Qualitrac Provider Portal Guide. Page 1 of 19

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1 Qualitrac Provider Portal Guide Page 1 of 19

2 Page 2 of 19 Table of Contents Section 1: Provider Portal... 3 Section 2: Security Administrator Instructions... 13

3 Page 3 of 19 Section 1: Provider Portal Welcome to Telligen s Provider Portal! Submitting a prior authorization request through Telligen s secure provider portal is a quick and efficient way to submit requests. Submit through the portal and receive these benefits Secure means for submitting data Paperless submission, no papers to mail or fax Quicker turnaround times Receive notifications on case status and outcomes Mobile and tablet friendly interface To get started, log into the secure pages of Telligen.qualitrac.com and follow these easy steps. Step 1: To start a new request, select Add Authorization button Step 2: Enter member s Policy ID and Date of Birth. **Must be exact match in order to proceed**

4 Page 4 of 19 Step 3: Select Liability Information Step 4: Enter Physician and Facility Information Ordering Physician Treating Physician Treating Facility

5 Page 5 of 19 Step 5: Enter Service Request Information The following information will be required: Level of Care where services will be received (Inpatient, Observation, Outpatient, Home Care/Home Health) Diagnosis Authorization Type (Diagnostic Radiology, DME, therapy, etc.) Treatment Requested Dates of Treatment Quantity Requested Cost and Rental (for DME requests) Treating Provider and/or Facility Depending on the Level of Care selected, different options will be available to be completed. Outpatient / Home Care/Home Based Level of Care selected: Inpatient / Observation Level of Care selected:

6 Page 6 of 19 Step 6: Information provided for Auto approval (if applicable) This screen shows all submitted information. To gather the clinical criteria needed for an Autoauthorization, click the Document button. Step 7: Select clinical guidelines that apply to the code entered Step 8: Clinical scenarios will be presented based on the clinical guidelines selected. Check boxes will be presented to you. Mark all that apply to the patient.

7 Page 7 of 19 Once all criteria are selected, you will be directed back to the main Auto Approval screen. Click Submit to complete this phase of the process. You may also select Re-Document if you want to review the criteria selected and make adjustments, or you may select Remove document to remove all criteria gathered. Step 9: Provide Clinical and Supporting Documentation Click the Upload Documents link to see the upload screen. Note: If your request can be auto-approved, you will not be required to upload documentation and you will not see this screen.

8 Page 8 of 19 Note: If you select Update Clinical Data, you will be taken back to the clinical documentation screen to redocument your case. To be sure your documentation can be accepted, please use one of the following document types: To upload documents from your device, either drag and drop your files in the area indicated, or select your files by clicking the Choose Files button. Then, click the Start Upload button to upload your documents. Click the Close button to return. Click Next to complete the documentation submission process.

9 Page 9 of 19 Click Update Clinical Data to restart the process of selecting the Service Information or clinical criteria again. Step 10: Review, Attest and Submit Review request details. To restart the process of selecting Service Information or gathering clinical criteria, click Update Clinical Data. Enter your username to attest to the information. Click Done to submit the request. Notifications: If the request requires manual review the submitter will receive an notification of the status change once the Telligen review team has completed the review. The submitter can login to the portal to view the case status at any time. Additional Ways Providers Use the Portal: Login to view submitted requests and current request status (see next page) Attach additional supporting documentation to an existing case in the event the Telligen review staff requests additional clinical information.

10 Page 10 of 19 View submitted requests, see current request status and attach additional documentation Step 1: After logging in to the portal, search for your request using any of the search fields. Enter the Case ID, First Name, Last Name, Birth Date or Submission Date in the box. The search will begin automatically. Select the desired case from the list. The Case Details page will open. Click the Attach Documentation button to attach documentation to the existing request (See page 8 for Upload process.)

11 Page 11 of 19 Step 2: Select the Reference ID to see more details The Medical Necessity Page will open. View submission details and current case status. Click Done.

12 Page 12 of 19 System Recommendations: For a better user experience the following internet browsers and settings are recommended: Microsoft Internet Explorer 8, 9, or 10 Google Chrome, version 32 Safari 5110 Screen Resolution 800 x 600 minimum, 1024 x 768 preferred Web Browser cookies enabled JavaScript enabled Pop-up blockers disabled Any questions regarding the usage of Telligen s provider portal can be directed to our customer support specialists at Telligen: qualitrac@telligen.com Toll Free Number:

13 Page 13 of 19 Section 2: Security Administrator Instructions Add a new user for your organization: Step 1: Go to the User Management Tab. Step 2: Select Add User at the bottom of the page.

14 Page 14 of 19 Step 3: Complete all required user information on the Add User page. Required fields are indicated with red asterisks. At the bottom of the page in Group Membership, check to see that the Provider Group or Facility associated with the User is listed. (Options provided will be consistent with Provider Groups or Facilities to which the Security Administrator has access). Select the appropriate group for the user being created. Once you have completed entering the user s information and have selected the Provider or Facility Group, select Save.

15 Page 15 of 19 To modify information for a user: 1) Click the User Management tab. 2) Search for the user whose information you wish to update. 3) Once you have found the person, click the person s user name. You will see the details for the user. 4) Click the Edit menu option in the upper right corner to modify the existing information.

16 Page 16 of 19 5) The Edit screen will appear. Update the information as needed. 6) When done, click Save. This confirming message will be displayed.

17 Page 17 of 19 To reset the password for a user: 1) Click the User Management tab. 2) Search for the user whose password is to be reset. 3) Once you have found the person, click the person s user name. You will see the details for the user. 4) Click Reset Password menu option on the upper right side of the screen 5) You will be asked to confirm the password change. Click Yes to continue, or No to abort the process. This confirming message will be displayed once the password is changed.

18 Page 18 of 19 To deactivate a user: 1) Click the User Management tab. 2) Search for the user you wish to deactivate. 3) Once you have found the person, click the person s user name. You will see the details for the user. 4) On the upper right hand side, click the Deactivate menu option. 5) You will be prompted to continue. Click Yes to continue, or No to abort the process.

19 Page 19 of 19 This confirming message will be displayed once the password is changed. The user has successfully been deactivated. This means that the user s association to your provider group and/or facility has been removed. The user has been moved to a deactivated group. Once you have successfully deactivated the user, they will be removed from your group for management. If you inadvertently deactivated a user or determine you need to reactivate a user, you will need to contact help desk. The help desk can be reached at