General Eligibility Questions
Please take a moment to answer the following questions.
1.Are you a resident of Washington or Sullivan County Tennessee? [Or are you a resident of Carter, Greene, Hancock, Hawkins, Johnson, or Unicoi Counties, have been established with a Provider in Washington or Sullivan County for at least one year, and have been seen within the last 6 months?]
2.Are you uninsured? Have you been denied health insurance coverage?
3.Do you have a current medical condition which requires the expertise of a Specialty Care Physician? [Cardiology, Dermatology, Gastroenterology, Gynecology, Neurology, Oncology, Pulmonology, Surgery, etc.]
4.Does your household earn 150% or below of the Federal Poverty Level? [Household of 1: $16,335 per year; 2: $22, 065; 3: $27, 795; 4: $33, 525; 5: $39,255]
If you answered "yes" to all of these questions, please speak with your Physician/Provider about referring you to Project Access.
Application/Enrollment Process
First, your Physician or Provider will need to send us a Referral Form. This Referral Form gives us your basic contact information, as well as the reason your Physician believes you could benefit from our services. Possible reasons could include diagnostic testing, consultation by a Specialist, or a needed surgery.
Second, you will be sent a Introductory Letter from the Project Access office. This letter lets you know that we have received a Referral from your Physician. This letter also requests that you telephone our office to set-up an Enrollment Appointment.
Third, you should anticipate being asked the Pre-Screening Questions listed above.
Assuming you qualify at this point, our staff person will then go through a List of Required Documents.docx which you need to begin gathering. You will then be asked to schedule an Enrollment Appointment at our Main Office or one of our Satellite Sites. Appointments are Monday - Thursday at our Main Office OR on Thursdays in Blountville.
Fourth, at your Enrollment Appointment, you will meet with a Care Manager. The Care Manager will copy and review the documents you bring. It is important that you bring as many of the documents as possible because your Care Manager will just have to request any missing documents from you, which will delay the enrollment decision. During this appointment, your Care Manager will ask you to confirm your contact information, specify an emergency contact person, and describe your education, employment history, and current household composition. Your Care Manager will also take you through two assessments, the Enrollment Assessment and Health Profile. There are also some important forms and documents you will be asked to complete and sign. These include a Client Needs Assessment, a Medication Log, the SF-12 Health Survey, the Patient Responsibility Agreement(PRA) , Acknowledgement/Waiver Form, Appeal Procedure, and HIPPA Form.
A copy of the PRA, HIPPA, Acknowledgement/Waiver, Appeal Procedure, and Notice of Privacy Practices will be provided to you. Please be sure to communicate any needs you may have, including any difficulty in obtaining your prescriptions, to your Care Manager.
Next, after your Enrollment Appointment, your file will be considered Processing or Under Review. This means your Care Manager is reviewing your file in accordance with Project Access's eligibility criteria (Residency, Income, Medical Need, Uninsured). This process can take anywhere from a few days up to several weeks. Care Managers process files in the order in which they meet with their clients, barring emergencies. Please be sure to provide any documents which your Care Manager may request within the time frame requested.
Last, your Care Manager will contact you upon reaching an Enrollment Decision. If you are Denied, you will be sent a Denial Letter explaining how this decision was made. If you are Approved, you will be sent an Enrollment Letter as well as an AMPA ID Card. Your Care Manager will then work with your Referring Provider to facilitate any needed testing/diagnostics and/or schedule any necessary appointments.
BROCHURE
The Enrollment Process.pdf