Instructions for Using the Alliance Behavioral Healthcare Electronic Systems

Transcription

1 Instructions for Using the Alliance Behavioral Healthcare Electronic Systems

2 Contents Alliance Center System Flow 3 Access to Care Line: (800) ProviderConnect Connectivity Requirements 4 Getting to the Alliance ProviderConnect Website 5 Main Menu Options 9 Change Your Password 10 Working With a Consumer 11 Checking the Status of Authorizations 13 Client Lookup 15 Navigating the Client Profile Screen 16 Demographic 16 Requesting and Receiving Authorization of Services for Medicaid-Funded Consumers 17 Requesting a Medicaid Service 19 Requesting IPRS/State-Funded Services 21 Attaching Files to Authorizations 25 Alliance Contact information 30 Updated 6/13/2012 Instruction Manual on the Alliance and Service Provider Electronic System Processes 2

3 Alliance Behavioral Healthcare IPRS Service Access Flow Access to Care Line: Consumer Calls Alliance (new to service or out of service 60 days or ) OR New or inactive client walks into provider office consumer calls Alliance completes screening, schedules appointment in Calcium and creates an LME record number. Alliance completes screening at and creates an LME record number Alliance Access and Information Department enters an authorization for a clinical assessment Referral Screening Report is sent to provider via Alliance s secure system Chosen provider sees client for services on day of appointment (Admission Assessment completed, service plan or PCP is started) Provider indicates if consumer seen in Calcium system. If provider determines more services are needed, completes LCAD to submit to the LME and does the following: Requests services through ProviderConnect, attaches required documents based in service request type and funding source Medicaid Consumer Billing is done directly to DMA (HP) by the provider IPRS/State Funded Consumer Billing is done through the Durham ProviderConnect system For Durham County Medicaid OPT services provider contacts Alliance to complete brief Pre-admit so Medicaid service requests can be submitted via ProviderConnect 3

4 ProviderConnect Connectivity Requirements The ProviderConnect system is a web-based system that requires an Internet connection. Although it is not required, a high speed connection is preferable. Internet Explorer 5.5 or greater is required to run the site. Each user is required to have a user id and password before using the Alliance ProviderConnect system. Passwords will only be given to trained users. You can request passwords from the Alliance Provider Relations Department. Contact and phone numbers are at the end of this document. Passwords for the ProviderConnect system will expire every 90 days. You will need to contact the Alliance Provider Relations Department to get your password reset when it expires. 4

5 Getting to the Alliance ProviderConnect Website Website address: or Below is the main home page of ProviderConnect. Logging in to the System Enter your unique username and password. You will receive a user id and password for the system after you have been trained to use it. Note: You must have training before you will be able to receive a user id and password. It is not necessary for all staff within your agency to be trained by Alliance. If you feel comfortable training other staff then you can do so and request their user ID and password for them. Press the Login button. 5

6 Your password is case sensitive. Make sure you enter your password exactly in the format it was created. If you incorrectly enter your username and password three times, the system will lock your user account. After 15 minutes, you may attempt to log in again. If your password expires, contact the Provider Relations Department 6

7 Security Page Click on Continue to pass through the security statement. 7

8 News Screen Click on Skip to Main Menu to move to the next screen. 8

9 Main Menu Options Navigating the Main Menu This screen is the main menu. From this screen you can do several things. Look up client This allows you to search for a client that has been assigned or authorized to you in the system. Change password This allows you to change your password. If you feel that there may be a security threat you should always change your password. Billing This option will allow you to bill for all the services you have entered through ProviderConnect. (IPRS only) News This option takes you back to the news page. Reports This option will allow you to pull reports based on your clients authorization history as well as run reports on cases that are awaiting review. Add New Client/Client Search This option will allow you to look up a consumer based on the consumer social security number, date of birth and last name, even if the consumer does not have a current or past authorization to you/your agency in the system, as long as the consumer has been screened or enrolled in the LME. Logout/Exit Logs you out of the system when you are done. 9

10 Change Your Password If you need to change your password at any time you can click on Change Password from the main menu. You will see the following screen. The screen will ask you to put in your old password and then put in your new one. You will need to enter your new password twice for system verification. ProviderConnect requires users to change their password every 90 days. Users may change their password at any time. Passwords are case sensitive, so when creating a new password carefully note how you are entering it into the system. 10

11 Working with a Consumer Look Up Client Option In order to request authorizations or enter treatment information for a consumer already enrolled with your agency you will need to work from the consumer s profile screen. In order to get to this screen you should do the following: From the main menu click Look Up Client You may enter the consumer s LME consumer record number or you may look the consumer up by name. If you want to view all the consumers you can just click on Search by Criteria. The system will then give you a list of all the consumers for your agency. You can click on the LME record number to pull up the consumers profile screen. 11

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13 Checking the Status of Authorizations In order to view all authorization statuses for the entire company you can click on the Reports menu from the main menu and then click on Authorization Request Status. You will be able to get a list of authorizations based on several search criteria Once the list of authorizations appears, select the consumer number to find a specific consumer authorization history. From the authorization history, you can view a specific authorization by clicking on the blue Request Number. 13

14 An IPRS/State-funded request can have four different status options for authorizations. 1 Approve UM has approved your authorization. Please check the start and end dates and the units of your authorization. 2 Pend UM has pended your request and is waiting on the provider or it is waiting or the UM Care Manager to review. Please check the comments section of the authorization for further clarification. 3 Deny UM has denied your request. You will have to submit a new request for review with all required documentation. 4 Not Reviewed this means that the authorization has never been reviewed or received by the LME. If you see this for more than 14 working days please contact the UM Department. A Medicaid request can have five different status options for authorizations. 1 Approve UM has approved your authorization. Please check the start and end dates and the units of your authorization. 2 Pend UM has pended your request and is waiting on the provider to submit more information to the care manager to review. Please check the comments section of the authorization for further clarification. 3 Deny UM has denied your request. A letter will be available to review as an attachment explaining the reason for the denial. A form regarding the local reconsideration process is also attached. 4 Unable to process this means that the authorization was received with missing required information and cannot be processed. 5 Waiting for Review this means that the LME has not reviewed the authorization yet. 14

15 Client Lookup Click on Client Lookup To look up a client within the ProviderConnect system, you can enter a combination of the consumer s information and click on the Search by Criteria button. For a list of all clients within the system, do not enter any information in the search criteria boxes and click on the Search by Criteria button. This will create a list of all clients within ProviderConnect. Each provider can only view clients that belong to their specific agency. 15

16 Navigating the Client Profile Screen On the left side of the client profile screen you will see several options. The profile screen automatically defaults you to the demographic page when you pull up the consumer for the first time. The information on this page is based on consumer demographics in the LME system, if they need to be updated please upload an LCAD with corrected information. Demographic 16

17 Requesting and Receiving Authorization of Services for Medicaid Funded Consumers Medicaid Service Request Menu The Medicaid Service Request menu contains a list of all authorizations currently in place for the client or authorizations waiting to be approved for the client. The status of the authorization show in the column labeled Request status. If you would like to review or print an authorization you should click the word Request Type. This will take you to the actual authorization and allow you to view the comments that have been added by the UM Care Manager (if any). You can print the authorization by selecting print under your file menu. 17

18 Sample Authorization 18

19 Requesting a Medicaid Service To submit an authorization to the LME for a Medicaid eligible consumer, the provider should click on one of the red buttons based on the type of request. o The CAP/Targeted Case Management button is for any requests for CAP services or for DD consumers receiving Targeted Case Management o The Inpatient Treatment Report Request button is for any requests for the following types of services: Inpatient Enhanced services Residential Foster Care PRTF Criterion 5 o The Outpatient Review Form button is for any requests for basic benefit services. 19

20 After clicking on the appropriate form you will then need to fill out the fields within the request. Any fields that are denoted in red or have red stars are required fields and have to be filled out before the request can be submitted to Alliance for processing. For inpatient hospital providers, select emergent as the request type, which will allow you to submit a request with a start state prior to the entry of the request. After the entire form is entered and submitted you are required to attach the appropriate clinical documentation based on the type of request/service type being requested. Information regarding required forms can be found at in the Provider section. Note: Go to section in this manual labeled Attaching Files in ProviderConnect for instructions on how to attach files. The request will automatically be put in a status of Waiting for Review until it is sent to the LME and the LME reviews the request and updates the authorization with a status of Approved, Denied, Pended, Unable to Process. 20

21 Requesting IPRS/State-Funded Services To request authorization for state funded services (IPRS consumers) click on the link on the navigation bar that says Authorizations. Click on the red button at the bottom the screen that says Create Request. 21

22 Enter the start date of the request. *Note: You can use the set to field to enter the number of days that you would like the request to be for and click on set which will then automatically populate the end date field OR you can just enter the end date into the system and click on Request Authorization. Make sure to put your date in the following format MM/DD/YYYY. 22

23 o Click on the Add Code button to select which service you would like to have authorized. Once you ve clicked on the Add Code button, select the correct code for authorization and enter the number of units you would like to request. o Note: Make sure to request the correct code for the provider providing the service. If the correct code is not requested or billed this could mean a payback situation for your agency. Remember that the code will determine how you calculate the units for that service. Note: Make sure you DO NOT click on Add Code again. o Enter the number of units that you wish to request based on the timeframe you are requesting. Note: Make sure to calculate the number of units correctly based on the type of code and the type of unit it is. Example: YA, YP and YM codes are in 15 minute increments. CPT codes are normally by event. Go down to the Comments on Authorization section and document the following: o Name of person submitting authorization requests and date (name, credentials, , and phone). o Brief justification for the service. o GAF, ASAM Level or SNAP. 23

24 Click the File Request button once all of the appropriate services, units of service and comments are on the authorization request. When requesting enhanced services an admission assessment and Person Centered Plan/Treatment Plan must be submitted after you request the authorization via ProviderConnect. You can attach your documents to the authorization. Your request will not be processed until ALL required information has been received. The forms can be found on Alliance website at 24

25 Attaching Files to Authorizations When requesting an authorization for a consumer who is new to your agency. When you request an authorization through ProviderConnect you will then be required to attach appropriate clinical documentation. For State-funded or IPRS requests you may be required to attach the latest Person- Centered Plan (PCP). For Medicaid services you are required to attach certain documentation based on the type of request you are entering. Required documents can be found in DMA Clinical Coverage policies located on the Alliance website To attach documents to an authorization do the following: At the authorization screen click on Add New beside the authorization that you need to attach your documents to. Click here to add documents to your authorization request 25

26 At the next screen click on the button labeled Browse Click here to look for file to attach 26

27 Find the file you are attaching on your computer in the choose file screen and then click open. 27

28 The file path and name should default in for you. When you see the path and filename in the box click Attach New Files. You can go back and use this same process to attach more files if necessary to the same authorization. Information defaults in here 28

29 After the file(s) are attached you will be able to see a disk show up beside the authorization. This lets you know that the files are attached. Click here Disk icon shows attachments 29

30 Alliance Contact Information ProviderConnect Password Issues Computer Technical Support Jeanette Williams, (919) , Authorization Questions April Parker, (919) , Claims Questions Kelly Goodfellow, CFO, (919) , Kim Willman,Claims Supervisor, (919) , Billing Questions Sara Pacholke, Finance Director, (919) , 30