The Challenge
A health plan with 10,000 MLTSS members was facing challenges with inconsistent hour allocations and
coding for ADLs and IADLs. Not only were assessors applying varying clinical judgment to time
recommendations, but the codes entered into the system often didn’t match those documented
in the assessment. This created discrepancies between assessments and service plans, leading to
misalignment between reimbursement and member acuity/care. Combined with high utilization rates, this
misalignment placed added strain on the plan’s budget and operational efficiency. The plan recognized
the need for a more reliable and supportive approach for its clinical team. They were seeking a solution
to help enhance consistency in time allocations, reduce subjectivity, and improve service planning
across assessors.
The Solution
QCSS Health implemented the Time-Tasking Validator product with this client to improve their utilization pain points. Time-Tasking Validator works in real time to guide assessors, ensuring ADL and IADL hour allocations align
with state-specific guidelines and clinical best practices. Our solution automatically flags
discrepancies between assessments and allocated hours, prompting suggestions to address before they impact
the service plan or reimbursement. Additionally, if allotted hours exceed established guardrails, a
supervisor review is triggered before approval, ensuring oversight and consistency across all assessors.
We also configured the solution to reflect the health plan’s internal policies and workflows, enabling
assessors to work efficiently while maintaining accuracy and alignment for each member.
Conclusion
QCSS Health's experience supporting MLTSS programs and our focus on assessment and service planning
workflows allowed us to deploy a solution that supports clinical decision-making without adding
friction. Our Time-Tasking Validator empowered assessors with real-time support and helped the plan
gain greater oversight, improve consistency in service planning, and ensure alignment with
reimbursement.