Therapy Provider Portal. User Guide

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1 Therapy Provider Portal User Guide

2 Page 2 of 16 UCare User Guide V1.7 Table of Contents I. Introduction...3 About HSM Therapy Management... 4 Terms of Use... 4 Contact Information... 6 II. Using the Therapy Authorization Portal...7 Registration Instructions... 7 Submitting Authorization requests on-line... 9 Viewing Authorization requests on-line Provider Resources Support... 16

3 Page 3 of 16 UCare User Guide V1.7 I. Introduction This document has been prepared to serve as a general guide to interacting with the Therapy Provider Portal and its associated workflow processes. Development teams have dedicated significant resources to making the application as user friendly as possible. Testing with Therapy practitioners has influenced the design of the application such that it should be easy to navigate by providers and their support staff. The application is available 24 hours a day, 7 days a week using your web browser (Internet Explorer 5.0 or greater). This authorization portal is available to both participating and non-participating providers as long as they have been identified and approved by UCare. If you feel that you meet these criteria but do not have the necessary credentials (i.e. UCare Provider ID) to use the Provider Portal please contact UCare. UCare Provider Assistance Center: or (toll free).

4 Page 4 of 16 UCare User Guide V1.7 About HSM Therapy Management: UCare has partnered with Health Services Management, Inc. (HSM) to manage the utilization of UCare member s outpatient and in-home rehabilitative and habilitative therapy services. As you are aware, as of January 1, 2011, UCare required prior authorization (PA) of therapy services beyond the 10th visit. I want to inform you of another important change in our PA process for therapy services. Beginning June 1, 2011, PA requests for additional therapy services beyond the 10th visit for each of therapy services (i.e. physical, occupational, and speech) will need to be submitted to HSM, rather than UCare s Clinical Services Department. UCare will transfer all PA approvals for outpatient and in-home therapy services that occurred prior to June 1st to HSM. If additional therapy visits are required beyond what UCare authorized, you will be required to submit the initial evaluation, progress notes, treatment plan, and any other relevant clinical information to HSM for continued authorization. Terms of Use Health Services Management, Inc. ( HSM ) has established this web portal for the convenience of Providers and to support the efficient delivery of medically appropriate specialty healthcare services. By using this Site, a provider may electronically send and receive protected health information. As a provider using this Site ( Provider ), you the Provider agree that your access and use of this Site are subject to the following terms and conditions. You will be required to electronically accept these terms of use and are thereby entering into an ( Agreement ) to comply with the following terms. Access to the Site. HSM has provided or will provide a Provider a password (the Password ) and a unique user identifier (the User ID) for electronic access to the Site which shall permit Provider to view and transmit certain information with respect to Health Plan Members. Access to this information shall be conditioned upon Provider s entry of the Password, User ID, and any other information required by HSM. In the event HSM issues multiple Passwords and User ID s for individual employees or agents of the Provider, the provisions in the Agreement that refer to the the Password and the User ID shall apply to all Passwords and User ID s issued to the Provider. Password Confidentiality. Provider will treat the Password as confidential and take all necessary steps to maintain the confidentiality of the Password and User ID, and will permit only its authorized employees and agents to have access to the Password and User ID. Only authorized employees and agents who need to use the Site for the

5 Page 5 of 16 UCare User Guide V1.7 performance of their job shall have access to the Password and User ID. Provider will notify HSM immediately if Provider believes confidentiality of the Password or User ID has been compromised or if an employee or agent with access to the Password or User ID leaves Provider s employment or agency, and HSM may, in its discretion, deactivate Provider s current Password and User ID and issue a new Password and User ID to Provider. At HSM s request, Provider shall provide HSM a list of persons who have access to the Password and User ID and a description of the safeguards used to ensure appropriate access. Use and Ownership of Information. Provider will use information available through the Site solely for purposes of providing services and determining coverage for patients. Provider acknowledges that the Site and all information retrieved through the Site is proprietary information of HSM, and its Health Plan clients, and shall be and remain the exclusive property of HSM and its Health Plan clients. Other than pursuant to the terms of this paragraph, Provider shall not appropriate or use any information retrieved through the Site without HSM s prior written consent. Provider acknowledges that any reliance on information contained at this Site is at the Provider s risk. Use of Site. Provider shall not use the Site for communication to HSM of information in any urgent or emergency situation. Provider will not knowingly introduce a virus-bearing document into the Site. Provider will notify HSM if Provider believes a virus has been introduced into the Site. Compliance with Laws. Provider agrees to comply with all applicable laws relating to Provider s use of the Site. Provider understands that HSM and Provider shall be subject to the rules and regulations promulgated pursuant to the Health Insurance Portability and Accountability Act ( HIPAA ), including 45 C.F.R Parts 160 and 164 relating to Standards for Privacy of Individually Identifiable Health Information (the Privacy Rules ). Provider shall cooperate with HSM to comply with the Privacy Rules, and agrees that HSM shall have the right to terminate Provider s access to the Site in the event that Provider fails to take all necessary actions for compliance with the Privacy Rules. Security. This Site uses Secured Socket Layer (SSL) encryption to protect the privacy of data during transmission across the Internet. This Site supports 128-bit encryption strength. Although HSM has taken these and other reasonable security measures, HSM and its Health Plan clients do not make any representations or warranties regarding the security of data exchanged to or from the Site over the Internet or through other electronic means. Indemnification. Provider shall assume sole responsibility for and shall defend, hold harmless and indemnify HSM and HSM for any and all claims, liabilities, damages,

6 Page 6 of 16 UCare User Guide V1.7 or judgments that may arise out of the acts of omissions, including any breach of this Agreement or any other unauthorized disclosure or use of any protected or confidential information retrieved from the Site, by Provider or its employees, agents or representatives. The provisions of this paragraph shall survive termination of this Agreement. Disclaimers and Exclusion of Liability. HSM and its Health Plan clients specifically disclaim to the fullest extent permitted by law any warranties, whether statutory, express or implied, regarding the Site, (including, where law permits, implied warranties of merchantability and fitness for a particular purpose). HSM and its Health Plan clients shall not be liable for any losses, damages or claims of any nature whatsoever arising from Provider s use of the Site. Amendments and Termination. HSM may amend the terms of this Agreement at any time by posting revised terms and conditions on the Site. Revised terms and conditions will become effective five days after posting. By continuing to use the Site after that time, Provider agrees to abide by and be bound to the revised terms and conditions. HSM may terminate Provider s Password and access to the Site without notice at any time for any reason. Entire Agreement: This Agreement and any additional terms posted by HSM on the Site constitute the parties complete agreement on the matters specified in this Agreement, and supercede all prior representations or agreements with respect to such matters. No oral modification or waiver of any of the provisions of this Agreement shall be binding on either party. Contact Information: Please contact HSM for all questions related to therapy authorizations, therapy provider web portal, and any other therapy authorization processing questions. HSM, Inc. Provider Customer Service: or (toll free). Mail to HSM at: HSM, Inc Hudson Road, Suite 190 St. Paul, MN Please contact UCare if you need assistance with non-therapy related authorizations or provider/network inquiries. UCare Provider Assistance Center: or (toll free)

7 Page 7 of 16 UCare User Guide V1.7 II. Using the Therapy Authorization Portal The Therapy application can be accessed by navigating your web browser to and logging on to the web site. Registration Instructions Navigate to the aforementioned HSM UCare therapy provider portal URL and select Log-in from the upper right menu options. Click here to Log-in or to access new user registration process. NOTE: ID verification is case sensitive First time users - click here to access registration process process

8 Page 8 of 16 UCare User Guide V1.7 Please enter the required information to initiate the process to receive a new user ID. If you do not know the UCare provider specific information requested during the portal enrollment process please contact UCare Provider Services at or (toll free). Upon completion of the Online Account Enrollment Form your request will be validated and you will receive separate s containing your User Id and Password. Please review the following terms of use as they specifically relate to your User ID and Password: Access to the Site. HSM has provided or will provide a Provider a password (the Password ) and a unique user identifier (the User ID) for electronic access to the Site which shall permit Provider to view and transmit certain information with respect to HSM Members. Access to this information shall be conditioned upon Provider s entry of the Password, User ID, and any other information required by HSM. In the event HSM issues multiple Passwords and User ID s for individual employees or agents of the Provider, the provisions in the Agreement that refer to the the Password and the User ID shall apply to all Passwords and User ID s issued to the Provider. Password Confidentiality. Provider will treat as confidential and take all necessary steps to maintain the confidentiality of the Password and User ID, and will permit only its authorized employees and agents to have access to the Password and User ID. Only authorized employees and agents who need to use the Site for the performance of their job shall have access to the Password and User ID. Provider will notify HSM immediately if Provider believes confidentiality of the Password or User ID has been compromised or if an employee or agent with access to the Password or User ID

9 Page 9 of 16 UCare User Guide V1.7 leaves Provider s employment or agency, and HSM may, in its discretion, deactivate Provider s current Password and User ID and issue a new Password and User ID to Provider. At HSM s request, Provider shall provide HSM a list of persons who have access to the Password and User ID and a description of the safeguards used to ensure appropriate access. Submitting Authorization requests on-line Click here to reach the on-line authorization request process.

10 Page 10 of 16 UCare User Guide V1.7 Click here upload clinical notes Complete the information as required in the Therapy Prior Authorization Request Form above. Note that this electronic form closely resembles the fax cover sheet that you may have been using to submit faxed therapy authorization requests to UCare. We hope that it is therefore intuitive and should improve your authorization request experience.

11 Page 11 of 16 UCare User Guide V1.7 You may still fax in your request rather than submitting it on line via this form please do not send both a fax and an on-line request. Submitting your request on-line requires that you have the appropriate medical records (clinical notes) available to you via a local or shared network drive (your computer). The most common file types for medical records are.pdf (Adobe

12 Page 12 of 16 UCare User Guide V1.7 Portable Document Format) and.tiff (Tagged Image File Format). The provider portal accommodates both of these file types. Simply select the Upload File button as you are completing the Authorization Request Form and follow the prompts to browse your computer for the appropriate records. Once located, select the file and the upload process will commence. Depending on variables such as connection speed, size of the document file, etc.. the process may take a few moments. Typical records usually take less than five seconds. You then can complete the transaction and exit or choose to submit another Therapy Authorization Request. Note that you have an option of receiving an when your authorization determination is available on-line. If you elect this option you will receive an message that serves as an alert that HSM has now completed your request. The will not contain any Protected Health Information (PHI). Electing to, or not to, receive this does not change in any way how your therapy request will be handled at HSM. In all cases your electronic authorization letter will be available to you both on-line and via fax. Once you request has been completed by HSM it can be viewed and printed by logging onto the provider portal. The next section of this guide explains this feature in detail. Viewing Authorization requests on-line Upon completion of your authorization request, HSM will provide both an electronic copy (via this portal) and a faxed copy of your important authorization information. As a reminder, if you elected to provide your information during the on-line request process you will receive notification alerting you that your recent request is now complete. HSM understand the importance of quickly completing your requests and is very focused on exceeding your fulfillment expectations. You can access the authorization on-line by selecting the link View Authorization Outcome as illustrated on the following page.

13 Page 13 of 16 UCare User Guide V1.7 Click here to view the results of your authorization request. You will be presented with a form (illustrated below) that requires specific data concerning the authorization outcome you are seeking. Please provide accurate UCare Member ID and date of birth (DOB) for the authorization. For privacy reasons you will only be granted access to authorizations for your clinic location. Clinic location is defined by your UCare Affiliation Number. The system will provide access to the most recent authorization letter the system is not intended to be used for archiving historical authorizations. If you have submitted an authorization request and it is not available when you attempt to look it up it may not be complete yet. HSM is very focused on completing your authorization requests as soon as possible most are completed in 2-3 business days or less. However, a lack of complete and legible information in the clinical notes can lead to delays and requests for additional information. Selecting to receive the aforementioned notification is a convenient way to be alerted when you request has been completed. Enter UCare member specific data here.

14 Page 14 of 16 UCare User Guide V1.7 If you have entered correct information that matches a completed authorization request you will be presented with a screen (as illustrated below) that allows you to print and or view the authorization request. If the information does not match an existing authorization, the information entered was incorrect, or you do not have permissions to view the authorization as it is at separate care system location, the search results will return a message indicating that there are no matching records. While HSM supports printing of the document, the system does not allow the electronic exporting of the document or data. Please not the printing instructions in the highlighted text boxes below. Using your browser print button will produce a blank page please use the print button on the left panel. To print click here

15 Page 15 of 16 UCare User Guide V1.7 Provider Resources HSM also provides links to important therapy websites and other artifacts that we feel are helpful to therapy providers. One example is copies of our Clinical Policy Bulletins (CPBs) as they relate to therapy services. The CPBs are developed by HSM from clinical valid research studies. The intent of the CPBs is to provide a guide to Providers to make effective and consistent treatment decisions. Examples of CPBs include: Measurable Progressive Improvement, Guidelines for use of Passive Therapies, Record Keeping and Documentation Standards, Guidelines for use of Active Therapies and Appropriate use of CPT We welcome any feedback you may have concerning additional resources and provider features that you feel you and your professional peers may find valuable. To share your thoughts, please be encouraged to contact HSM at the support numbers located elsewhere in this user guide.

16 Page 16 of 16 UCare User Guide V1.7 Thank you for you interest in the Therapy Authorization Portal. For questions or concerns use the following contact information: Support Please contact HSM for all questions related to therapy authorizations, therapy provider web portal, and any other therapy authorization processing questions. HSM, Inc. Provider Customer Service: (toll free). Mail to HSM at: HSM, Inc Hudson Road, Suite 190 St. Paul, MN Please contact UCare if you need assistance with non-therapy related authorizations or provider/network inquiries. UCare Provider Assistance Center: or (toll free)

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