Online RA Transactions

Transcription

1 Overview Notification / Authorization Requirements Submit the authorization request for Advanced Reproductive Technology services at least one week prior to the date of service, or if services take place on a weekend, holiday or after hours, submit the authorization request no later than the next business day after initiating the services. Reminder: Failure to comply with Harvard Pilgrim Health Care authorization requirements will result in an Administrative denial of the claim payment. Members cannot be held liable for claims denied for failure to meet these requirements. Submission Process Go to Select For Providers. Click on log into HPHConnect and sign in. Step 1. Verify patient eligibility. Is the patient active with HPHC? If no, contact the patient for information. Step Check Referrals/Auth status to see if a transaction is already in the system. If yes, review the Service Request Record Detail. Step 3. If no transaction exists, enter the Outpatient request. Requesting Provider Only providers with the specialties listed can submit ART transactions: Acute Care Facility Fertility Clinic Infertility Sterility Provider Reproductive Endocrinologist IMPORTANT: Be aware that providers not participating in First Seniority must call Harvard Pilgrim directly to enter notification / authorization transactions for First Seniority members. Servicing Provider One (1) Servicing Provider is required on transactions for ART services and can be any of the following specialties. Acute Care Facility Fertility Clinic Infertility Sterility Provider The provider s name or HPHC provider number is required. 08/06/2003 HPHConnect Service Center Page 1 of 7

2 Enter the Transaction Outpatient Services Form 08/06/2003 HPHConnect Service Center Page 2 of 7

3 Required Fields All required fields display a blue dot, and must be completed in order to process the request. This includes the following: Patient Requesting Provider Diagnosis, at least one ICD-9 code is required. Up to 12 can be submitted. Servicing Provider, only one (1). (Can also be the Requesting Provider.) Requested Service Advanced Reproductive Technology Start Date & End Date Release of Information In addition to the standard Required Fields, the Requesting Provider must supply: Contact Name and Contact Number Procedure Code, a valid ART procedure code Related Cause information, if the service requested is due to an automobile accident (check Auto, specify the Date of the accident, and the State/Prov or Country) 08/06/2003 HPHConnect Service Center Page 3 of 7

4 The Transaction Response Key Information In the blue title bar, you will find the: Transaction number, e.g., HPA12345 Status of the transaction - Approved, Pended* or Denied Member s Name and Member s ID# *Note: all ART transactions Pend for review. On approved ART transactions, the End Date displays but not the # of Units Approved. A letter that details the specific services authorized is mailed to the provider. The Remarks field displays a summary explanation of the status of the transaction. The Edit button only displays on approved transactions. The Cancel button displays on Pended and Approved transactions. Finalized ART Transaction Patty Patient Patty Patient HP /06/2003 HPHConnect Service Center Page 4 of 7

5 Pended for Review All ART transactions pend for review. When a transaction pends for review, the HPHC reviewer updates the ART record to reflect the final status, Approved or Denied, within two (2) business days of receiving all information needed to complete the review. The Requesting Provider, Servicing Provider and PCP will receive notification of the changed status of the transaction via the Activity Summary, if enabled. Pended ART Transaction MARGUERITE CANARD MARGUERITE CANARD HP /06/2003 HPHConnect Service Center Page 5 of 7

6 Revisions to an ART Transaction Guidelines Important: 1. ART transactions with a Start Date of 6/30/2003 or later can be edited online. Art transactions with a Start Date prior to 6/30/2003 cannot be edited online. You must continue to request edits to these transactions via phone or fax to Harvard Pilgrim. Only the Requestor or the Servicing Provider can Edit or Cancel a transaction. Only approved transactions can be edited. Only approved or pended transactions can be canceled. No changes can be made to: the type of request (Outpatient, Admission, Specialist, Home Care, Transportation), the Patient, or the Service Requested (Adv Repro Technology vs. a different service on the list). All ART transaction Edit submissions pend for review. Note: Revision of procedure code on an approved ART transaction requires authorization. Submit/request the revision prior to rendering the service. Reminder: Failure to comply with Harvard Pilgrim authorization requirements will result in an Administrative Denial of the claim payment. Members cannot be held liable for claims denied for failure to meet these requirements. Edit the Transaction Before the Start Date Edits can be made to the following fields: Servicing provider Diagnosis code (add or change) Procedure code (add or change) Start date (not prior to today s date) End date (no more than one year from Start Date) Units (add or reduce) After the Start Date but prior to the End Date Edits can be made to the following fields: Diagnosis code (add or change) Procedure code (add or change) End date (not prior to today s date & no more than one year from Start Date) Units (add, only) 08/06/2003 HPHConnect Service Center Page 6 of 7

7 After the End Date HPHConnect will not accept requests for edits after the end date of a record. Cancel the Transaction When to Cancel a Transaction The requestor or the servicing provider can Cancel a pended or approved transactions at any time, if: 1. The record was entered for the wrong patient. The wrong service type was selected in the original request, i.e., a service other than Advanced Reproductive Technology. To correct this error, it is necessary to cancel the original record and enter a new one for the appropriate service. 3. The wrong type of request was submitted, i.e., Specialist or Admission rather than Outpatient, etc. 08/06/2003 HPHConnect Service Center Page 7 of 7

8 Prior to submitting an ART Transaction: HPHConnect Advanced Reproductive Technology (ART) Quick Reference To submit an ART Transaction: 1. Check member eligibility 1. Select the Outpatient tab. 3. When you are sure that you have the correct member, click on Select to add the member to the Patient List. Check to see if an ART authorization is already in place (See To search for ART Transactions below) 3. Complete the required information for the Patient, Requesting Provider, and Servicing Provider. Provide Contact Name/Number and Requested Service information, including the Procedure Code, Units, and Start/End Dates. 4. Have your provider ID number 4. Complete any additional optional fields Have the attending physician s HPHC provider ID number, which you can find via the Office Management / Provider Directory. Have the diagnosis code(s) and ART procedure code, which you can preselect from the Office Management / Code Lookup. These codes are required for all ART transactions. 5. Click on Submit 6. The response will be returned to you directly and display the status. 7. To print a copy or the response for your records, use the Print Referral link. To search for ART Transactions: Helpful Hints: In Patient Management, select the member from the Patient list. 1. Click on the Referrals/Auths link to access the Service Request Search Results screen that will display a list of the member s referrals/admissions. (Optional) To sort the data on the Service Request Search Results screen, click on the column-heading link: single click for ascending order or double click for descending order. Click on the number link in the Service Request Number column to access the Detail of an existing record. If no record exists for the service in question, click on Add to enter a new transaction. 3. To enter multiple diagnosis or procedure codes, separate the codes with a semi-colon. Do not leave a space between the characters. (Example: 250;780). To advance from field to field, use the TAB key instead of using your mouse. Do not hit Enter unless you need to Search for the information for a field. 4. To move the cursor back a field, use the SHIFT + TAB keys together. 5. Approved ART transactions will display Start Date and End Date but not the # of visits approved. A letter will sent out with specific information. Troubleshooting problems: 1. If you receive an error message and need to correct data in one or more fields, click the Return to previous page link to correct the mistake(s) and resubmit the request. If you receive the message, Your request has not been returned from the server. You will receive a communiqué shortly., click your browser Back ( ) button to resubmit the request. 3. If you have not used HPHConnect for 15 minutes, you will need to Sign In again before you can create a new admission transaction. Prepared by: HPHC Provider Training Department HPHConnect Service Center:

9 Outpatient Tab Advanced Reproductive Technology 1. The Patient Name auto-populates from the Current Patient list. Requesting Provider: An HPHC contracted Acute Care Facility Fertility Clinic Infertility Sterility Provider, or Reproductive Endocrinologist 3. Enter Contact Name and Contact Number in the two corresponding fields. 4. Diagnosis: You can enter up to 12 diagnoses. Search by code or by name. Be sure to include the decimal point if the ICD-9 code requires one. If you know the correct codes, you can submit multiple entries at one time, separated by a semicolon. If not, see below*. 5. Enter the Servicing Provider: one of the following (Requesting Provider can be the Servicing Provider.) Acute Care Facility Fertility Clinic Infertility Sterility Provider 6. Select the Requested Service from the menu: Advanced Reproductive Technology 7. Enter the Requested Units. 8. Required: Enter a valid ART Procedure code. 9. Enter both the Start Date and End Date of service: maximum date range = 1 year. 10. Optional. A Delay Reason may be selected if the request is submitted late. 11. Related Causes: Check one or more boxes, as appropriate. If an automobile accident is indicated, that date of the accident must be given. Select from the drop-down menu the state in which the accident occurred. 1 Release of Information: Select Informed Consent/Med or Signed Statement/Claims 13. Remarks: This is a message board to communicate information between the Provider and HPHC. 14. Click on Submit to send the request. *When Entering Multiple Diagnoses: If you don t know the correct names or terms for a field, you must search for each entry individually. a. Enter a partial name or number in the appropriate field. b. Click on the Search button at right. A list, beginning with the characters you entered, will appear. c. Select the correct item from the list provided. d. Repeat this process for each entry.