Maryland Provider Portal Training Prior Authorization Concurrent and

Maryland Provider Portal Training – Prior Authorization, Concurrent, and 3871 B Reviews April 2016

Agenda § § Telligen Patient Portal Update 3808 Prior Authorization and Concurrent 3871 B Long Term Care Questions and Answers 2

Update 3

Telligen Provider Portal Update § The Telligen Provider Portal went live on April 1, 2016 § As of April 15 th: – Over 70 facilities have set up Security Administrators – Over 3, 300 cases have been submitted for retrospective reviews § The Security Admin registration packet can be downloaded from the website at: http: //telligen. medicalauth. com/ § Once downloaded, three sections will need to be completed. – Section 3: Executive Agreement – Section 4: Security Administrator Agreement – Section 5: Security Administrator Registration Form 4

Methods of Submission of Provider Registration § Fax – Please submit your completed form to Telligen with a cover page titled: Maryland Provider Registration and send to 1 -888 -297 -4276 U. S. Mail – Telligen, Inc. 6518 Meadowridge Road Elkridge, MD 21075 ATTN: Provider Services § Telligen will need a hard copy of your notarized form at the above address within 30 days of initial electronic submission § An email will be sent with the security administrators login and temporary password within 3 business days of receipt. 5

Provider Portal Training- 3808 Prior Authorization and Concurrent Reviews 6

Telligen Portal – How the Provider Benefits Information and timing – Portal submission equals quicker turnaround § When you upload a document to the Portal you will receive an email confirmation § When a determination is made on your request, you will receive an email notification § When you access the portal, you can view the status of all requests and the authorization number § Save time and telephone calls by utilizing the Portal 7

Key points for Elective and Emergency Reviews § Elective Admission Reviews: – A hospital is required to submit a Prior Authorization Request in advance of the admission to receive medical necessity approval for the admission – If Member needs to stay in the hospital for extended days longer than originally expected, the Hospital is required to submit a concurrent review request for that elective admission to receive guidance on whether those additional days would likely be approved – If admit day changes, a new prior auth needs to be submitted. § Emergency Admission Reviews: – Submit Concurrent Review within 48 hours of admission and any additional concurrent reviews that may be required. 8

Tips For Eliminating Errors When Uploading Documents § Do not upload documents that are password protected. § Do not upload documents directly from a secure drive. § If documents are larger than 300 Mb, split the document in to smaller files making them easier to process. § Please submit all documentation required to make an accurate determination, complete medical record. § Speed does affect the upload time of the document. Slower internet connections will result in extended upload times. 9

Provider Portal: Start a New Request § To get started, navigate to the website: http: //telligen. medicalauth. com/ § Utilize the “Login” option in the top right hand corner to log-in to the Patient Portal. § To start a new request, select “Add Authorization” button 10

Select the Request Type §Select one of the options from the drop down box: – Acute Hospital Review – Adult Chronic Hospital Review – Home and Community Based Review – Nursing Facility Review – Special Pediatric Hospital Review §Choose the review type that you are requesting a review for. 11

Provider Portal: Patient Information § Enter the member’s Medicaid ID and Date of Birth – The data entered MUST be an exact match to continue. 12

Provider Portal: Provider and Facility Information § Enter the Ordering Provider and Treating Facility Information. – Treating Facility is required. 13

Provider Portal: Service Request § Admission Type has three options: – Elective – Emergency – Retroactive § Admit date is required. Admit Date determines if review will be Prior Authorization or Concurrent. – Future Admit date says that this is a Prior Authorization review and the discharge date field will not show. – A current or past Admit date tells the system that this is a Concurrent review. The Discharge Date box will show and a future expected Discharge date should be entered. 14

Continuation of Services/Concurrent Review §When a subsequent review is entered that has the same member, treating facility, and Admission date, the system will provide a message. §At this time, additional documentation that is necessary to support the request for additional days will need to be uploaded. 15

Provider Portal: Summary and Attestation § The user will review the information for accuracy, enter their Username to confirm that they agree to the terms, and click “Done”. 16

Provider Portal: Summary and Attestation § Clicking the “Done” button is necessary to submit the case through the system for review. § An email will be sent to the User with the case number. This confirms that the case has been submitted. § The User will also receive an email when case review is complete. § A User may log in at any time to determine case status, view applicable correspondence, and attach additional information. 17

Patient Portal: Requesting a Reconsideration Click the Request Reconsideration button to request a reconsideration. 18

Provider Portal Training – 3871 B Submission 19

Provider Portal: Start a New Request § To get started, navigate to the website: http: //telligen. medicalauth. com/ § Utilize the “Login” option in the top right hand corner to log-in to the Patient Portal. § To start a new request, select “Add Authorization” button 20

Select the care facility §Select one of the options from the drop down box: – Acute Hospital Review – Adult Chronic Hospital Review – Home or Community Based Review – Nursing Facility Review – Special Pediatric Hospital Review §Choose the review type that you are requesting a review for. 21

Provider Portal: Patient Information § Enter the member’s Medicaid ID and Date of Birth – The data entered MUST be an exact match to continue. – If the member does not have a Medicaid ID, select the link above the Member ID box to enter patient information. 22

Member Information §The submitter will need to answer questions related to the member including: –Is the member currently in the facility that the request is for? –The submitter will be able to enter information for a Personal Representative if the member has one. –Attending Physician is not required but should be entered if available 23

Request and Diagnosis Information § Submitter is required to enter the: – – Requested Eligibility Date Admission Date Reason for Request Principal Diagnosis § Secondary Diagnosis is not required but up to 18 can be entered if needed. 24

Medical Eligibility Questionnaire § The submitter will move in to the Medical Eligibility Questionnaire. § All questions must have answers to proceed 25

Provider Portal: Supporting Documentation § Attach supporting documentation. – This is where supporting documentation for the requested level of care will be uploaded as well as any other required forms. Examples include ventilator questionnaire and PASRR (if applicable). – The system will provide notification for applicable forms. 26

Summary and Attestation §The submitter will have the opportunity to review all information that was entered including support documentation that was uploaded. §Once everything is correct, utilize the electronic signature and select done to submit the case. 27

Provider Portal: Summary and Attestation § Clicking the “Done” button is necessary to submit the case through the system for review. § An email will be sent to the User with the case number. This confirms that the case has been submitted. § The User will also receive an email when case review is complete. § A User may log in at any time to determine case status, view applicable correspondence, and attach additional information. 28

Resources for Questions and Assistance We are here to help – local resources § For questions regarding acute submissions – please contact Jada Scarborough - JScarborough@telligen. com § For questions regarding 3871 B submissions in Qualitrac, please contact Ed Mitchell Emitchell@telligen. com § For general operational questions, please contact Michael Mercado – mmercado@telligen. com 29

Questions Telligen will become your partner in serving Medicaid clients 30