NHPNet Online Referral User Guide

Transcription

1 NHPNet Online Referral User Guide Submitting Referrals through Health Trio October 30, 2012, v 1.2 nhp.org

2 Introduction NHPNet, a web-based tool, is used to submit referrals for specialist visits and authorization requests for specific services and to receive real updates on the status of these requests. To submit a referral request the NHPNet user must have the appropriate provider permissions and the patient must have an active NHP Eligibility. The following table lists the service types that can be created in the NHPNet application and provides a brief description of each referrals link available: NHPNet Referrals Tabs Referral Status Brief Description Allows user to create and send a real-time referral request to NHP Allows user to search and view all Referral responses. Helpful Hints NHP s systems are updated for maintenance on the third weekend of every month, from Friday at 5:00 p.m. until Monday morning. You will be able to enter Referrals or Authorizations during this time, but you will not receive a status report until Monday morning. Please indicate in the Remarks section of the Referral/Authorization if you have attached a document to the auth request in NHPNet. If a user requires access to a specific Referral link/feature, it must be approved by your assigned NHPNet system administrator. Error notification: If required fields have not been entered, one or more error messages will show immediately after hitting the Submit button. You will be able to return to the original screen and complete the fields. Revision requests can be made on existing referrals when requesting additional visits or to add remarks. NHP will not accept corrected/revised dates of service through Health Trio, therefore NHP recommends a one-year date span for referrals. Referral status Health Trio Status NHPNet Status Edit Functionality Yes or No PEND PEND Yes APPROVED APPROVED Yes CANCELLED CLOSED No NOT CERTIFIED DENIED No The following services should continue to be requested via NHP s vendor sites: Sleep Studies Sleep Management Solutions (SMS) Outpatient MRI s, CT, and PET imaging studies MedSolutions p. 2

3 Logging into NHPNet to Submit Referral and Authorization Requests Log onto If you encounter issues with login, searching for an authorization or attaching a file in NHPNet, please contact NHP's Provider Relations department at prweb@nhp.org. Single-site access or multi site-access exists. The view may vary, depending on your security. Below are two examples: Click on the Authorizations & Referrals tab. Site name will appear here p. 3

4 Submit new or revised referral and authorizations. New and revised referral and Authorization Service Requests can be submitted by clicking on one of the following options. If you have questions regarding referral or authorization entry, please contact NHP Provider Relations at See Desktop Procedures for instructions on creating or updating a Referral Request, Outpatient and/or Inpatient Authorization Request. p. 4

5 Desktop Procedure for NHP Referral Submission into Health Trio Referrals can only be submitted by the member s PCP p. 5

6 Create Referral Request 1. Click on the Specialist tab at top of screen. 2. Enter member s NHPID or Last Name and click Search. 2a. Select member s active enrollment segment for the DOS you are submitting. See print screen below. 2a Member may have more than 1 Effective dates segment listed. The active segment is the one without an end date. The inactive segment is the one with both a start and end date and is in red. If the only member Effective dates segment listed is an inactive one, then the member is not active with NHP. 3. Enter PCP site name in the Requesting Provider s name or NPI and click Search. 4. Enter PCP site contact name and phone number in Requesting Provider fields. - Area code is required. 5. Enter diagnosis code or description, click Search, and select appropriate diagnosis from list. - Up to six diagnosis codes can be entered. First diagnosis code will default as primary. 6. Enter the Individual doctor's name or NPI in the Servicing Provider field and click Search. If the individual provider is associated with more than one group, be sure to choose the correct provider option to ensure claims payment. 7. Enter Servicing Provider s contact name and phone number. - Area code is required. 8. Requested Service will default to Consult. 9. Enter requested units. 10. Enter Procedure Code (consultation code examples ) and Units (enter the same number of units here as in step 9). - The units field will not appear until a procedure has been selected. - Although a consult code is required to submit the request, the exact consult code that the specialist will be submitting on their claim is not required. 11. Enter Start Date and End Date. p. 6

7 12. Remarks (Required field) Use for specialist name, and brief clinical or other information. - There is a 225-character limit. 13. Submit. Response Screen Member s name and NHP ID Member s name Revisions Editing a Service Request On the main screen, click on Revise Auth/Referral. Screen will default to the Status Tab. Use any combination of information for the search criteria and click Search. p. 7

8 To edit the Referral, click on the Referral number under the Service Request Number column. p. 8

9 Click the Edit button at the bottom of the screen and the applicable tab will open for editing. Member Name & NHP ID Member Name p. 9

10 Referral Revision Rules Only the following fields can be edited in a Referral: Requested units Remarks Before you begin, print the approved transaction to have a record of the services and date range already authorized. When requesting additional units (visits), the original units must be deleted in the Requested Units field and populated with only the additional units requested at this time. Original Requested Units (4) Original Request Units Deleted Additional Units Requested (5) Status Tab Once you complete an authorization, you will receive a real-time response. The Status screen displays the transaction details as returned by NHPNet on the HIPAA X transactions. This page may contain referral/authorization information or error messages about the original request. For each section, the fields could be blank, populated with data taken from the original referral request sent to NHP, or populated with data that is sent by NHP. p. 10

11 Member Name & NHP ID Member N p. 11

12 View or Attach Documentation to an Existing Service Request To view or Attach Documentation to an Existing Service Request 1. Click on E-Business 2. Enter Authorization ID and click Go. 3. Choose Click here and it will take you to the Authorization and Referral screen below User may view a referral by: View an authorization or referral by ID View authorization and referrals for a member View authorization and referrals for this site p. 12

13 To attach documentation, click on the Submit Documentation button. p. 13

14 Attach document with the Choose File button. Enter a description as shown below. p. 14

15 Once a document is attached, it will appear at the bottom of the authorization view screen. More documents can be attached at any time. p. 15