Note: The higher the resolution, the less top to bottom and side to side scrolling is required to see the entire screen. Consider using 1280 by 1024

Transcription

1 1

2 2

3 Note: The higher the resolution, the less top to bottom and side to side scrolling is required to see the entire screen. Consider using 1280 by 1024 pixels if you can. 3

4 4

5 5

6 6

7 To obtain the HNFS System Access Request Form, For access to the Training Environment, required for any training activity, open Health Net Connect then: Enter the URL from the training data sheet Save as a Favorite for quick access during class NOTE- External users will not be able to access the CR Training Environment outside of the HNFS office for this training. 7

8 8

9 9

10 10

11 11

12 CCS is the legacy system. For those that have access, it will be available for an undetermined amount of time. 12

13 Note: The first time you log into CareRadius as a new user you will have to enter the assigned password and then change it to a new password. Note: The User ID is case sensitive. 13

14 Note: Your User name is tied to YOU. When you log on, you re presented to the following page AKA Home Page. The system automatically defaults your home page to the Search Portlet. If you do ROFR s, your home page will look a little different. 14

15 If you perform ROFR s at your MTF, you will manually select the drop down list in the Task List, and locate your assigned MTF to view the Tasks to be completed. Once you select your assigned MTF, a list of all the ROFR s will be displayed, oldest tasks display at the top of the list. You will manually select the hyperlink in the Subject to view the authorization and complete the ROFR section. 15

16 16

17 17

18 18

19 19

20 20

21 -The Search Portlet is the Home Page for Care Radius - Member search auto-populates as the default search option. -There are 3 different member search options: (DEERS Family Search, DEERS Unique Member Search, and Member Repository Search). - The user has to -check the box next to the Member search being performed. -DEERS Family Search is used most times because it requires the least amount of information. SEE Next Slide. -The DEERS Unique Bene Search requires at least the Sponsor SSN and one of the other elements. -The Member Repository Search does not call out to DEERS. Instead it searches the CareRadius database. If the member was not entered into that system or if there are more than one member with the same name the search will return inconsistent results. 21

22 -Check the box next to DEERS Family Search -Enter the Sponsor SSN, no dashes or spaces -Select the Search button -You may also perform a retrospective search by manually entering the dates. You can manually enter the dates, or click the calendar and select the desired dates. Note: The Eligibility From and To dates must be entered when: the eligibility inquiry is falls outside of the defaulted range (e.g., retrospective request). the eligibility of the sponsor or beneficiary will change within 90 days 22

23 -The Member Search results can be sorted by column -The system will only display 10 results per page. If there are more than 10 results, use the page numbers displayed at the bottom of the results list to navigate to the next page. 23

24 Additionally : Gender: Beneficiary s gender City: The beneficiary s city of residence State: The beneficiary s state of residence Eligibility From Date: Date entered on the Search page or current date if allowed to auto-populate Eligibility To Date: Date entered on the Search page or 90 days after the current date if allowed to auto-populate Add/Edit Indicator: Indicates whether or not the beneficiary information was recently edited (e.g., permanent address change) or added (e.g., newborn) but not yet updated in DEERS. True = new information. False = All family information is in sync with DEERS 24

25 25

26 26

27 27

28 28

29 -By selecting the member s SSN, you can view the member s Activity Page. This is reviewed in the next slide. 29

30 -How do we know it s the Member Activity page? Note the yellow line at the top of the Activity Tab. The yellow line identifies the Active Tab is in your current view. -The top of each page displays the Member Stripe. From here, you can view any Authorizations on file for the member. 30

31 -The chevron pointing up indicates the Member Stripe is in a maximized state. The chevron pointing DOWN indicates the Member Stripe is in a minimized state. -The minimized Member Stripe only includes the first line Number, Name and Age. If applicable for this member, a second line would display any alerts (e.g., Privacy issues) and any Program enrollments (e.g., ECHO or a Disease Management program like Asthma). -The Details hyperlink opens a view only version of the Member Information Tab, without the Alert information. 31

32 -The Member Information Tab includes demographic information for the member. -A history of Alerts are viewable for the member from the Member Information Tab. -Most of the information in this tab is not used by HNFS. 32

33 33

34 34

35 35

36 -The Search Portlet is the Home page for CareRadius and will default to the Member search portlet. Select Provider from the dropdown list. NOTE- Provider and Provider Locations are the same, either selection will display the Provider search fields 36

37 -On the next few slides we ll discuss the different search options / fields and drop downs.. -We ll discuss the drop down lists on the next Left Side: Right Side: Contract Status Region Code Provider Type State Specialty Language Provider ID Type Provider Gender Facility Services Description Radius Search: State Search In Radius 37

38 -Note- The Contract Status always defaults to Network, Provider Type defaults to Individual, and Region Code defaults to North. You may manually change the values. -If you re searching for an Acute Care Hospital, this is an example of where you need to change the Provider Type to Facility. If you perform the search and keep the value set to Individual Provider Type, no providers are returned. 38

39 39

40 Other basic fields: -Provider Gender = Male or female -State = (None) or 2 character state code -Language = includes over 80 languages ranging from Albanian to Zulu 40

41 If the search does not produce a provider, the system displays error message: {PROV} No result found for and will include criteria needed to complete search. 41

42 -Using the Radius Search option, the Provider Search portlet also allows you to find a provider when a specific provider has not been identified. -The MapInfo System used to perform radius searches is called GeoSearch, and is designed to locate the closest provider based on the member s address. You have the ability to edit the drive time and distance fields. The GeoSearch is performed using the beneficiary s geographical data. If HNFS receives a request for a beneficiary, and no servicing provider was identified, we will use the Radius Search to locate a provider. 42

43 43

44 Group = Princess for Princess Anne Urgent Care, Surgery PC, Imaging Center, Psychiatric are the results Facility = Southside for Southside Hospital or Regional Medical Centers are the results 44

45 45

46 -Clicking the column headers on ANY results page will allow you to sort that data. -Providers are always displayed in a random order to prevent the same providers from being put at the top of the list for each search. -When performing a Radius Search, select the Time/Dist Status to resort the order of the results. When selecting, you can re-sort the order for the closest providers to be displayed at the top of the list, the furthest at the bottom of the list. 46

47 -When a provider is selected, it opens to the Standard View. There is not that much information available here. Select the Custom Provider hyperlink in the top right corner to view more information.

48 -Custom Provider View displays some helpful information including the reimbursement model for Acute Care Facilities DRG/Per Diem

49 49

50 50

51 51

52 52

53 -Most Government users will not have the HNFS generated Authorization number. Most searches will be performed by Member Search, locating the member and reviewing the Activity Page to view the Authorization history. 53

54 -In this search, you will perform a member search as reviewed earlier. You will locate the member and view the Authorization/Referral History from the Activity Page. This will be the way you search for cases more frequently as often you won t have the HNFS generated Authorization number. 54

55 -If you don t have the HNFS generated authorization number, enter the members SSN as we reviewed earlier, select the member from the list to view the Activity Page. 55

56 Helpful Tips The Activity Page always defaults to show the last 90 days of history in your immediate view. If you re looking for an authorization that is older than 90 days, manually delete the date defaulted in the Global Activity Date Filter, and select the Refresh button. By removing the date, the system will display all the activity history for the member 56

57 -To view the authorizations, select the expand icon. Note After the Global Activity Date was removed the date and selected Refresh, there are now 44 Authorizations available. 57

58 -To see the service line information associated with the authorization, select the + icon beside the date in the Service Begin field. This will display all the service lines. Here you will see the Service Type, Status Reason, and Procedure Codes. -In this example, we see a Specialty Referral that is Approved, the Procedures or CPT codes, and the Facility the Referral was approved to. Note that there are two service lines attached to this referral. One service lines ends in 001, and second, ends in By selecting the expand icon, you can view additional summary-level information without opening the authorization -If there are multiple authorizations, the most recent one appears at the top of the list, oldest cases are displayed at the end of the list -There may be multiple pages, select the desired page number to view older authorizations. 58

59 -To narrow down your search to a more specific Authorization type, the Filter Authorizations is helpful. From here, you can select to narrow down your view to a particular auth type. For example Show only Inpatient Authorizations. 59

60 -From this page, you can select to view only Inpatient Authorizations, or to view only those that are Approved. 60

61 61

62 -You will now see a new tab, just as the one shown here with the authorization number. 62

63 -In this search, you will need the HNFS generated Authorization/Referral Number, or the UIN/Order Number. This is the quickest way to locate an exact case if you have the number. -CareRadius automatically assigns a sequential number to every referral or authorization entered into the system. This number is called a reference number. Also known as a Tracking number in CCS (Legacy System). -The reference number stays with the authorizations throughout its life cycle, regardless of status and status reason. -The reference number is listed in the General Information Tab, Authorization Main panel bar link. -It will also display on the letter in the Reference Number field. 63

64 -To perform a search using a reference number, authorization number, or UIN/Order number go to the Home Page, open the search portlet, and select the Auth/Referrals option from the drown-menu. -The search screen will change to display fields to search by reference number. -Avoid using the Auth/Referral Services option because it requires additional numbers you may not have access too. 64

65 -If you have the unique HNFS generated Reference/Authorization number, this is the quickest, easiest way to locate the case. Simply enter in the number, and the case will be returned. 65

66 66

67 NOTE When you search for a case by the Reference/Authorization number and select the case, you by-pass the member activity page and go directly into the authorization. However, you still have access to view the Members Activity page from the Authorization. Simply select the Activity Tab directly to the left of the authorization tab. 67

68 68

69 Note- The UIN # must include the dashes 69

70 -An exact match should be returned. To view the authorization, select the Reference number. 70

71 NOTE When you search for a case by the Reference/Authorization number and select the case, you by-pass the member activity page and go directly into the authorization. However, you still have access to view the Members Activity page from the Authorization. Simply select the Activity Tab directly to the left of the authorization tab. 71

72 72

73 73

74 74

75 75

76 76

77 -The user must have been able to successfully search for a beneficiary and or search for an Auth/Referral. 77

78 Helpful Tips We suggest starting at the General Information Tab and working your way from left to right to the Documentation Tab. Each of these tabs has important information about the Authorization. You will know what tab is in your current view, as it will be illuminated yellow above the tab. In this example We are viewing the General Information Tab, it has a subtle yellow bar above the name. -Also pay attention to the Navigation Panel for the tab you re currently viewing. In this example we are in the General Information Tab, and the Panel Bar options for this tab are displayed. Note ROFR Main is only used when a case has pended for ROFR. 78

79 79

80 -The General Information Tab/Authorization Main shows who the requesting provider is, what is being requested, the request priority, and diagnosis information. 80

81 -The Reference Number is automatically populated by the system during the initial creation of the case. This is not an authorization number, rather a tracking number. Only when the case is closed and in a final status, will a Authorization number be populated. 81

82 82

83 83

84 -Request Profile corresponds to the type of service being requested. In this example, the request is for a Evaluate and Treat Specialty Referral. This is a Routine request. 84

85 In this example This is a request is for a Behavioral Health Outpatient Therapy. This is a Routine request. 85

86 86

87 -Multiple Diagnosis may be added, only one is selected as the Primary Code. -The ICD 10 has replaced the ICD 9, however you may still see the ICD9 codes in older auths. Also DMVIV typically not used, BH uses ICD 10 87

88 -By selecting the Custom Member hyperlink, you will see more information about the sponsor including branch of service, rank, MTF Optimization indicator to name a few. Note: The Member Snapshot is only available within an authorization. This information is not available just by performing a Member search. 88

89 This section has important details: -Branch of Service -Pay Grade -MTF Optimization Indicator This indicator is very important as it indicates if the member is in catchment to a MTF. If the indicator is set to Yes, most requests for service will ROFR back to the MTF. 89

90 90

91 91

92 -The Date Request Received field captures the date HNFS received the request, not the date it was entered into CareRadius. However, they may be the same day. 92

93 93

94 -The Services Tab will show you the service line information to include the services requested, status of the services, quantity, and the Servicing Provider information to name a few. 94

95 -In this example, there are two service lines associated with this authorization. They both have the same reference number, but proceeded with 001 for the first line, and 002 for second line. The service line that s highlighted yellow, will have the corresponding information displayed. To view the detailed information for the second service line, click the line. Once the line is highlighted yellow, more detailed information will display. This is demonstrated on the next image. 95

96 -In this example, service line number 2 is highlighted yellow, and displays the corresponding information below. 96

97 -This is important information as it shows what the valid Service From and To dates are, the Procedure code(s), and the quantity. 97

98 -In this example, I can see that the service was Approved, and a TRICARE Covered Benefit. 98

99 99

100 100

101 -This is the date HNFS had all the information to process the case. 101

102 102

103 -In this example, there are 13 service lines associated with this authorization. Notice that each service line is proceeded with 001 to

104 104

105 Helpful Tip Keep the All Documentation selected to view all the documentation. By changing to other options (Notes/Document History), that acts as a filter and will only show that documentation type. 105

106 -Make it a best practice to always get in the habit of filtering all documentation and deleting the date when you open the Documentation Tab. 106

107 -Manually delete the date in the From Field to view any documentation for the case older than 30 days. Once you ve deleted the date, select the Apply Filter button. 107

108 108

109 109

110 110

111 111

112 112

113 113

114 114

115 115

116 Helpful Tips - You can filter the view by selecting the Document History link on the panel bar. -The Document History will display all the correspondence that was created for the authorization. Correspondence is Identified with the Document Name Auto Generated Auth Letter. Also note that in this example, the Status of the letter is Pending. This indicates the letter has not yet been sent. All letters are sent same time, so in Production, you should rarely if ever see a status of Pending, rather Success. 116

117 117

118 -The communication history detail will open in a new tab. 118

119 In this example of the Communication History Detail, we see the following information: -The Date the Task was Initiated -The Type of Letter Sent/Template Name This is an example of a Specialty Referral Approval Letter to the Beneficiary -The Bene/Role, and Mailing Address. NOTE-All Beneficiary letters are sent via mail to the address we have on file at the time the authorization was created. 119

120 -If you scroll to the right of the Communication History Detail record, you will see the Status and Status Reason. This indicates if the letter was sent Successfully, or in this example, the letter did not get sent. Again, in production, you should rarely see letters that didn t get sent. -To View a copy of the letter that was triggered or sent, simply select the View Document button. All Letters open in Adobe PDF. 120

121 -Pfd view of the letter that was sent. -Use the arrow button from the tool bar to scroll to the 2 nd page of the letter. -The user can print the letter by selecting the printer icon from the tool bar. 121

122 122

123 123

124 124

125 125

126 -The user must have been able to successfully search for a beneficiary and or search for a case. 126

127 -Just like the outpatient authorization, the General Information Tab contains the same information. 127

128 128

129 129

130 130

131 Note-If the request is Urgent or Emergent, this is a good indicator the patient presented through the ER and admitted. 131

132 -There only difference in the Navigation Panel for Inpatient Authorizations, is the Inpatient Details. Otherwise, it functions the same way as the Specialty Referral/Authorization slides. 132

133 133

134 The Inpatient Details displays: -The Target LOS goal length of stay -Actual Admission Date -If no admission date is listed, the inpatient authorization is a prior auth. The anticipated date of admission is listed in the From field. -Actual Discharge date -Includes the discharge disposition -If there is an admission date, but no discharge date is listed the patient is either still in the hospital or HNFS has not been notified of the D/C yet 134

135 135

136 The Inpatient Details displays: -The Target LOS goal length of stay -Actual Admission Date If no admission date is listed the inpatient authorization is a prior auth. The anticipated date of admission is listed in the From field. -Actual Discharge date Includes the discharge disposition 136

137 Helpful Tip Keep the All Documentation selected to view all the documentation. By changing to other options (Notes/Document History), it filters the view and will only show that documentation type. 137

138 -Manually delete the date in the From Field to view any documentation for the case older than 30 days. Once you ve deleted the date, select the Apply Filter button. -Make it a best practice to always get in the habit of deleting the date when you open the Documentation Tab. 138

139 139

140 140

141 141

142 142

143 143

144 144

145 -If you do not currently have access to view case management cases complete the access request form, check the case management box and fax to the number listed on the top of the form. 145

146 -Beneficiaries that are enrolled in the Case Management Program, will have the Program displayed in the Member Stripe. In this example, we see that the beneficiary is enrolled in the Physical Health Case Management Program. 146

147 -Unlike searching for an authorization or referral by the unique HNFS authorization/reference number, there is no unique case number to search for a Case Management module. To view the Case Management module, you must first locate the member by performing a member search, and viewing the Activity Page. -To open the Case Management Module from the Activity page, select the hyperlink Case Management Physical health 147

148 -The two tabs you have access to viewing are the Program and Documentation. 148

149 -The Program Main form displays the status of the case -Open -Pending -Closed -Begin and end dates for the program -Lists all of the case managers who are involved in the case -Indicates which case manager is primary -Program Outcome information is not completed until after the 6 months once the beneficiary is closed to the case management program. 149

150 150

151 Helpful Tip Keep the All Documentation selected to view all the documentation. By changing to other options (Notes/Document History), it filters the view and will only show that documentation type. 151

152 152

153 -Manually delete the date in the From Field to view any documentation for the case older than 30 days. Once you ve deleted the date, select the Apply Filter button. 153

154 -Government Users are able to view 30 Day Summary notes AKA M180. The HNFS Case Manager enters a 30 day summary note monthly. This provides a summary of where the beneficiary is at with their goals. To view the note, select the hyperlink under the Assessment Type. 154

155 155

156 -Using the x to close the case may cause it to lock. -The system will return you to the member s activity record. 156

157 157