MMAC Participant Lock-In Unit Report
Cost Avoidance: $519,152.46
|Biennial cases reviewed:||64|
|Six-month case follow-up reviews:||37|
|New Lock-In cases opened:||20|
|Watch cases opened:||3|
|No Abuse cases:||8|
|PENDS cases open:||275|
Approximate number of active cases: 1651
Definitions/Descriptions of Lock-In Terms:
Biennial Reviews –Participants are locked in for two years of eligibility. Each month, reviews are conducted for those reaching their two-year mark (two years from the initial lock-in date to a provider).
Six Month Case Follow-up Reviews – Monitors participant progress with regard to compliance.
New Lock-In Cases – An initial review of 12 months of data indicates a pattern consistent with abuse of services or drugs. As a result, the participant is locked into a physician, pharmacy or both.
Watch cases –An initial review of 12 months of data indicates a potential for abuse of services or drugs. An education letter is sent. A six month follow-up review may be done.
No Abuse –An initial review of 12 months of data has determined there was no abuse. No further action is taken.
PENDS – Participant cases are tracked to ensure lock-in occurs when and if necessary. “PENDS” are cases which are reviewed daily for activity.
Cost Avoidance – Dollar amounts denied due to participants being locked in to providers.