Provider Portal User Guide. For the Provider Portal External Use

Transcription

1 Provider Portal User Guide For the Provider Portal External Use IT Department Issued January 2017 mynexus All rights reserved. Version 1.4 Revised

2 Contents Getting Started with the Portal... 3 Introduction... 3 Key Terms... 3 Next Steps... 3 Frequently Asked Questions... 4 Registering to Use the Portal Overview Starting the Registration Process Choosing Your User Role (Provider Type) Registering as a Home Health Agency User Registering as a Hospital, SNF, Physician or Physician Group User Registering as a Health Plan Case Manager User Accepting Terms of Use Agreement Verifying You Are Not Spamming Important Messages Logging into the Portal Resetting Passwords Searching for Members and Authorizations Authorization Details Page Creating Authorizations Overview Getting Started (after Finding Member) Learning about the Request Form Request Form Tabs Diagnosis Tab Physician Tab Services Tab Files Tab Completing the Files Tab Creating Subsequent Authorization Requests Viewing, Uploading and Printing Documents Overview Understanding File Services Features Viewing Documents Additional Features on PDF Viewer

3 Uploading Documents Verifying Document Upload Printing Authorization Summary Adjusting Dates Overview Adjusting Dates Procedure

4 Getting Started with the Portal Getting Started with the Portal Introduction What is mynexus? We are the company behind the Provider Portal. We are a healthcare company that provides comprehensive delegated management services for care and support traditionally delivered or coordinated from the beneficiary s home. For more information about who we are and what we do, click this link. This document will help you get started using the Portal. The Portal is an easy-to-use tool, but we have also created this document to support users and enhance their experience when using the Portal. What is the Portal? The mynexus Provider Portal is a web-based software application that provides health care professionals the ability to create home health care authorization requests for eligible members enrolled in participating health plans. Key Terms We have put together a short list of terms used throughout this User Guide. We define these so everyone will be on the same page and understand common terms. Authorization: This is the record number that is created when the initial authorization is requested for a member Provider Types: These are roles that are used by the portal to identify different types of health care providers. Requestor: The user who created the authorization request. Service Lines: The services requested for a member Service Provider: This is the entity that performs the requested care service for the member. Service providers are home health agencies or home health agency consolidators Next Steps Do these things: 1. Register Register to use the Portal if you haven t already. 2. Review Review this document and help video tutorials to become familiar with the tasks you will be performing when using the Portal. 3. Prepare Prepare to use the portal by being aware of the things you will need when creating requests. 3

5 Frequently Asked Questions Frequently Asked Questions What are the benefits to using the Portal? If you are requesting home health care services, the Portal provides a convenient tool to create requests. Authorization status details are displayed in real time. Service lines requested using the portal qualify for auto approval. By providing an easy-to-use tool to requestors and providers of home health care services, the Portal saves users time and money, and more importantly supports the timely delivery of home health care services to eligible health plan participants. Is the Portal always available? Generally, the Portal is available 24 hours a day, 7 days a week. However, there are times of scheduled maintenance, usually late in the evenings. We will do our best to notify the user community well ahead of the scheduled times. Because the Portal is dependent on you having an Internet connection and related outages, we cannot guarantee the Portal will be available when you need it without interruption. Does the Portal do everything automatically? The Portal is a software application that has totally automated the necessary processes of requesting your home health authorization requests. Due to clinical guidelines, not all requests will lead to an immediate approval. In the event this happens, the request is sent to qualified staff onsite that manually review and make the appropriate clinical determinations. Who uses the Portal? The Portal can be used by the health care professionals types below. When users register, they are required to specify what type of provider they represent. This list includes: Health Plan Case Managers Home Health Agencies (HHA) MD Physicians MD Physician Groups Skilled Nursing/Rehab Facilities (SNF) Hospitals All user types can request authorizations and check status of details. All user roles can be an owner of an authorization. 4

6 Frequently Asked Questions What s an owner? An owner is a user who is able to view detailed authorization information due to their responsibility in the arrangement and delivery of care to the member. To be an owner, a user must be one of the following on the authorization: 1. Ordering Physician (initially ordered the care) 2. Ordering Facility/Physicians Group (initially ordered the care) 3. Following Physician (following the episodic of care and responsible for continuing orders and sign off) 4. Service Provider (home health agency) 5. Health Plan Case Manager These fields are specified during the create request process. How do I qualify to use the Portal? Your provider must be in network with a mynexus contracted health plan in order to request a user account through the registration process. After you register, your application is vetted by mynexus personnel to ensure you are qualified to use the Portal. How long before my account is validated and I can start creating requests? Generally, it takes 2-4 business days to review and make a decision on your registration. Once a decision has been made, you will be notified by regarding the status of your registration. If you are approved, you will be provided with additional information in this so that you can complete the registration process and begin to use the Portal. What happens during registration if I cannot find my organization s name? Your provider must be in network with a mynexus contracted health plan in order to request a user account through the registration process. During the registration process, you must search and select the NPI you work for. If you cannot find your provider, double check the NPI you are entering. If you still encounter issues, you will can send an to portalsupport@mynexuscare.com. We will verify your organization s eligibility to appear in the Portal or may transfer you to Network Operations & Contracting. What do I do if I don t receive the confirmation code after I complete the registration? Check your to make sure the code was sent there. If it s not in your , check your junk drive and consult with your IT Department. Once confirmed you still have not received it, you can portal support. What if I m having other problems registering on the Portal and need assistance? If you experience problems while registering to use the Portal and cannot complete the process, portal support. What happens if I forget my password or it expires? 5

7 Frequently Asked Questions If you forget your password, the Portal provides a link that you can use to reset it. This link is located on the Log In page that is displayed when you first access the Portal. What should I do if I encounter technical problems when using the Portal? If you experience any technical issues while using the Portal, you should send an to portal support. We usually respond to s within hours. What are the main features of the Portal? The Portal was designed to address major functionality areas needed to support the administration of requesting authorizations and fulfillment of services. The areas below are the primary feature areas of the Portal with a brief description. Registration: the portal allows users to create a personal account to represent your provider or health plan Member Search: the portal allows user to search by beneficiary ID or authorization number Status Check: the portal allows owners to review authorization details including service line and staffing status File Services: the portal allows users to upload the required documents that support requests Date Adjustments: the portal allows users to adjust dates on qualifying service lines Creating Requests: the portal allows users to create authorization requests Are instructions provided for completing these tasks? Does the Portal provide online help? Yes, additional information about using the Portal is provided through online help. There are 3 types of help: Help and Support Page: access this document and video tutorials by locating the Help and Support page. Field-level help: The Portal provides field-level help. This help is displayed in pop-up boxes that appear when users click on blue question marks displayed next to some fields on Portal pages. Any questions not answered in the features above can be ed to portal support. How do I search for a member after I login to the Portal? Searching for a member is easy using the Portal. The search menu in the Portal is located on the left side of the welcome page upon logging in. You can search for a member by Subscriber ID. Remember not to include the member ID prefix. How do I search for an authorization after I login to the Portal? Searching for an authorization is easy using the Portal. The search menu in the Portal is located on the left side of the landing page upon logging in. You must have the authorization number. You can also search for an authorization by first searching for a member. Once the member is found, the Portal displays a list of authorizations for the member, if any exist. 6

8 Frequently Asked Questions What if I cannot locate a member in the Portal? If you cannot find the desired member using the Portal search feature, you will need to call the mynexus Intake Department in order for us to verify that the member is enrolled in the health plan and is eligible to receive benefits or if the member is part of a benefit plan that has been delegated to mynexus. If the member is no longer enrolled in the health plan, or not delegated to mynexus, they will not be searchable in the Portal. It is also possible that a member may show a certain status on the Health Plan website but be different in the mynexus system due to the fact that mynexus receives eligibility feeds daily and these updates may not have occurred yet. Is there any special information I need to know about before using creating requests on the portal? The portal may ask you a few questions before allowing you to create an authorization, based on the member s authorization history. This is important for coordination of care and avoiding duplication of services. Once it is determined that an authorization is appropriate, the Portal displays a Checklist of requirements you will need to create the authorization. Generally, the requirements are below Member information: homebound status and location where services will be performed Diagnostic information about the member s condition requiring care such as Diagnosis code Ordering physician information Service provider information Services being ordered with date ranges Required documentation including orders and supporting clinicals Throughout the process, the Portal provides guidance regarding completing the request. How long does it take to create a request? The user is led through the Request Form which is 7 tabs requiring information. If you possess the required information, it takes about 2-5 minutes to create an authorization request. When you create your first few requests, it may take a little longer until you get familiar with the process flow. Once you have completed a few, you will find the process is very fast and easy to complete. What happens if I start creating a request but can t complete it because of an office interruption? Can I save a partial request? Unfortunately, we do not allow partial requests to be saved in our system. You must provide all requested information in one session. You don t have to rush to get through the process, but we recommend that you avoid any distractions during the time you use the Portal. What happens if I take longer than 2-5 minutes to complete the request? You will not encounter any problems as long as you re working consistently through the Portal pages. Initially, you may want to take your time as you work through and explore the Portal. However, be aware that the Portal will time out if you undergo 30 minutes of inactivity and will not save your work; so be sure that you are actively using the Portal. 7

9 Frequently Asked Questions What happens if I enter wrong information on the Request Form? Does the Portal allow going back to a tab to make corrections? Users can click the Reset Form located in the bottom area of each Request Form tab to clear entries that have been made on the current screen. Users can also use the Previous to move backwards to previous pages and make changes. Most information can be modified up to the point of submitting the request. Overall, please ensure accurate information is entered on each tab during the request process. If you need to make changes to the request information after it has been submitted, please call mynexus or portal support. What do I do if a field does not allow me to enter information? There are some display-only fields that exist on the Portal when various procedures are performed. If you cannot enter information into any field, it is probably because the Portal automatically populates that information from our database or from information you will enter later on in the process. Who approves my request? There are two ways that a determination is made on a request. First, a number of authorizations can be auto-approved by the guidelines in the Portal. In this case, you will be presented with a valid approval at the completion of the request. If for some clinical reason the request requires review, the service line will stay in pending status and be sent to our internal clinical team, who will then review the request and make a determination. Notifications for manually reviewed lines will be performed per mynexus staff, but the decision will also be reflected on the portal in real time. How is an authorization staffed? Home health agency staffing can occur in a few different ways. If you are a home health agency (HHA) that will service the request, the staffing will be automatic and you will be provided an authorization number. If you a Non-HHA user such as a Health Plan Case Manager or Physician, you will be asked if you have already staffed the authorization. If you respond that you have staffed the request, you will be prompted to pick the specific provider based on the members benefit plan and network. mynexus staffing department will confirm acceptance with this agency. If you respond that you have not staffed the request, mynexus Staffing department will coordinate this. I m a home health agency user, can I create a request and then refer it to another home health agency? No. One HHA cannot create a request and then refer it to another HHA for staffing. The referred-to agency must create their own request if they want to staff it. Can I upload any type of document including Word files? We require that all documents be in PDF, PEG, PING, PNG format only. Zip files are not accepted. Where can I find the Authorization fax forms if I cannot use the Portal for requests? The link to provider materials for request forms is located on website. 8

10 Frequently Asked Questions I created an authorization using the Portal and when I return some of the data has changed. Why? Once you have created your request, the Portal will tell you the results of all your service lines. Some may be approved; others may require review. Users should expect the service lines requiring review to be updated once reviewed. In this instance, data will be difference from what was initially entered by the user. If you notice any changes in previously approved service lines, call the mynexus Intake Department. What if I get an error message while using the Portal? Although we have tested and continue to monitor the performance of the Portal, you may experience unexpected technical issues while using it. If the Portal displays an error message page, we request that you take a screenshot of the page using the PrtScr button on your keyboard. Send us an about the problem including the screenshot, a brief description about what happened, the member s health plan and ID. You don t need to send the member s name, but the ID will be very helpful. Send the to our Technical Support Group at Portalsupport@mynexuscare.com. You can also try again later or fax in your request. 9

11 Registering to Use the Portal Registering to Use the Portal Overview Welcome to the mynexus portal. The portal has been designed to enable you to easily create and submit authorization requests for home health services. But first you need to register. Registration is an easy process where we request some basic information in order to create a user account for you. We ll ask you to provide basic information including your provider type, select the specific provider, and your name and personal business contact information. The image below shows the Registration page that is displayed after you click the Register link in the upper-right corner of the browser. Starting the Registration Process After you click the Registration link, the screen below is displayed. A pop-up window opens and provides general information about the registration process and a summary of the steps to complete the process. Review this information before starting to register. 10

12 Registering to Use the Portal Choosing Your User Role (Provider Type) First, you ll need to specify your provider type. If you click the blue question mark above the Provider Type field, a pop-up window is displayed that describes the provider types that can be selected. This pop-up window is shown below. After you have reviewed this information to determine which provider type to select, click OK to close the window. 11

13 Registering to Use the Portal When you click the down-arrow of the Select Provider Type field, the screen displays a menu with available choices. After you make your selection, you will need to identify the provider you are associated with. You can search by NPI. Health Plan case managers can search by their health plan. 12

14 Registering to Use the Portal Registering as a Home Health Agency User The screen below is displayed when you select the Home Health option as your provider type. 1. Start typing the full NPI of the home health provider in the Provider field. A list of matching providers is displayed in the lower left area of the page. 1 Note: If the name of the desired provider does not appear in the list, check for typos in your NPI entry and retry. If provider name still does not appear, you can mynexus Network Operations or portal support. 13

15 Registering to Use the Portal 2. Click on the name of your provider to select it Click the right-facing arrow to add it to the selection area on the right. 3 14

16 Registering to Use the Portal You are prompted to enter Tax ID for the selected provider. 4. Enter the requested information and then click the Validate and Add button. 4 15

17 Registering to Use the Portal If the system validated your selection, it will appear in the lower right area of the page. If you need to add other providers, repeat the process as necessary. If the portal could not validate your entries, a message is displayed informing you the information you provided is invalid and to try again. Double-check your information and re-enter. If you continue to have problems, portal support. Once the provider information you provided is validated, you can proceed to the Your Information in section. 16

18 Registering to Use the Portal Registering as a Hospital, SNF, Physician or Physician Group User The screen below is displayed if you select a clinical Non HHA as your provider type. 1. Enter full NPI of your provider. Matches will appear in a drop-down menu. Select the desired name. 1 Note: If the name of the desired provider does not appear in the list, check for typos in your entry and retry. If provider name still does not appear, you can mynexus Network Operations or portal support. Registering as a Health Plan Case Manager User The screen below is displayed if you select the Health Plan Case Manager option as your provider type. 17

19 Registering to Use the Portal 1. Enter the first letters of the insurance health plan you work for. Names that match those letters appear in a drop-down menu. 1 Note: If the name of the desired health plan does not appear in the list, check for typos in your entry and retry. If the name still does not appear, you can mynexus Network Operations or portal support. 18

20 Registering to Use the Portal 2. Select the desired plan. 2 Entering Your Information Once you have specified your provider type and selected the provider you are registering on behalf of, Next, enter your personal name and business contact information in the appropriate fields in the right area of the page. Note: You must complete the left side of the screen related to provider information prior to entering in your user specific account details. Accepting Terms of Use Agreement You will also need to review and accept Terms of Use. If you decline, you will not be able to complete the registration process. 19

21 Registering to Use the Portal Verifying You Are Not Spamming As part of our security protocol to prevent the portal from receiving unwanted , we use CAPTCHA. It stands for Completely Automated Public Turing test to tell Computers and Humans Apart. Clicking the I m not a robot checkbox starts this widget. A pop-up window opens. The selection criteria is displayed at the top and a series of images appear below it. Select all images that contain similar traits. Sometimes this can be a little tricky, so take your time and be very thorough 20

22 Registering to Use the Portal After you have selected all similar images, click Verify. If you successfully selected the correct images, the screen below is displayed that now shows a green checkmark indicating you correctly selected all similar images. 21

23 Registering to Use the Portal Completing the Registration Process 1. Click Submit and Register to continue the registration process. 1 The screen below is displayed telling you to check your . This is the address you entered in the Your Information area of the Registration page. 22

24 Registering to Use the Portal 2 2. Click OK to close the pop-up window. You can now exit the Registration page. Confirming Your Account When you check your , you should have received a message from mynexus similar to the one below Click CONFIRM. After you click CONFIRM, a browser window opens showing the page below. 23

25 Registering to Use the Portal You will also receive another containing the code you will need to use on this page. Check your and copy this code or write it down to enter on the page as shown below Click Submit. This competes the process. The screen below is displayed. 24

26 Registering to Use the Portal You will receive an from us acknowledging your registration request has been submitted. Your request will be approved or denied within 2-4 days. Important Messages We have listed some items below that you should be aware of that are related to the registration process. When your registration is approved, you will receive an telling you that your account has been approved. The message will contain a link that you will need to use to log-in and a temporary password. After you enter your temporary password and access the portal, you will be prompted to setup a permanent password. You will also be requested to select and answer two security questions. After you have completed these items, your portal account will be active. If your registration is rejected, you will receive an informing you of that decision. 25

27 Logging into the Portal Logging into the Portal Once your account is set up by completing the registration process, you can log in as needed to perform your work. Be sure you are entering your username and password correctly. Your username is the you entered during registration. Be careful when entering your password especially if you have used any special characters or capitalization. Resetting Passwords Can t remember your password? If you are still having problems, you can request that we reset your password. Click the Forget Your Password? link as shown below. 26

28 Resetting Passwords Just enter your address as indicated below and click the Link button. We ll send you an containing instructions on how to reset your password. 27

29 Searching for Members and Authorizations Searching for Members and Authorizations This section provides procedures for performing a member search. The portal allows you to search different ways. Search using an authorization number Search using a member s (health plan) Subscriber ID *Do NOT use the member ID prefix Note: If a user searches for an authorization that does not exist, the user is not listed as the owner, or for a member who is not eligible, the portal displays a message that the information is not found or permitted and instructs the user to call mynexus. Starting from the Provider Welcome page. 1. Click the Search button under Menus. 1 The menu expands and shows available options. 28

30 Searching for Members and Authorizations 2. Click the By Auth Number button. 2 The menu expands and displays an entry field for the authorization number. 3. Enter the patient s authorization number in the Auth Number field Click Search. If the portal finds a match for the authorization number you entered, the screen below is displayed. The area highlighted is known as the Authorization List. 29

31 Searching for Members and Authorizations Performing a Member Search Using a Member s ID Note: If a user searches for a member that is not eligible or does not exist, the portal displays a message that the information is not found and instructs the user to call mynexus. Starting from the Provider Home page. 1. Click the Search button under Menus Click By Member. 30

32 Searching for Members and Authorizations 2 The menu expands and show additional fields. 3. Click Select Health Plan. 31

33 Searching for Members and Authorizations 3 A drop-down menu displays health plan options that can be selected. Note: Health Plan Case Managers will only see their registered health plan as an option on the dropdown menu and can only search for members in that health plan. 4. Choose the patient s health plan Enter the patient s health plan ID in the Member ID field. 32

34 Searching for Members and Authorizations Click Search. If the portal finds any authorizations for the patient ID entered, they are displayed. Authorization List Once you have located the desired member, the portal displays the Authorization List for that member. This list is all the member s authorization history with mynexus. The amount of information displayed on this list is based on user ownership. As mentioned previously, to be an owner, a user must be one of the following on the authorization: Ordering Physician (initially ordered the care) Ordering Facility/Physicians Group (initially ordered the care) Following Physician (following the episodic of care and responsible for continuing orders and sign off) Service Provider (home health agency) Health Plan Case Manager For authorizations on this list that you are the owner of, you can see full details and further select to the authorization to go to the Authorization Details page. If you are not the owner of an authorization, you will only be able to view limited information and asterisks may appear in place of certain information. This ensures that protected health information (PHI) is only shown to those who have a need to know this information. Non owners will not have access to the Authorization Details. Page. 33

35 Searching for Members and Authorizations 1 2 The first highlighted area indicates the user currently signed in is not the owner of the authorization. This is because of the asterisks that appear in place of actual PHI data. This information is not displayed to non-owners. The second highlighted area indicates the user is the owner of the authorization. This is because all information is displayed on the row and no asterisks appear. The table below lists and describes the user groups and how much information each one is provided on the Authorization List. User Group How Much Information Can Be Viewed? 1. Owner All information is displayed and can be viewed on the Authorization List page. Authorization Details page can be accessed by selecting the desired authorization. 2. Non-Owner Non-HHA Can be Physicians, Physicians Group, Skilled Nursing Facility, Hospital Less information is displayed on the Authorization List page. Authorization Details page is not displayed upon selection on the authorization, but a message will provide some details, just enough for coordination of care. 3. Non-Owner HHA Less information is displayed on the Authorization List page. Authorization Details page is not displayed upon selection of the authorization. Notes about Health Plan Case Manager: When this user registers, the portal restricts access to authorizations for the registered health plan. HPCM can only search for members and authorizations in their health plan. HPCM own all authorizations for members in their health plan. Authorization Details Page As per rules above, owners can select an authorization from the Authorization List and are transferred to the Authorization Details page. From this page, additional tasks can be performed for that authorization. The section identifies the different areas of the Authorization Details page. 34

36 Searching for Members and Authorizations # Page Area Description 1 Member Information Member information regarding health plan and eligibility. 2 Buttons Selecting one of the buttons displays associated information in a pop-up window for the selected authorization. The information that appears on the pop-ups is specified when the authorization is created, or added/modified since then. 3 Refresh Refreshes the page. 4 Authorization Details Provides summary of ordering details about the authorization. o 4A: Authorization Number. This is the number assigned to this authorization. It is automatically generated by the portal. o 4B: Authorization Level. There are two types Active and Discharged. Active means there is a request pending under this authorization or there are current approved dates of service. Discharge means there are no services pending or currently there are no approved dates of services. Note: The level does not always correctly indicate that the member is actually receiving care. 5 Services Lists the services that have been requested for this authorization and details about those services. This area also provides the ability to print the services listed on the page using the Print Services button. 6 Next Steps Provides button that allow users to perform additional actions such as Requesting additional visits, performing dates adjustments, or uploading supporting clinical documents. 35

37 Creating Authorizations Creating Authorizations Overview This section provides information on using the portal to create authorizations. Requests is the functional area of the portal where users create and work with authorization requests. This feature allows users to: Create new authorization requests Add requests for additional services to existing authorizations Confirm Discharge from authorizations and create new ones The table below provides the business rules for each provider type regarding creating authorizations. Provider Type No Authorization History Exists for Member or Not within Last 30 Days Non HHA User User can create new authorization If Owner: Authorization History Exists for Member within Past 30 Days Can see details Must coordinate any new orders with listed agency If Non-Owner: Can only see summary details Must coordinate any orders with listed agency or call mynexus for assistance with coordination of care HHA User User can create new authorization With Their Agency (2 options): User can request additional services under that authorization or User can confirm discharge from authorization and create new authorization Not With Their Agency (only 1 option): If a new authorization is needed or additional visits under an authorization that is not the most recent, the HHA user must call mynexus for coordination of care to avoid member receiving services from multiple agencies 36

38 Creating Authorizations Note: As shown in the table above, all provider types can create a new authorization for a member if the member does not have an authorization history or any authorizations within the past 30 days. Creating an Initial Authorization Request The first step in creating an authorization is finding the member who needs home health care services by using the member search menu. After finding the member, the portal verifies the member s eligibility to receive the home health care being requested. If the portal finds previous authorizations for the member, the member s Authorization List is displayed. You may be asked a series of questions based on provider type and the member s recent authorization history, to best determine if you need to create a new authorization or if you need to work with an existing authorization. This is important for coordination of care and to avoid duplication of services. Note: if the member has more than 1 active authorization or there is one actively being created, limited activity will be permitted. If the member does not have any authorization history, the portal displays the Create Authorization Start Page shown below. Getting Started (after Finding Member) Once it is determined that you need to create a new authorization, this is where the create authorization process begins. The Checklist pop-up message is displayed as shown below. 37

39 Creating Authorizations Review the message that appears in the pop-up window. Note: The message lists the information that is required to be successfully complete the authorization using the portal. As a best practice, we recommend that you have all required documents and information ready to be before you begin the authorization process. 2. After reviewing the message, click Continue. The portal displays the Request Form page as shown below. There are 7 tabs that require information from the requestor. Learning about the Request Form Let s review features of the Request Form page before creating the authorization request

40 Creating Authorizations The table below describes the features identified on the screenshot above. # Page Feature Description 1 Member Information This area displays the member s name and date of birth. 2 Health Plan Information This area displays the member s health plan information including their member ID and eligibility dates. 3 Authorization Number This number is generated by the portal after the authorization request is submitted. 4 7 Tabs The Request Form is 7 tabs. The user is lead through these 7 tabs entering necessary information. 5 Level Displays if the authorization is active or discharged. This will be null until the authorization is created. 6 Content Area for Tabs Displays information and fields that must be competed in order to move to the next tab. 7 Reset Form Clicking this button clears all entries for the current tab. 8 Page Navigation Button Clicking Next moves forward to the next tab after all required information has been entered on the current tab. Clicking Previous moves backward to view or alter information that has already been entered. Note: Clicking Cancel ends the authorization process. 9 Blue Question Marks These appear on various portal pages. These appear next to fields on pages displayed during the create authorization process and elsewhere in the portal. Provide pertinent information to help complete the field when users hover over with mouse. You should review all blue question marks to ensure your understanding of how to complete the field. Request Form Tabs You will be guided through the 7 tabs, collecting necessary information. 39

41 Creating Authorizations The table below describes the tabs that appear on the Authorization page. # Tab Description 1 Homebound Used to specify the homebound status of the member. 2 General Used to provide general authorization demographics about the home health care request. 3 Diagnosis Used to specify the diagnosis of the member s condition that supports the home health care request. 4 Physician Used to specify information about the physician who is ordering the services. 5 Service Used to specify information about the location where services will be performed and the service provider who will be providing staffing. 6 Services Used to specify information about the services and dates of care. 7 Files Used to upload the required documents to the portal. Identifying Required Fields on the Tabs If you click Next without specifying any fields on the page, the portal highlights the current tab and the fields that must be specified before you can move to the next tab. Some fields are locked view only. These fields will be auto populated by the portal once the request is submitted or completed later in the process. 40

42 Creating Authorizations General Tab After completing the Homebound tab and clicking Next, the portal moves to the General tab. Completing the General Tab Perform the steps below to complete this tab. 1. Click the down-arrow of the Order Type field and select the appropriate option. 2. Click the down-arrow of the Sub-Type field and select the appropriate option. 3. Click the down-arrow of the Urgency field and select the appropriate option. 4. Click the down-arrow of the Referral Source and select the appropriate option. 5. Click Next The portal displays the next tab Diagnosis. 41

43 Creating Authorizations Diagnosis Tab After completing the General tab and clicking Next, the portal moves to the Diagnosis tab as shown below. This tab is used to specify the diagnosis of the member s condition (in priority order) that supports the requested care. Completing the Diagnosis Tab Perform the steps below to complete this tab. 1. Enter at least the first few letters of the diagnosis. You can search by code or description. 2. Click Search. 1 2 The portal displays a list of ICD codes that contain letters that match those you entered. 3. Select the desired code from the list. 4. Specify additional diagnosis codes using the remaining fields, if needed. 5. After specifying all necessary diagnosis codes, click Next. 42

44 Creating Authorizations The portal displays the next tab Physician. Physician Tab After completing the Diagnosis tab and clicking Next, the portal moves to the Physician tab as shown below. This tab is used to specify information about the physician who is requesting the home health care. Completing the Physician Tab Perform the steps below to complete this tab. 1. Type the full NPI of the ordering physician s name in the Ordering Physician field. 2. Click the Search button

45 Creating Authorizations The portal displays a list of names that match the typed NPI from database. 3. Select the desired name from the list. 3 4 Important: If the desired physician is not found, users can indicate the physician is not found and must enter the required physician information directly into the fields. User must enter the indicated information per the field. Please do not enter invalid information not specified for that field. Service Tab After completing the Physician tab and clicking Next, the portal moves to the Service tab as shown below. This tab is used to specify information about the location of the patient where the requested home health care will occur and information about the service provider related to staffing. The screen below is displayed for non-hha users asking if the request has been staffed. 44

46 Creating Authorizations When Non-HHA providers answer Yes to already referring staffing, they must select the service provider care has been referred to. mynexus will confirm staffing with this agency. No service provider selection is required if the Non HHA user has not already staffed the case. mynexus Intake Department will coordinate staffing. HHA users will se the screen below confirming that they are accepting the care. For HHA user accounts that represent multiple agencies, the requestor must indicate which agency on the account is providing the care. In some cases, users must indicate the network administrator. As explained above, the service tab displays different screens for Non-HHA and HHA users. These vary slightly due to the different information that is needed from these different types of providers. Completing the Service Tab 1. Review the message. 45

47 Creating Authorizations After selecting your response related to staffing, the portal displays the next step of the Service tab Service Location where users will specify information about the location where services will be rendered. Completing the Service Tab Service Location Information Perform the steps below to complete this page. 1. Click the down-arrow of the Location field and select the appropriate answer. 2. Type the street address of the location. 3. Type the city of the location. Note: The portal populates the State and County fields based on the zip code you enter. You cannot type information directly into these fields. 4. Type the zip code for the city. 5. Press Tab or Enter. The portal populates the State and County fields. 6. Optional to Type an alternative name and phone number for the patient in the Contact Name and Contact Phone fields, respectively if there is an contact other than the member 7. Click Next. 46

48 Creating Authorizations Completing the Service Tab Service Provider Information 1. Click Next. The portal displays the next tab Services. Services Tab After completing the Service tab and clicking Next, the portal moves to the Services tab and displays the page below. 47

49 Creating Authorizations This tab is used to specify details about the home health care services that have been ordered. Completing the Services Tab Perform the steps below to complete this tab. 1. Click the down-arrow of the Revenue Code field and select the appropriate answer. 2. Click the down-arrow of the HCPC field and select the appropriate answer. Options will appear based on the entry selected for Revenue Code. 3. Click the down-arrow of the Effective Date field and use the calendar pop-up to specify the desired date. 4. Click the down-arrow of the Effective Thru field and use the calendar pop-up to specify the desired date. 5. Click inside the Visits field and enter the desired number appointments for the requested treatment. 6. Click Add Another Service Line if you need to add more services to the request. 7. Click Remove if you want to remove the service line from the request. 8. Click Next. 48

50 Creating Authorizations The portal displays the pop-up message shown below Review the message carefully. After pressing continue, you will not be able to edit or add any other services for this request 10. Click Continue to Files if you would be to proceed to the next tab. 11. Click Revise Services if you would like to add more services. If Continue to Files is selected, the portal displays the next tab File Services. 49

51 Creating Authorizations Files Tab After completing the Services tab and clicking Continue to Files, the portal displays the Files tab. This tab is used to upload the required documents to the portal. Completing the Files Tab Perform the steps below to complete this tab. 1. Click inside the date field next to the item you want to upload. 2. Specify the date of the item using the calendar pop-up. Note: the date of the document or order is required. This is NOT the date you are performing the upload 3. Click Continue Note: Selecting I have None of These will give the option to revise or cancel the authorization request. The portal displays the Select Documents to Upload page as shown below. Completing the Select Documents to Upload Page Perform the steps below to upload your documents. 1. Click Browse. 50

52 Creating Authorizations 1 The portal displays window below Navigate to the document on your local drive that you want to upload. 3. Select the desired document. 4. Click Open. Note: Each document must be uploaded separately. The window closes. The selected document appears in the Select File field. 51

53 Creating Authorizations Click the down-arrow of the Document Type field and select the appropriate option. 6. Type a brief description for the document being uploaded. 7. Click Add File. The portal displays the pop-up message below Review the message. 9. Click inside the checkbox to confirm. 10. Click OK. The selected document to be uploaded appears at the bottom of the page. 52

54 Creating Authorizations 11. Repeat steps 1 through 10 to add the other required documents. 12. After all documents to be uploaded have been selected and appear onscreen, click Save

55 Creating Authorizations After completing the final tab, File Services, the authorization will immediately undergo a series of quality checks; all timely (non-retro) service lines will qualify for auto approval based on clinical guidelines. A message will display the result of the service lines. Some service lines may require manual clinical review. If any service lines were auto approved, the requestor will immediately receive an authorization to their personal business fax number listed on their account, that they set up during registration. To change your personal business fax number, locate the My Account page by clicking on your username in the right upper corner of any page. For any lines that were not auto approved, they will be in pending status and will be sent for manual clinical review. Once a manual determination has been made for those pending service lines, the service status will be updated and visible form the portal. mynexus staff will fax the authorization to your main provider fax number listed on the health plan s provider file. To change the main provider fax number, users can submit the Fax Attestation Form available at Note: At any time using the portal, users can check the status of service lines Click OK. The portal retrieves the new Authorization Details page. 54

56 Creating Authorizations 55

57 Creating Authorizations Creating Subsequent Authorization Requests A subsequent request is when more services are being requested under an existing authorization. During this subsequent request, additional information is collected using the Request Form tabs, similar to the initial request process. First, portal users must locate the authorization. From the Authorization Details page, press Request Visits. Note: Only an HHA owners can request additional visits. When all other provider types press Request Visits, the portal displays a message instructing them to call the listed service provider to confirm authorization status and discuss any potential new orders. Non HHA providers can also call mynexus for assistance with coordination of care when a member has an authorization Click Request Visits. The portal displays the screen below inquiring on the nature of the request. The user is asked a series of questions to determine what is needed. Based on this answer, the HHA user is then free to add visits on to the existing authorization or is led down a path of discharge and creating a new authorization. 56

58 Creating Authorizations Review the message. 3. Select the appropriate option. 4. Click OK. If it is determined that the user is to continue working with the existing authorization, the portal displays the pop-up message below. It contains information about what is required to complete the request for more visits under that authorization Review the message. 6. Click Continue. 57

59 Creating Authorizations The portal displays the General tab and you will be prompted to complete specific additional information such as the Start of Care Click inside the Start of Care field and specify the date using the calendar pop-up that is displayed. This is required if there is no value entered yet. 8. Click Next. The portal moves to the Diagnosis tab Modify or specify the fields as needed. 10. After making changes or if no changes, click Next. 58

60 Creating Authorizations The portal moves to the Physician tab. The following physician information must be specified on this page if not yet given. Note: Users can also update the physicians as appropriate in cases such as ROC or new physician assuming responsibility in following the care Users must search by NPI number. Select the physician from names that appear in the list that is displayed. Important: If the desired physician is not found, users can indicate the physician is not found and must enter the required physician information directly into the fields. User must enter the indicated information per the field. Please do not enter invalid information not specified for that field. 12. Click Next. The portal moves to the Service Provider tab. The information that appears is display-only and cannot be modified

61 Creating Authorizations 13. Click Next. The portal moves to the Services tab. All previously requested services in the authorization are also displayed Use the fields in the In Progress area to specify details about the additional care services to be provided to the member. 15. Click Next. The pop-up message below is displayed Review the message. 17. If you need to add more services, click Revise Services to add the addition care using the Add Another Service Line to proceed. 60

62 Creating Authorizations 18. If you want to proceed to the next tab, click Continue to Files. The portal moves to the Files tab. The pop-up message below is displayed Review the message. Note: Selecting I have None of These will give the option to revise or cancel the authorization request. 20. Click OK. 21. Click Browse

63 Creating Authorizations The window below is displayed Navigate to and select the desired document to upload. 23. Click Open. The window closes Click the down-arrow of the Document Type field and select the appropriate option. 25. Click inside the Description field and enter a brief description about the document. 26. Click Add File. 62

64 Creating Authorizations The pop-up message below is displayed Click the checkbox. 28. Click OK. The uploaded document is listed in the lower area of the page Click Save. 63

65 Creating Authorizations After completing the final tab, File Services, the authorization will immediately undergo a series of quality checks; all timely (non-retro) service lines will qualify for auto approval based on clinical guidelines. A message will display the result of the service lines. Some service lines may require manual clinical review. If any service lines were auto approved, the requestor will immediately receive an authorization to their personal business fax number listed on their account, that they set up during registration. To change your personal business fax number, locate the My Account page by clicking on your username in the right upper corner of any page. For any lines that were not auto approved, they will be in pending status and will be sent for manual clinical review. Once a manual determination has been made for those pending service lines, the service status will be updated and visible form the portal. mynexus staff will fax the authorization to your main provider fax number listed on the health plan s provider file. To change the main provider fax number, users can submit the Fax Attestation Form available at Note: At any time using the portal, users can check the status of service lines Click OK. The newly added service line is displayed in the lower area of the Authorization Details page. 64

66 Creating Authorizations New Service Line 65

67 Viewing, Uploading and Printing Documents Viewing, Uploading and Printing Documents This document contains the topics below: Overview These features are part of our File Services functionality and allows users to: View documents that have been uploaded to the authorization Upload supporting clinical documents (not during a request process) Print information about the services requested When authorizations are created, the portal requires that you upload specific clinical documents during the process as reviewed in the Creating Authorizations chapter above. The items that must be uploaded at the time the authorization is created is based on provider type and other care plan variables. Documents can also be uploaded not associated with a request process once the authorization has been created. File Services provides the ability to upload these documents. Note: Only PDF, PING, PEG, PNG format documents can be uploaded to the portal. Zip files are not accepted but can be faxed to mynexus. 66

68 Viewing, Uploading and Printing Documents Understanding File Services Features The Authorization Details page contains features used to perform activities associated with File Services functionality. The screenshot below identified the features on the page associated with File Services functionality The table bellows describes the features identified in the screenshot above. # Page Feature Description 1 View Documents button Used to view documents associated with the authorization. 2 Upload Documents button Used to upload missing clinical documents and additional information. 3 Print Services button Used to print the Services information. 67

69 Viewing, Uploading and Printing Documents Viewing Documents The screenshot below is the Authorization Details page that is displayed after a user selects an authorization that appears on the Authorization List. 1. Click Documents. The Documents menu expands and displays additional options Click View Documents. The portal displays a pop-up window that lists the documents associated with the authorization Click the View link next to the item you want to view. 68

70 Viewing, Uploading and Printing Documents The item opens in a new browser tab. Once the item is displayed, users can rotate the document if needed, download, and print it. The screenshot below identifies the portal features that are used to perform those activities. After you have completed reviewing the item, you should close the browser tab to ensure no PHI is at risk of being compromised Click Close to return to the Authorization Details page. 69

71 Viewing, Uploading and Printing Documents Additional Features on PDF Viewer The PDF Viewer allows user to print or download the items that is displayed in the viewer # Page Feature Description 1 Rotate Clockwise Turns the document that is displayed 90 clockwise. 2 Download Allows users to download the document that is displayed and save. 3 Print Allows users to print the document that is displayed. The document can also be saved using this feature. 4 Fit to Page Reduces the document to completely fit inside the browser window. 5 Zoom In Enlarges the document that is displayed. 6 Zoom Out Reduces the document that is displayed. 70

72 Viewing, Uploading and Printing Documents Uploading Documents The portal provides the ability to upload documents. These can be missing documents that need review or they can be documents that do not require review but just need to be added to the record for audit purposes. Documents can be uploaded from the Authorization Details page using: 1. The Upload Documents button located on the menu. Note: Users should never upload a document containing a request for more visits. HHA users should request more visits for the authorization using the Request Visits button on the menu. Non HHA users can select this button for instructions on what to do if additional visits are needed. When users select this button, they will be asked if the documents they are uploading require review or simply need to be added to the file. Important: It is necessary that the user indicates if the documents require review accurately. 1 71

73 Viewing, Uploading and Printing Documents Verifying Document Upload 1. Click View Documents. 1 The portal displays a pop-up window containing a list of documents that have been uploaded to the authorization. The newly uploaded document appears in the list. 72

74 Viewing, Uploading and Printing Documents Printing Authorization Summary The portal provides the ability to print a summary of all the service lines that have been requested. 1. Click Print Services. 1 The View Services page opens in a new browser tab. The Print View page is also opened in a pop-up which shows the items that will be printed. 2 The Print View page allows you to print or save the item that is displayed. Users can print to any connected device or choose to save the file as a PDF. 1. Click Change to choose the desired output device. 73

75 Viewing, Uploading and Printing Documents The pop-up window below is displayed Select the desired destination from the options that appear onscreen. 74

76 Adjusting Dates Adjusting Dates Overview This section provides information on performing date adjustments. Only an HHA user who is the owner of an authorizations can perform date adjustments on it. Locate the member s authorization that you would like to perform a date adjustment on. Adjusting Dates Procedure Perform the steps below to adjust dates. 1. Search for the member. 1 If the member is found, their authorization history is displayed. 2 75

77 Adjusting Dates 2. Click on the row of the desired authorization. The Authorization Details page is displayed Click Adjust Dates. The Adjust Dates button is displayed to HHA owners if the authorization qualifies for an adjustment by meeting the following criteria: The authorization must be active. Service lines that meet all criteria below can be adjusted: Initial and reauthorization request type Status of Approved Less than 30 days old from the request date No overlapping dates with another service line of the same HCPC/Revenue code can be adjusted If NO authorization s service lines meet the above criteria, it does not qualify for a date adjustment and the Adjust Dates button does not appear as an option on the portal menu. When the authorization does contain service lines that qualify, the button will appear, but only the qualifying service lines will appear as option to adjust. 76

78 Adjusting Dates The pop-up window is displayed as shown below. Users can change the Effective Thru date by using the New Effective Thru field. 4. Click inside the New Effective Thru field for the service line to be modified and specify the new date using the pop-up calendar that is displayed. 4 The calendar displays dates that can be selected on the calendar as darker than dates that cannot be selected. Users who want to make an adjustment that is not offered from the portal must call in or fax their request to the mynexus Intake Department. 77

79 Adjusting Dates 5. Click Submit/Exit. 5 The portal displays the message below. 6 The message informs users that their adjusted dates were accepted and that the adjusted dates do not initiate reprocessing of any previously filed claims. 6. Click OK. 78