North Carolina Medicaid and Health Choice

Transcription

North Carolina Medicaid and
Health Choice ProviderConnect
User Guide
ProviderConnect User’s Guide
About This Guide
This ProviderConnect User Guide is specific to North Carolina Medicaid (NC Medicaid)
and North Carolina Health Choice (NC Health Choice). There are several links and
functions contained on the ProviderConnect homepage and throughout the software that
are not relevant to NC Medicaid and NC Health Choice. This User Guide addresses
only the links and functions relevant or applicable to NC Medicaid and NC Health
Choice.
Last Reviewed: 1/2016
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North Carolina Engagement Center
Table of Contents
1
INTRODUCTION ................................................................................................................................. 4
PROVIDERCONNECT OVERVIEW ................................................................................................................. 4
CONTACT INFORMATION ............................................................................................................................. 4
2
PROVIDERCONNECT LOG ON ...................................................................................................... 5
ACCESS PROVIDERCONNECT ...................................................................................................................... 5
NEW USER REGISTRATION .......................................................................................................................... 5
LOG IN ........................................................................................................................................................ 7
3
PROVIDERCONNECT NAVIGATION ............................................................................................. 8
NAVIGATION BAR ....................................................................................................................................... 8
YOUR MESSAGE CENTER ............................................................................................................................ 8
USE NEXT AND BACK BUTTONS ................................................................................................................. 9
4
MEMBER INFORMATION .............................................................................................................111
SEARCH MEMBER ....................................................................................................................................111
VIEW MEMBER AUTHORIZATIONS ...........................................................................................................133
View Authorization Letter ...................................................................................................................133
View Authorization Details .................................................................................................................144
SEND INQUIRY TO CUSTOMER SERVICE ...................................................................................................155
VIEW CLINICAL DRAFTS ........................................................................................................................... 18
5
AUTHORIZATION LISTING ........................................................................................................... 19
6
VIEW MY RECENT AUTHORIZATION LETTERS ....................................................................211
7
ENTER AN AUTHORIZATION REQUEST..................................................................................233
SEARCH A MEMBER .................................................................................................................................233
REVIEW DEMOGRAPHICS .........................................................................................................................244
CAPTURE PROVIDER ................................................................................................................................244
ENTER REQUESTED SERVICES ..................................................................................................................244
Submitting the ITR Request.................................................................................................................255
Submitting the ORF2 or Psych Testing or TCM Requests ................................................................... 36
8
SAVE REQUEST AS DRAFT ......................................................................................................... 49
9
SUBMIT A DISCHARGE ................................................................................................................522
10
MY ONLINE PROFILE ............................................................................................................ 55
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NETWORK SPECIFIC INFORMATION ............................................................................... 56
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1
Introduction
ProviderConnect Overview
ProviderConnect is an online system that gives providers an easy-to-use application for
completing everyday service requests. This system will allow users to access
information 24 hours per day/seven days per week. Providers will be able to use
ProviderConnect to:
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Submit authorization requests
View authorizations and print and/or download authorization letters
Submit discharges
Submit a secure email inquiry to Customer Service
NC Medicaid providers can NOT use ProviderConnect to:
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Verify eligibility and/or benefits of recipients
Submit a claim or check claim status
Change provider specific information currently in the Beacon Health Options
system, such as provider address; changes to provider information must be
made through Computer Sciences Corporation (CSC)
Each user must have a valid Beacon Health Options Provider ID.
Contact Information
For assistance with any technical problems (such as connecting to or accessing the site)
please call our e-Support Help Line at 888.247.9311 during business hours Monday
through Friday 8AM - 6PM ET or you can e-mail an Applications Support Specialist at
[email protected]
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2
ProviderConnect Log On
ProviderConnect is a web-based application that can be accessed from the
ValueOptions web site.
Access ProviderConnect
To access ProviderConnect:
1. Enter the www.valueoptions.com URL in the web browser.
2. Click on the Providers link.
(The Provider Services page will display)
New User Registration
New users must register to access ProviderConnect.
1. Click on Register.
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The Provider Online Services Registration screen will display.
2. Fill out the fields. Note: The fields with a red asterisk are required.
3. Enter the provider/agency name in the Last Name field exactly as it is registered
with North Carolina Medicaid.
4. Enter the name of the person to contact at the office in the Contact Name field.
5. Enter the provider number in the Provider ID field. This is your Medicaid
Provider Number (MPN) plus alpha suffix, if appropriate. If you have multiple
sites and services contact the Helpdesk (888.247.9311) to set up a Group
Practice account versus having to register each site and service. Enter the ninedigit Federal ID number or Social Security number in the Tax ID field.
6. Enter the provider’s primary e-mail address in the Primary Email Address field.
Note: The e-mail address must be in an [email protected] format.
7. Enter the same e-mail address in the Verify Primary Email Address field.
8. Enter a ten-digit phone number without dashes in the Phone Number field.
9. Enter a ten-digit number without dashes in the Fax Number field.
A password must be created on the same Provider Online Services Registration
screen. To create a password:
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1. Enter a password in the Select a Password field. Passwords:
 Must be between 8-10 characters in length
 May contain numbers
 Can contain lowercase and uppercase letters
 Cannot contain spaces or special characters
 Are case sensitive
2. Enter the same password in the Confirm New Password field.
3. Create a question in the Password Reminder field.
4. Enter the answer to the question in the Password Reminder Answer field.
5. Click Submit.
Log In
To log in to ProviderConnect:
1. Click Log In.
2. Enter the user ID and password.
3. Click Log In.
4. Click I Agree on the ProviderConnect Use Agreement Page.
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ProviderConnect Navigation
Users have two options to navigate ProviderConnect. The first option is to use the
hyperlinks on the Main Menu screen. The second option is to use the hyperlinks on the
Navigation Bar.
Main Menu
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Find a Specific Member (authorizations)
Enter an Authorization Request
Review an Authorization
View Clinical Drafts
View My Recent Authorization Letters
Navigation Bar
The Navigation bar contains numerous options, eight of which are relevant:
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Home
Specific Member Search
Authorization Listing
Reports
My Online Profile
Network Specific Information
A user can access a specific section by clicking on the hyperlink on the navigation bar.
Your Message Center
Your Message Center is located on the Home Page to provide a secure message
center to ensure confidentiality and to comply with HIPAA requirements. Providers can
send messages to and receive messages from Beacon Health Options through the Your
Message Center section. Providers can view:
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Inquiries sent by the provider in the last 30 calendar days that have not been
responded to by a Beacon Health Options Customer Service Representative (CSR)
The last five inquires sent that were responded to by Beacon Health Options
A Message Center Inbox that displays all of the inquiries for the Provider logged by
the system
A Message Center Sent box that displays all of the inquiries sent by the Provider
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
Details of a specific inquiry
To view the Inbox:

Click the Inbox icon.
The Message Center – Inbox screen will display.
To view Sent items:

Click the Sent icon.
The Message Center – Sent screen will display.
Use Next and Back Buttons
In ProviderConnect, several processes require filling information out on more than one
screen. Use the Next and Back buttons located on the bottom of the screens to
navigate to the next screen or to return to a previous screen. If these buttons are not
used, the information that was entered may be lost.
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Note: Do NOT use the Next and Back arrows on the Internet browser’s toolbar.
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Member Information
A user can search for and access information for a specific member through the
Specific Member Search section of ProviderConnect. ProviderConnect can not be
used to verify recipient benefits, eligibility, or to submit a claim for NC Medicaid or NC
Health Choice.
Search Member
To search for a member:

Click on either the Specific Member Search link on the navigation bar or on the
Find a Specific Member (authorizations) button on the Main Menu page.
The Eligibility & Benefits Search screen will display. To retrieve member information:
1. Enter a member ID number in the Member ID field. This is the recipient’s NC
Medicaid ID number or NC Health Choice ID number.
2. Enter a date in the Date of Birth field. Note: Enter information in MMDDYYYY
format only.
3. Enter the member’s first and last names to further refine the search (this step is
optional).
4. Click Search.
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Once the search has been completed, the member’s information is displayed.
Demographics Tab
The Demographics screen displays member-specific information such as ID, name,
date of birth, etc. Please disregard the information in the eligibility section as a
recipient’s eligibility can not be verified through ProviderConnect. Eight buttons are
located at the bottom of the screen, four of which are relevant:

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View Member Auths – Displays all of the authorizations for the selected member
Enter Auth Request – Authorization requests can be submitted electronically (see
chapter 7)
Send Inquiry – (see Send Inquiry to Customer Service section)
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
View Clinical Drafts (see chapter 8)
View Member Authorizations
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Click on the View Member Auths button on the Demographics tab. Entering
values into the Auth # and/or Service From and Service Through fields is
optional.
Click Search.
The Authorization Search Results screen displays. This screen contains
information on member-specific authorizations. Clicking on the hyperlinks in this
screen enables users to view authorization letters and authorization detail
information.
View Authorization Letter
To view an authorization letter:
1. Click on a View Letter icon on the Authorization Search Results screen.
2. Click the View hyperlink to display the authorization letter. The letter will display.
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Note: As of October 1, 2011, adverse determination letters will also display in
ProviderConnect.
View Authorization Details
To view authorization details:
1. Click on the View Member Auth button on the Demographics screen. The
Authorization Search Results screen will display.
2. Click the desired Auth # hyperlink on the Authorization Search Results screen.
The information for that authorization will display on three screen tabs: Auth Summary,
Auth Details, and Associated Claims (not relevant for NC Medicaid and NC Health
Choice).
Auth Summary Tab
Click on the Auth Summary tab to view the following information:
 Member ID
 Authorization Number
 Client Auth Number (Prior Authorization Number)
 NPI # for Authorization
 Authorization Status (always Open)
 From Provider
 Admit Date
 Discharge Date
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Auth Details Tab
Click on the Auth Details tab to view the following information:
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Submission Date
Service Code
Modifier Code
Service Class Description
Dates of Service
Visits Requested/Approved
Visits Actually Used (Not applicable to NC Medicaid & NC HealthChoice)
Status (always reads “Open” for NC Medicaid & NC HealthChoice)
Reason
Enter Auth Request
Refer to Chapter 7: Enter an Authorization Request of this user guide for detailed
instructions on how to enter an authorization request (Request for Services).
Send Inquiry to Customer Service
In addition to contacting Customer Service by telephone (888.510.1150), providers can
submit recipient specific customer service inquiries via ProviderConnect. Providers
receive written responses from Customer Service that will appear in the Inbox of the
Message Center in ProviderConnect within five business days. There are two screens
from which to submit an inquiry to Customer Service; the Auth Summary tab and the
Demographics tab.
Use the Auth Summary tab ‘Send Inquiry’ function for:
 Authorization questions
 Requests to withdraw an authorization request
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
Submit additional/missing information (as an attachment); if directed by Beacon
Health Options staff to fax the requested information to the designated Lack of
Information fax line, then follow the direction to fax the information rather than
using the Send Inquiry function
The following screen appears after clicking the Send Inquiry button. Complete the
requested information, attach documentation (if applicable) and click Submit at the
bottom of the page.
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Use the Demographics tab ‘Send Inquiry’ function to:
 Submit Provider Change Attestation forms
(Demographics tab)
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The inquiry will be sent to the Beacon Health Options Customer Service Center. A
confirmation of the submission and an inquiry number will be displayed.
Refer to Chapter 8: Save Request as Draft of this user guide for detailed instructions on
how to save a request as a draft prior to submission and how to access a saved draft
request.
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Authorization Listing
In this section of ProviderConnect, a user can search for information on provider-specific
authorizations.
To access the Authorization Listing section:
1. Click either on Authorization Listing on the navigation bar or on Review an
Authorization on the Main Menu screen.
The Search Authorizations screen will display.
2. Click View All to see all authorizations for the provider. The Search Results
screen will display all of the authorizations. Note: Results can be sorted by
Member ID, Member Name, Authorization Number, or Service.
Or
3. Enter a number in the Authorization # fields or Client Authorization # field
4. Enter a date range in the Effective Date and Expiration Date fields.
5. Click Search. The Search Results Screen will display the specified
authorization(s).
For detailed information on the Search Results section (including the Auth Summary
and Auth Details tabs), refer to the “View Authorization Details” section of this user
guide.
Providers can also download a spreadsheet of authorization activity which occurred over
a seven day period from the Search Authorizations screen.
1. Select the Provider ID, if needed.
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2. Delete any values from Vendor ID, Member ID, Authorization # and Client Auth #.
These must be completely blank.
3. In the fields “Activity Date From” and “Activity Date To” enter a date range of no
more than 7 days.
4. Select whether you want the downloaded file to be delimited by commas or
pipes.
5. Click Download, and choose where to save the file. You can open the file in
Microsoft Excel or any other spreadsheet program.
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View My Recent Authorization Letters
Providers can access authorization letters multiple ways in ProviderConnect but the
most direct method is clicking View My Recent Authorization Letters from the
ProviderConnect Home page. This initiates a search for authorization letters created in
the last 7 days.
Note: Authorization approval letters created since March 1, 2010 can be retrieved using
this link from the Home page. Adverse Determination letters created since October 1,
2011 can be retrieved using this link as well. Providers should use the procedure
discussed in Chapter 4 (View Member Authorizations) to retrieve authorization approval
letters created prior to March 1, 2010.
The Search Authorization Letters screen displays a listing of the letters created in the
previous 7 days (150 maximum records display per page). A “Next” hyperlink will
display if the search yields more than 150 authorization letters for the chosen time
period. Search parameters such as the Provider ID, Member ID, Letters From, and
Letters Through can be changed to modify the search.
Letters that have not yet been viewed are identified as “New” and those already viewed
show the date it was Last Viewed. To view a letter, click View on the right hand side of
the screen.
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The authorization letter will display and can be printed, downloaded as a PDF, or both.
Close the letter to return to the Search Authorization Letters screen.
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The Enter an Authorization Request function enables users to electronically submit
authorization requests online.
To access the Enter an Authorization Request section:
1. Click on either Enter an Authorization Request on the navigation bar or on
Enter an Authorization Request on the Main Menu screen.
The Disclaimer screen will display.
2. Read the disclaimer.
3. Click Next.
Search a Member
The Search a Member screen will display.
1. Enter the member’s ID in the Member ID field. This is the member’s NC
Medicaid ID number or NC Health Choice ID number.
2. Enter the member’s date of birth in the Date of Birth field.
3. Enter the requested start date in the As of Date field so the request is submitted
under the applicable benefit plan (Medicaid vs Health Choice)
4. Click Search.
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Review Demographics
The Demographics screen will display.
1. Review the member’s information.
2. Click Next.
Capture Provider
The Provider screen will display.
1. Click the Capture button to capture the provider’s information. If this is a Group
Practice Account, make sure to capture the provider ID number from the dropdown menu that matches the requested level of care.
Note: Clinical Home providers submitting initial Residential/PRTF or
provisionally licensed providers submitting Outpatient or requests for
Therapeutic Foster Care--use any direct enrolled provider number
available from the Provider ID drop down menu.
2. Click Next.
Enter Requested Services
The Requested Services Header screen displays next. The level of service that is
selected on this screen determines which additional fields will display on this screen and
which screens need to be completed. There are two options for the level of service:


Select Inpatient/HLOC/Specialty for completion of the ITR or for submitting
Initial Criterion 5 requests.
Select Outpatient for completion of the ORF2 or for submitting outpatient
requests and Psychological Testing requests.
The steps for entering an Inpatient/HLOC/Specialty request will be covered in the next
section, followed by steps for entering an Outpatient request Note: Directions are given
for all of the fields on a screen; however, only the fields with an asterisk are required.
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Submitting the ITR
For an Inpatient/HLOC/Specialty level of service:
1. Enter a date in the Requested Start Date field.
2. Select Inpatient/HLOC/Specialty from the Level of Service drop-down list.
3. Select an option from the Type of Service drop-down list.
4. Select the appropriate service from the Level of Care drop-down list. See the
Requesting Services Grid below as a guide.
5. Select an option from the Type of Care drop-down list.
6. Enter a date in the Admit Date field. The admit date is the date of first contact
with this recipient by your agency for this episode of care. This date remains the
same on all concurrent/subsequent requests.
Requesting Services Grid:
The following services should select INPATIENT/HLOC/SPECIALTY as the Level of Service:
Service:
Community Support Team
Assertive Community Treatment Team
Psychosocial Rehabilitation
Intensive In-Home
Child/Adolescent Day Treatment
Multisystemic Therapy
Residential (group home level II-IV)
Therapeutic Foster Care
Facility Based Crisis
Substance Abuse Intensive
Outpatient Therapy
Substance Abuse Comprehensive
Outpatient Therapy
Opioid Treatment
Substance Abuse Non-Medical
Community Residential Treatment
Substance Abuse Medically Monitored
Community Residential Treatment
Ambulatory Detoxification
Non-Hospital Medical Detoxification
ADATC
Select Level of Care as:
COMMUNITY SUPPORT TEAM
ASSERTIVE COMMUNITY TREATMENT
PSYCHOSOCIAL REHAB
INTENSIVE IN-HOME
DAY TREATMENT
MST
RESIDENTIAL CHILD CARE
FOSTER CARE
FACILITY BASED CRISIS
IOP/SOP
Select Type of Care as:
Select appropriate option
SACOT
OPIOID TREATMENT
NCMC ONLY SA NON MED RESI OVER
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NCMC ONLY SA MED MONITORED RESI
NCMC ONLY AMBULATORY DETOX
NCMC ONLY NON-HOSPITAL MED
DETOX
NCMC ONLY MEDICALLY
SPVSD/ADATC
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MH/SA Targeted Case Management
Inpatient
PRTF
TARGETED CASE MANAGEMENT
INPATIENT
PRTF
7. Attach all required documentation i.e., PCP, Discharge Plan, Assessment, etc.
 Does this Document contain clinical information about the member:
Select ‘Yes’
 Document Description: select based on document being attached
 Click ‘Upload File’ button
 Click ‘Browse’ button
 Find and select the document, double click the file or click ‘Open’ button
 Click ‘Upload’ button
Note: Acceptable file formats are Word, Adobe, Excel, and Text files.
Note: Documents that are required to display original signatures must be in PDF
format.
8. Click Next.
Initials vs Concurrents
Providers do not mark online submissions as either Initial or Concurrent. The system
will identify the request as either Initial or Concurrent based on built-in logic. If a
concurrent request is entered correctly, ProviderConnect will prompt the following screen
for processing a concurrent request or discharge. Click the appropriate button based on
your request.
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A concurrent review is identified by matching the following elements from the previous
authorization:
o Member
o Provider
o Level of Service
o Type of Service
o Level of Care
o Type of Care
o Admit Date (this date remains the same on all concurrent/subsequent requests)
o Requested Start Date (or date of submission) is no more than 1 day after the last
authorized day.
NOTE: Providers should not be deterred whether the system identifies the request Initial
or Concurrent.
A screen with ten tabs will display. Note: Each field on every screen will be covered;
however, only the fields with asterisks are required.
The Level of Care screen is completed first.
1. Enter the treatment in the Treatment Unit/Program field. Please type the level
of care being requested in this field.
2. Enter a name in the Member’s Guardian field.
3. Select an option from the Member’s Current Location drop-down list.
4. Select an option from the Primary Referral Source drop-down list.
5. Enter the Utilization Reviewer contact name and phone number. This is the
person ValueOptions will contact should there be any clinical questions.
6. Click Next.
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The Currents Risks screen will display next.
To complete this screen:
1. Select an option from the Precipitant (Why Now?) drop-down list and provide
the following information in the precipitating event text box: current behaviors
the recipient exhibited causing you to request this service; include root cause or
particular history; include progress or lack of progress during the reporting
period. There is a limit of 2000 characters in this field.
2. Please note at the beginning of the precipitating event text box if any of the
following apply:
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
Provider Name and MPN for Initial Residential/PRTF requests
Retrospective request due to member’s Medicaid eligibility and include
dates of service requested for the retrospective authorization period
Additional Units request for current authorization period
EPSDT request
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3. Fill out the Member’s Risk to Self section. This entails an assessment of any
current suicidal ideation (SI), plans and intent. Utilize the free text box to provide
additional information regarding recent attempts or gestures or if rating is 2 or 3.
4. Fill out the Member’s Risk to Others section. This entails an assessment of
any current homicidal ideation (HI), plans and intent. Utilize the free text box to
provide additional information regarding recent attempts or gestures or if rating
is 2 or 3.
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5. Click Next.
The Current Impairments screen displays next.
1. Rate the severity of each impairment.
2. Click Next.
The Diagnosis screen displays next.
1. Select Diagnosis codes (ICD-10 codes as of 10/1/2015) for the Diagnosis code
I and Diagnosis code II sections.
2. Enter Diagnosis information for the Diagnosis code sections (if any).
3. Indicate Overall Severity of Psychosocial Problems.
4. Indicate Course of Illness.
5. Click Next.
The Treatment History screen will display next.
1. Fill out the Psychiatric Treatment in the Past 12 Months section.
2. Fill out the Substance Abuse Treatment in the Past 12 Months section.
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Note: If ‘Is member currently on psychotropic medication?’ is set to No, the Psychotropic
Medications tab will not be accessible.
3. Fill out the Additional History section.
4. Click Next.
Information must now be entered on the Psychotropic Medications screen.
Note: If ‘Is member currently on psychotropic medication?’ from Treatment History tab is set
to No, the Psychotropic Medications tab will not be accessible.
1. Click the hyperlink to select a medication in the Medication field. Do not type-in
the medication name.
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Note: Click on the Medication hyperlink to view the Select Medication Code window.
2.
3.
4.
5.
6.
7.
8.
Enter the amount in the Dosage field.
Select an option from the Frequency drop-down list.
Select Yes or No for the Side Effects field.
Select Yes or No for the Usually adherent field.
Select an option from the Prescriber drop-down list.
Select an option for Is Medication found to be effective?
Repeat steps one through seven for each medication.
Note: if the psychotropic medication is not listed in the table, select the option
for ‘Other’ and type in the name of the medication.
9. Click Next.
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The Substance Abuse screen displays next.
1. Check all Substance Abuse types that apply.
For each selected substance:
2.
3.
4.
5.
6.
Select an option from the Total Years of Use drop-down list.
Select an option from the Length of Current Use drop-down list.
Enter an amount in the Amount of Use field.
Select an option from the Frequency of Use drop-down list.
Enter a date in the Date Last Used field.
7. Select all Withdrawal Symptoms that the member is experiencing. Note: This
field is required if the Type of Service is Detoxification.
8. Fill out the member’s vitals in the Blood Pressure, Temperature, Pulse,
Respiration, and Blood Alcohol fields. Enter information regarding UDS.
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The ASAM/Other Patient Placement Criteria section must be filled out next.
1. Select Low, Medium, or High for the Dimension 1, Dimension 2, and
Dimension 3 fields if the Type of Service is Detoxification.
2. Select Low, Medium, or High for the Dimension 1 through Dimension 6 fields
if the Type of Service is Substance Abuse.
3. Click Next.
The Treatment Plan screen will display next.
Click Next as the Treatment Plan tab will not be used at this time since the PCP is
attached already.
The Treatment Request screen will display next.
1. Select Yes or No for the Certificate of Need Required field.
2. Select Yes or No for the Is Family/Couples Therapy Indicated field.
If Yes, enter a date in the Date of First or Next Scheduled Appointment field.
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1. Check all that apply for the Treatment Request Information fields.
2. Indicate the number of units being requested for a specific time period in the free
text fields.
Ex: 200 units per 90days
3. Select an option from the Primary Reason for Continued Stay drop-down list.
(Required for Concurrent requests)
4. Select an option from the Primary Barrier to Discharge drop-down list.
5. Check all applicable Baseline Functioning behaviors. If Other is checked,
describe the behavior in the text box.
6. Enter a date in the Expected Discharge Date field.
7. Enter a date in the Estimated Return to Work Date field. Check N/A if the
information is not available or not applicable.
8. Select an option from the Planned Discharge Level of Care drop-down list.
9. Select an option from the Planned Discharge Residence drop-down list.
10. Click Submit.
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The Determination Status/Results screen will display next.
Once the request has been submitted, buttons for printing and/or downloading the
results and/or request to your computer are at the bottom of the page.



Click Print Authorization Result to print determination status/results of
authorization request.
Click Print Authorization Request to print the authorization request.
Click Download Authorization Request to download the authorization request
to your computer as a pdf or xml file.
Submitting the ORF2 for Outpatient and Psych Testing
The following services should select OUTPATIENT as the Level of Service:
Service:
Outpatient
Psych Testing
Mobile Crisis Management
TCM-IDD (select Type of Service =
Developmental Disability )
Select Level of Care as:
OUTPATIENT
OUTPATIENT
MOBILE CRISIS
Targeted Case Management
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Select Type of Care as:
Psych Testing
For an Outpatient level of service:
1. Enter a date in the Requested Start Date field.
2. Select Outpatient from the Level of Service drop-down list.
3. Select an option from the Type of Service drop-down list.
Note: For TCM-IDD requests, select Developmental Disability.
4. Select an option from the Level of Care drop-down list.
5. Select an option from the Type of Care drop-down list.
Note: For Psych Testing requests, select Psych Testing.
6. Attach all required documentation i.e., PCP, Service Order, Assessment, Psych
Testing form, CTCM, NC SNAP, etc.
Does this Document contain clinical information about the member: Select
‘Yes’
Document Description: select based on document being attached
Click ‘Upload File’ button
Click ‘Browse’ button
Find and select the document, double click the file or click ‘Open’ button
Click ‘Upload’ button
Note: Acceptable file formats are Word, Adobe, Excel, and Text files.
7. Click Next.
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The Outpatient request generates the ORF2 form or a Short form (for TCM-IDD and
Psych Testing requests).
For the Short form (TCM-IDD and Psych Testing requests), the following screen will
display:
Note: required forms (CTCM, Psychological Testing Form, etc) should still be attached
to the request.
For the ORF2 form, the following screens will display:
1.
2.
3.
4.
5.
6.
7.
8.
Type of Services
Current Risks
Diagnosis
Treatment History
Treatment Plan
Psychotropic Medications
Requested Services
Results
The first tab is the Type of Services
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1.
2.
3.
4.
5.
Enter a Contact Name and Phone #
Enter a name, if applicable, in the Member’s Guardian field.
Select an option for Is member currently receiving disability benefits? field.
Enter Attending Provider Name and Credentials.*
Enter Attending Provider Medicaid #.*
Note: up to three Provider Medicaid ID #s can be entered, separated by
commas and no spaces
6. Enter Attending Provider Telephone #.
7. Enter Billing Provider Name and Credentials.
8. Enter Billing Provider Medicaid #.
9. Enter Referring Provider Name (if applicable).
10. Enter Referring Provider Medicaid # (if applicable).
*Provisionally licensed providers note: enter the provisionally licensed individual’s
name and provisional credential as the Attending Provider Name. If billing “incident to” a
Medicaid enrolled physician, enter the Medicaid enrolled physician’s MPN as the
Attending Provider Number.
If requesting authorization for reserve therapists, enter up to three MPNs in the
Attending Provider Number field, separated by a comma “,”.
Ex: 610####,591####,610####
11. Click Next.
39
The Current Risks screen displays. This screen contains two sections: Current Risks
and Current Impairments.
In the Current Risks section:
1. Enter a rating in the Member’s Risk to Self field.
2. Enter a rating in the Member’s Risk to Others field.
Note: Click on the hyperlinks to display the rating information windows.
In the Current Impairments section:
1. Select options for all of the fields.
2. Click Next.
40
Note: If a rating of 2 or higher is selected for the Weight Change Associated with a Behavioral
Diagnosis Eating Disorder field, additional fields will be displayed that will need to be
completed.
Note: If a rating of two or higher is selected for the Substance Abuse/Dependence field, additional fields
will be displayed that will need to be completed.
Information must now be entered on the Diagnosis screen.
This screen has the following sections:
41

Diagnostic category I –V
On the Diagnostic category sections:
1. Select an option in the Diagnosis Code 1 field for the Diagnostic category I
section. The Description field will auto-populate.
2. Select an option in the Diagnosis Code 1 field for the Diagnostic category II
section, if applicable. The Description field will auto-populate.
Note: When a user clicks on the hyperlinks, windows will display that contain ICD-10
codes and descriptions.
If applicable (these fields are not required), in the Diagnostic category III and
Diagnostic category IV sections:
1. Select an option from the Diagnostic category drop-down list in the Diagnostic
category III section. Enter up to three Diagnoses, if applicable.
2. Select all psychosocial problems that apply in the Diagnostic category IV
section.
In the Diagnostic category V section:
3. You may enter a number in the Current GAF Score field, but this is not required
as of 10/1/2015.
4. Click Next.
Information must now be entered on the Treatment History screen.
1. Check the applicable boxes in the Psychiatric Treatment in the Past 12
Months section. Complete additional fields as prompted.
2. Check the applicable boxes in the Substance Abuse Treatment in the Past 12
Months section. Complete additional fields as prompted.
3. Check the applicable boxes in the Medical Treatment in the Past 12 Months
section.
4. Click Next.
42
Information must now be entered on the Treatment Plan screen.
1. Select an option from the Reason for Continued Treatment drop-down list.
2. Select an option from the Type of Treatment drop-down list.
43
3. Select an option from the Frequency of Sessions drop-down list.
4. Answer the questions in the Medication management? section.
5. Answer the questions in the Family psychotherapy? section.
6. Answer the questions in the Individual psychotherapy? section.
7. Answer the questions in the Group therapy? section.
44
8. Answer the remaining questions.
9. Click on the Treatment Guidelines Interventions hyperlink to pick appropriate
intervention(s). After selecting appropriate intervention(s), click Submit.
10. Enter Narrative in the Narrative Entry box provided, if needed.
Ex: indicate if this is a retrospective request due to change in member’s
Medicaid eligibility.
Click to open selection pop-up
45
11. Click Next.
Information must now be entered on the Psychotropic Medications screen.
1. Click the hyperlink to select a medication in the Medication field. Do not type-in
the medication name.
Note: Click on the Medication hyperlink to view the Select Medication Code window.
2.
3.
4.
5.
Enter the amount in the Dosage field.
Select an option from the Frequency drop-down list.
Select Yes or No for the Side Effects field.
Select Yes or No for the Usually adherent field.
46
6. Select an option from the Prescriber drop-down list.
7. Select an option for Is Medication found to be effective?
8. Repeat steps one through seven for each medication.
Note: if the psychotropic medication is not listed in the table, select the option
for ‘Other’ and type in the name of the medication.
9. Click Next.
Information must now be entered on the Requested Services screen.
1.
2.
3.
4.
Select a Place of Service.
Enter the CPT Code.
Enter a Modifier (if applicable).
Enter the # of Visits/Units.
Enter a record for each individual service being requested.
Clicking the Submit button on the Requested Services screen generates the
Determination Status/Results screen. The following information is displayed on this
screen:





Determination Status – Pended
Message
Subscriber Information
Provider Information
Authorization Information
47





Reason Code – for Determination
Print Authorization Results button
Print Authorization Request button
Download Authorization Request button
Return to Provider Home button
Once request has been submitted you have options for printing and/or downloading the
results and/or request to your computer.



Click Print Authorization Result to print determination status/results of
authorization request.
Click Print Authorization Request to print the authorization request.
Click Download Authorization Request to download the authorization request
to your computer as a pdf or xml file.
48
8
Save Request as Draft
The Save Request as Draft functionality allows a provider to save an authorization
request as a work in progress prior to submission. The provider has the option to save
the authorization on each tab/screen. The draft will be maintained for 30 days. After 30
days the draft request will expire and a new request will be required. The Save Draft
Request function will display as a Save Request as Draft button on the Request for
Services header.
To save a draft of an authorization request:
1. The Save Request as Draft button may be selected on any of the subsequent
screens.
(Save Request as Draft Button)
2. After clicking the Save Request as Draft button, the following pop up
message will appear advising the user how long the draft will be available for
viewing and modification. The message also indicates that attachments will
not save with this draft; any attachments will need to be added again prior to
submission.
49
3. After clicking OK, users will receive a message stating the Draft Request has
been successfully saved.
To view saved draft requests from the Home page, click on either of the View
Clinical Drafts hyperlinks.



Click View link to view a Read Only version of the saved draft request.
Click the Open link to modify or continue with the Request for
Authorization.
To delete a draft request, check the box to the left of the saved draft
record, and click the Delete Request Drafts button.
Saved Clinical Request Drafts that have expired within the last 30 days will display
at the bottom of the screen under Expired Clinical Request Drafts heading.
50
51
9
Submit a Discharge
Providers can submit discharges via ProviderConnect when terminating services to a
member.
To submit a discharge:

First navigate to the correct authorization for the member by clicking either the
Authorization Listing or Review an Authorization hyperlinks from the
ProviderConnect Home page (can also navigate to the correct authorization by
clicking Find a Specific Member and then View Member Auths).
The Search Authorizations Screen displays:
1. Enter information into the Member ID, Authorization #, Client Authorization # or
Effective Date/Expiration Date fields to navigate to the specific authorization from
which the member is to be discharged.
2. Click Search.
The Authorization Search Results screen displays:
52
1. Click the Auth # hyperlink for the relevant authorization.
The Auth Summary tab displays which contains the Complete Discharge Review
button. Providers can initiate the discharge by clicking this button BUT to ensure that
this is the correct authorization and treatment episode from which the member needs to
be discharged, click the Auth Details tab to display the dates of service of this
authorization.
From the Auth Details tab:
1. Click Complete Discharge Review.
The Discharge Information screen displays:
2. Enter the clinical information requested in the required fields (at minimum).
3. Click Save Discharge Information button at the bottom of the screen in order to
submit the discharge to Beacon Health Options.
The Results page displays next providing confirmation that the discharge was
successfully transmitted to Beacon Health Options. Data on the results page includes
53
member information, provider information, the related authorization number and level of
care the member was discharged from, and the discharge date. Providers have the
option of printing the results page by clicking the Print Discharge button at the bottom
of the screen.
No further action is required for submitting a discharge.
Additional confirmation that the discharge was submitted to Beacon Health Options is
found by navigating to the related authorization for which the discharge was submitted.
The Auth Summary tab now displays the discharge date.
54
10
My Online Profile
In this section of ProviderConnect, users can access and modify their own information.
To access this section, click on the My Online Profile link in the navigation bar.
A screen containing two sections will display:


The Modify Profile section contains information that cannot be changed (e.g.,
Provider ID, Provider Name, and Tax ID).
In the Editable Profile Details section, however, the user can edit information
(e.g., E-mail Address, Phone Number, and Password).
To edit provider information:
1. Enter the new information in the Editable Profile Details section.
2. Click Update Profile.
55
11
Network Specific Information
Users can access network-specific information in this section of ProviderConnect.

To access the Network-Specific Information screen, click Network Specific
Information on the navigation bar.
The Network-Specific screen will display. The network specific information for NC
providers can be found by clicking on the hyperlinks shown below.


North Carolina Health Choice
North Carolina Medicaid
56
Examples of network information that can be accessed from these links are:




Clinical and administrative forms as well as instructions for completion
Resources explaining the authorization process
Links to relevant websites (e.g. DMA, DMH/SA/DD)
Upcoming Provider Training Opportunities
57

North Carolina Medicaid and Health Choice

Transcription

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