Type drop-down list.
  4. Select the "Enclosed is a draft copy of the monitoring report…." checkbox in the letter.
  5. Click [Add].
  6. Navigate to the Work Item Details page, and change the Work Flow Status field to Reply to Field Review Report.
  7. Select the correct agency from the Assigned Org drop-down list.
  8. Click [Save].
  9. Clicking [Save] triggers the following task "Reply to Field Review Report" to the correct Field Review team according to the CCR&R/Site's routing rules.
  10. The draft field review report is now available to CCMS users for viewing.

The CCR&R/Site/Provider completes the below steps

  1. Receive the Reply to Field Review Report task.
  2. Navigate to the Document Search page to conduct a document search to view the Draft Field Report and Outcome Letter.
  3. Review the Draft Field Report and Outcome Letter.
  4. Navigate to the Work Item Notes page.
  5. Create a Work Item Note with feedback. Indicate if you agree with the Draft Field Review Report or if changes are requested.
  6. Navigate to the Work Item Details page, and change the Work Flow Status field to Prepare Final Field Review Report.
  7. Select BCCD from the Assigned Org drop-down list.
  8. Click [Save].
    • Clicking [Save] triggers the following task "Prepare Final Report" to the BCCD Field Review team according to BCCD's routing rules.

The BCCD PIQA Team completes the below steps:

Important Note! If the corresponding CR&R/Site does not respond to the Field Review Report and update the Work Flow Status field within a specified timeframe on the Manage Alerts page, CCMS sends a reminder to the Field Monitor to generate a second Outcome Letter. The Field Monitor should generate a new Outcome Letter with the following checkbox selected in the letter:

  • A response, due by: MM/DD/YYYY was not provided. We wish to inform you that if a response is not received by: MM/DD/YYYY, the monitor(s) will be compelled to prepare their report without your response. The review findings will reflect that the requested response was not made available due to failure on the part of the provider to fully cooperate with the review and that further steps by the Department be initiated.

If a second letter is not generated, the PIQA Supervisor has the option of updating the Work Flow Status to Issue Non-Compliance Letter. This generates an "Issue Non Compliance Letter" task to the Field Monitor to follow up with the unresponsive Provider.

The following steps are completed by the PIQA Monitor:

  1. When the final Field Review Report is updated with the provider's comments (if needed) and is ready to be issued the Field Monitor adds the form to CCMS using scan, fax, email, or the Upload Documents page.
  2. Navigate to the Work Item Details page, and change the Work Flow Status field to Issue Final Report.
  3. Click [Save].
    • Clicking [Save] triggers the following task "Issue Final Report" to the PIQA Supervisor.

The following steps are completed by the PIQA Supervisor:

  1. When the Draft Field Review Report is ready to be shared with CCR&R/Site/Provider, convert the Field Review Report into PDF and navigate to the Upload Documents page.
  2. Upload the document to CCMS and associate the document to the corresponding Work Item number.
  3. Navigate to the Generate Documents page and select Outcome Letter from the Document Type drop-down list.
  4. Click [Add].
  5. Generate a new Outcome Letter with the one of the following checkboxes selected in the letter, depending on the need:
    • Based upon your response to the findings of the draft report, this review has been finalized. Attached is a copy of the final report for your records.
    • Since we did not receive a response from you despite two notices, we have no choice but to finalize the report without your response. The review findings reflect that the requested response was not made available due to failure on the part of the provider to fully cooperate with the review and that further steps by the Department be initiated
  6. Navigate to the Work Item Details page, and change the Work Item Status field to Complete to close the Work Item.
  7. Click [Save].

Field Review for Providers without access to CCMS

The following steps are completed by the PIQA Supervisor:

  1. When the Draft Field Review Report is ready to be shared with Provider, navigate to the Generate Documents page and select Outcome Letter from the Document Type drop-down list.
  2. Click [Add].
  3. Select the "Enclosed is a draft copy of the monitoring report…." checkbox in the letter.
  4. Click [Submit].
  5. Print the Outcome Letter and send the letter and draft field review report to the Provider.
    • Important Note! If the provider does not respond to the Field Review Report within the specified timeframe on the Manage Alerts page, CCMS sends a reminder to the Field Monitor to generate a second Outcome Letter. The Field Monitor should generate a new Outcome Letter with the following checkbox selected in the letter:
      • A response, due by: MM/DD/YYYY was not provided. We wish to inform you that if a response is not received by: MM/DD/YYYY, the monitor(s) will be compelled to prepare their report without your response. The review findings will reflect that the requested response was not made available due to failure on the part of the provider to fully cooperate with the review and that further steps by the Department be initiated.
    • If a second letter is not generated, the PIQA Supervisor has the option of updating the Work Flow Status to Issue Non-Compliance Letter. This generates an "Issue Non Compliance Letter" task to the Field Monitor to follow up with the unresponsive Provider.
  6. When the provider responds to the Outcome Letter, add the form and any supporting documentation to CCMS using scan, fax, email, or the Upload Documents page.
  7. Navigate to the Work Item Details page, and change the Work Flow Status field to Prepare Final Field Review Report.
  8. Select the Field Monitor from the Assigned Worker drop-down list.
  9. Click [Save].
    • Clicking [Save] triggers the following task "Prepare Final Report" to the PIQA Monitor.

The following steps are completed by the PIQA Monitor:

  1. Receive the "Prepare Final Report" task.
  2. When the final Field Review Report is updated with the provider's comments (if needed) and is ready to be issued, add the updated Field Review Report to CCMS using scan, fax, email, or the Upload Documents page.
  3. Navigate to the Work Item Details page, and change the Work Flow Status field to Issue Final Report.
  4. Click [Save].

Clicking [Save] triggers the following task "Issue Final Report" to the PIQA Supervisor.

The following steps are completed by the PIQA Supervisor:

  1. Receive the Issue Final Report task.
  2. Navigate to the Generate Documents page and select Outcome Letter from the Document Type drop-down list.
  3. Click [Add].
  4. Generate a new Outcome Letter with the one of the following checkboxes selected in the letter, depending on the need:
    • Based upon your response to the findings of the draft report, this review has been finalized. Attached is a copy of the final report for your records.
    • Since we did not receive a response from you despite two notices, we have no choice but to finalize the report without your response. The review findings reflect that the requested response was not made available due to failure on the part of the provider to fully cooperate with the review and that further steps by the Department be initiated
  5. Navigate to the Work Item Details page, and change the Work Item Status field to Complete to close the Work Item.
  6. Click [Save].

Field Reviews resulting in Potential Overpayments:

This process is used if the PIQA Supervisor identifies a potential overpayment during the field review.

The following steps are completed by the PIQA Supervisor:

  1. Navigate to the Work Item Details page, and change the Work Flow Status field to Generate Overpayment Referral
  2. Updated the Assigned Worker field to the PIQA Monitor.
  3. Click [Save].
    • Clicking [Save] triggers the following task "Generate Overpayment Referral" to the PIQA Monitor.

The following steps are completed by the PIQA Monitor:

  1. Receive the Generate Overpayment Referral task.
  2. Create a new Overpayment Work Item and assign to the BCCD Customer Service team.
    • Refer to the Overpayment Job Aid for information on how to create an Overpayment Work Item.
  3. Navigate to the Work Item Details page for the Field Review Work Item, and change the Work Flow Status field to Overpayment Referral Created.
  4. Click [Save].
    • Clicking [Save] triggers the following task "Overpayment Referral Created" to the PIQA Monitor.

The following steps are completed by the PIQA Supervisor:

  1. Navigate to the Work Item Details page for the Field Review Work Item, and change the Work Item Status field to Complete to close the Work Item.
  2. Click [Save].

Field Review: Work Flow Status Key

The agency in the Assigned Org field is the organization that owns the Work Item and receives the task. CCMS will send the task to the correct team according to that agency's routing rules.

Work Flow Status When do I select? Related Task
Schedule Field Review The PIQA supervisor assigns a Field Review to the PIQA Monitor. Schedule Field Review
Draft Field Review Report After the field monitor schedules the Field Review and sends a confirmation letter to the Site or CCR&R. Complete Draft Field Review Report
Approve Field Review After the field monitor conducts the Field Review and submits a draft copy of the report to the PIQA supervisor. Approve Field Review
Revise Field Review Report When the PIQA supervisor requests the field monitor to do a revision of the draft or final Field Review Report.
*This status can be used at any time through the process.		 Revise Field Review Report
Reply to Field Review Report When the PIQA supervisor determines the Field Review Report is ready to be sent to the corresponding Site or CCR&R. Reply to Field Review Report
Prepare Final Report After the Site or CCR&R has reviewed the Field Review Report and indicated they agree or are requesting changes. Prepare Final Report
Issue Non Compliance Letter When the PIQA supervisor requires the field monitor to follow up on a lack of response from the Site or CCR&R after receiving the Field Review Report. Issue Non Compliance Letter
Issue Final Report To assign to the PIQA supervisor when the Field Review Report is complete. Issue Final Report
Generate Overpayment Referral When the PIQA supervisor identifies a potential overpayment. Generate Overpayment Referral
Overpayment referral created When the PIQA monitor creates the Overpayment Work Item. Overpayment referral created
PIQA requests additional information from CCR When PIQA needs additional information from CCR&R.
*This status can be used at any time through the process.		 PIQA requests additional information from CCR&R
Additional Information Received When PIQA receives additional information from CCR&R.
*This status can be used at any time through the process.		 Additional information received
Case File Updated When the CCR&R/Site updates the case file and wishes to notify the BCCD PIQA team.
*This status can be used at any time through the process.
 Case file update