# Presentation: 095270

## CHEF Case Monitoring

- CHEF case reporting system
- Tracks client with medical expenses obligated at $25,000 threshold.
- -Priority I.  Monitor closely.  It is very easy for a priority II case to change to priority I.
- -CHS Eligibility/Proof of Indian descent.
- -Alternate Resource Determination.

## Area CHEF Checklist

- Utilized for every CHEF case.  Documentation submitted in checklist order format.
- CHEF Request form w/original signatures
- Proof of CHS Eligibility/Indian descent
- CHS referrals or CHS Emergency call-in documentation.
- Case Summary (vendor contracts) Non-contracted (ask for discounts).  Tribal Acquisitions Manager.
- Medical discharge summary.
- Alternate resources determination denial.  (Medical Benefits Coordinators).
- EOBR or Tribal payment documentation. (CHEF Case report provides data for Accounts Payable to provide payment documentation)
- Copies of documentation (collate by Purchase Order number)
- HCFAs/UBs related to case.

## Fiscal Year (FY) 2007 CHEF Presentation

- Vendor Negotiations are negotiated with surrounding vendors.
- Prevea Physicians
- St. Mary’s Hospital
- St. Vincent Hospital
- 25% Disc – non-insured clients
- 30% Disc – OB non-insured clients

## Other Vendor Discounts

- BayCare physicians
- 10% non-insured clients
- Green Bay Radiology
- RBRBS discounts (Medicare rates)

## Non-negotiated vendors

- * Non-contracted vendors are contacted and discounts are requested.

## Automatic entries

- Encore Software System/Infinium
- 	* Area (1)
- 	* Ordering Facility (2)
- 	* Tribe (7)

## Manual Entries

- CHEF Case Assignment (this can be located on page 1 #3) Area, Fiscal year, number. (ie:BE070001) (box 3)
- Catastrophic Code assignment (this can be located on attachment #2) 2007 Catastrophic Health Emergency Fund Instructions. (box 9)
- Trauma (this can be located on page 2, #10) (box 10) (will include injury date, responsible party information)
- _*Located on CHEF Request form_
- 	* Patient Name (box 4)
- 	* DOB (box 5)
- 	* Sex (box 6)
- 	* DX, ICD-9 CM, OR, DRG # (box 8)
- 	* Priority (box 11)
- 	* Episode of Care (box 14)
- 	* Type of Coverage
- 	* Provider and all related referral information. (boxes 15 – 20)

## Helpful Hints

- Time Management.  Process all CHEF cases in an urgent manner.  First come first serve basis.
- Pay all claims quickly.  Complete 100% incomplete 50%.  Should be a 45 day reporting time notification for requested advances.
- Don’t wait until your case is complete to request CHEF reimbursement.  Make sure you are focusing on case management.  (contracts discount negotiations.
- IP related charges can be used from Sept to meet threshold of $25,000(prior fy year). If inpatient admission begins in September and continues into Oct, request vendor to close Sept 30 begin new bill Oct 1.
- CHEF IP cases can only run for 90 days after discharge.
- Mail CHEF request overnight mail.
- Fax additional information not provided ie: copies of checks.
- CHEF fund completion.  Determination as to closing case early.  (50% vs 100%)  Is it feasible?  If you have an $80,000 chef case and you are still pending $3000 at towards the end of chef funds, you may want to consider writing off the $3000.00 and closing the closing the case early to obtain 100% of $80,000.
- If CHEF funds are still remaining and you pay additional claims you can request an amendment.
- Communicate with Area Office regularly.

## Good Luck with your CHEF Case Requests

- 2003 $54,484 for 3 cases.  50% completion.  All 50% completion.
- 2004 $336,338.00 for 3 cases.  100% completion.  1 was 50% completion.
- 2005 Oneida received $87,000 for 3 cases. All 100% completion.
- 2006 Oneida received $515,000 for 20 cases.   All 100% completion.