NaviNet Drug Authorizations. User s Guide

Transcription

1 NaviNet Drug Authorizations User s Guide

2 NaviNet Drug Authorizations User s Guide 1 Overview NaviNet has partnered with CoverMyMeds to create NaviNet Drug Authorizations, an all-payer, HIPAA compliant solution that allows you to quickly find, complete, and submit Prior Authorizations (PAs) to the plan electronically. There are forms for Medicare, Medicaid, and most commercial insurance plans, and for all medications. Use NaviNet Drug Authorizations to: Quickly find the right PA request for your patients medication needs. Fax the request to the plan with a digital signature. Easily manage follow-up for all your PAs. Finding the right PA When a Prior Authorization is needed, log in to your NaviNet account and access NaviNet Drug Authorizations from the Services menu to submit a PA request electronically. Once on the Dashboard, click Create New. On the Find the form you need page: 1. Select your patient s state (The system defaults to your state so you may have to change it). 2. Enter the name of the medication and then select the strength from the drop down list (Tip: Enter the first 4 or 5 letters of the medication). 3. In the Search terms field, enter in any of the following information: Plan name, PBM, form name, BIN number or contract ID e.g.: AARP, Medco,

3 NaviNet Drug Authorizations User s Guide 2 Humana PPI, , S5803 etc. (Tip: Narrow your search results by adding additional search terms). You are presented with the best PA options. Click on the PA you need and select Start request to complete and send the request. If you need more information before choosing your PA, click More info. If this is the PA you need, click Start request with this form, if not, select the Back button. To view additional PA options, click Show more forms. Click New request to start a PA request. Don t see the PA you need? Suggest a form. If you don t see the PA request you need, chat with us or give us a call at (855) and we can help. Completing the request Once you ve selected the right PA, complete Patient details, Prescriber details, Medical details, and Rationale. When finished, click Save changes.

4 NaviNet Drug Authorizations User s Guide 3 Using the Address Book Use the address book to store your contact information for patients, prescribers, and pharmacies. Once you complete the information, click Save changes. This will store the information in the address book for future use. To store multiple contacts, follow the steps below: 1. Type the contact s information into the provided fields (Patient details, Prescriber details, and Pharmacy details.) 2. Once finished, click Save changes on the left-hand panel next to the request. This will save typed information into the address book for future use. 3. Clear all information from the previous contact and begin the next contact. 4. Repeat this process until you are finished entering all desired pharmacies, physicians, and patients. To retrieve an already stored entry, begin typing into the name field. The address book will change to Do you mean: and list entries matching the name entered. Narrow your results by continuing to type. In addition, retrieve entries by clicking on the address book and selecting from the drop down list. Click Clear to search for another entry. Required and Important tags The red Required tags indicate fields used by the plan or another healthcare provider to identify the patient. These fields are also required to send or print the PA request. The orange Important tags indicate fields most commonly used by the plan to make an accurate determination. We highly recommend completing these fields before submitting the request to the plan.

5 NaviNet Drug Authorizations User s Guide 4 Using a key to access a request The key is a 6 character series of letters and numbers assigned to each PA request you start using CoverMyMeds. It is also used to easily identify a PA request when sharing it with another healthcare provider. To allow another provider to access the request, they need to know the key and patient s name and date of birth. Pharmacies that also use CoverMyMeds will fax a key for PAs they ve started and need a physician to finish. To access a request via key: 1. Go to your NaviNet Dashboard, click Lookup by CoverMyMeds Key Enter the key, patient s last name and date of birth. 3. Click Enter key.

6 NaviNet Drug Authorizations User s Guide 5 Request To a PA request to another healthcare provider, enter at least the patient s first and last name as well as their date of birth. Add other details as available. When you are ready to send the request, click Save changes, then click request. Enter the address for the provider. If the address matches a provider already using CoverMyMeds, the provider will receive an including a link to access the request or view the request by going to their Dashboard. If you are ing a non-user, the will request that the recipient create a CoverMyMeds account. Then, they are asked to notify you so you can re-send the request. *Note: You can only a request to another healthcare provider. Prior Authorization requests cannot be ed to the plan.

7 NaviNet Drug Authorizations User s Guide 6 Faxing a request to another provider To fax a PA request to another healthcare provider, enter at least the patient s first and last name as well as their date of birth. Add other details as available. When you are ready to send the request, click Save changes, then click Fax request. Choose to fax to prescribing physician or other. Complete any missing fields on the fax screen and click Fax to send the PA to another healthcare provider. Your fax will automatically include a fax cover sheet with your information and instructions for accessing the request you already started in CoverMyMeds. To view or print the fax, click Preview. Sending a request to the plan Once the PA request is complete, click Fax request. Then, choose to fax to plan. The fax number auto-fills for most requests in CoverMyMeds. Complete any missing fields on the fax screen and when finished, click Fax.

8 NaviNet Drug Authorizations User s Guide 7 Storing provider signatures Some PA s require a physician s signature before it can be sent to the plan. Through CoverMyMeds, physicians can sign PA s electronically using their mouse. From the fax screen, the provider can sign the PA request on the dotted line by left-clicking on the mouse to request a signature. You may reset and resign until you are content with the signature. CoverMyMeds automatically stores the signature after the request is faxed. The provider s signature will be available in your stored signatures the next time you fax a request to the plan. To print the request and manually fax it, click Download/Print. Click Download and Mark as sent to recognize this request as sent to the insurance plan. Print the request and sign, then fax to the plan. The phone and fax number for the plan are located in CoverMyMeds next to the PA request image.

9 NaviNet Drug Authorizations User s Guide 8 Setting reminders and adding notes Notes and reminders help you manage and track the activity of a PA. The system automatically records notes for events like faxing and sharing a request. To access notes for a PA: 1. Open the request you would like to view. 2. Click the Notes tab in the left section of your screen. 3. View the request history including date, time, and action taken. When a fax is successfully sent, Fax by you: Successful and a link to the image will appear in the notes. 4. Click All at the bottom of the Notes to view and print a fax confirmation sheet. You can easily add your own notes by entering information in the text block that reads Add note and clicking Add. To add a reminder: 1. Open the request you would like to view. 2. Click in the text block that reads Add note. 3. Enter information for follow-up. 4. Check mark Set reminder and use the drop down box to choose a date. 5. Click Add.

10 NaviNet Drug Authorizations User s Guide 9 Using Archive & Notify Once you ve received a response from the plan, we recommend archiving the PA request. This allows us to track the success of submissions by provider, plan and drug. You should archive a request when the plan has notified you of the determination. To archive a request: 1. Go to your NaviNet Dashboard and find the request you want to archive. 2. Click on the request you want to archive to open it. 3. Click Archive request. 4. Choose an outcome of Approved, Denied, Not sent to plan, or Don t know outcome. If Denied is chosen, a dropdown menu will appear to select the reason for the denial. If the given reasons aren t sufficient, you may type the reason in the Other field. A dropdown menu will also appear if Not sent to plan is selected.

11 NaviNet Drug Authorizations User s Guide 10 After archiving a request, it is labeled with the Status on your Dashboard, and an is sent to all users with access to the request. For requests archived as Approved or Denied, the user(s) receives an notifying them of the determination. For Not sent to plan or Don t know outcome, the user(s) receives an notifying them that the request has been removed from their Dashboard. Because the Status of the PA has been changed, that particular PA will move to the top of the list on your Dashboard. Printing a request On your Dashboard, open the request you would like to print. Click Download/Print. Then, click Download only or Download and Mark as sent. The file will open in a PDF that you can view and print.

12 NaviNet Drug Authorizations User s Guide 11 Printing your Dashboard To print a list of all of your PA requests, click View as PDF on your NaviNet Dashboard. The list will open in a PDF that you can view and print.

13 NaviNet Drug Authorizations User s Guide 12 epa makes the prior authorization process on NaviNet even faster than before. With epa, you can submit patient information to the plan electronically and get real-time responses, including their determination. Starting an epa Select your patient s state, medication, and prescription insurance plan. If epa is available for your patient s plan, you will be given the option to proceed with it or use the paper process. Select Use epa and click next.

14 NaviNet Drug Authorizations User s Guide 13 Finding your prescriber Type in the prescriber s last name or NPI into the Find your prescriber field and select them from the drop down menu. If your prescriber does not appear, they may still need to be validated. If you still need to validate your prescriber, click Manage your prescriber here link in the note section.

15 NaviNet Drug Authorizations User s Guide 14 Checking eligibility After selecting your verified physician, type your patient s name, date of birth, and address. When completed, click Check Eligibility. Patient details are crossed checked by the plan to determine if the information entered is the same as what is on file with the plan. Once you ve located the patient, click Start Request.

16 NaviNet Drug Authorizations User s Guide 15 If the plan returns patient information that is different from what you ve entered, you can continue with epa with the information returned from the plan or the information you ve entered. You can also choose a new form if the incorrect plan was selected. This information will be carried over to the epa and won t be editable once the request is started. Once the epa is started, fill in the additional patient, prescriber, and medical details. Fields with grayed out information are taken from the previous page and cannot be edited. When the form is complete, click Send

17 NaviNet Drug Authorizations User s Guide 16 Sending off to the plan Once you ve clicked Send your epa is sent to the plan for a real time review. For most requests, a response will only take a few seconds. If the plan needs more time to come to review the request, an info box will alert you. You can move on to other PA s and return to that request a little later for an update.