NHPNet Online Authorization User Guide

Transcription

1 NHPNet Online Authorization User Guide Submitting Authorizations through Health Trio Inpatient October 30, 2012, v 1.3 nhp.org

2 Introduction NHPNet is a web-based tool 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 or authorization request, the NHPNet user must have the appropriate provider permissions and the patient must have active NHP eligibility. The following table shows authorizations that can be created in NHPNet, with a brief description of each referral link available: NHPNet Referrals/PA Tabs Referral Outpatient (includes Observations and Surgical Day Care) Admission Status Brief Description Allows user to create and send a real-time referral request to NHP Allows user to create and send a real-time outpatient authorization request to NHP Allows user to create and send a real-time admission certification request to NHP. Allows user to search and view all Referral/Authorization responses. Helpful Hints NHP s systems are updated for maintenance on the third weekend of every month starting Friday at 5:00 pm 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. Observation or surgical day care authorization that becomes an inpatient admission: If a patient is admitted from SDC or OBV, a separate authorization must be submitted. The provider must also indicate in the Remarks that the OBV or SDC has converted to an inpatient stay. The same is true for Inpatient to SDC or OBV. Revision requests can be made on existing authorizations when requesting additional units to a procedure code already submitted or when a new procedure code (Inpatient Surgical or SDC Only) is needed. NHP will not accept corrected procedure codes or dates of service through Health Trio. Do not submit a new request. o Please fax the request to NHP at This is a new fax number. p. 2

3 The following services should continue to be requested through NHP s vendor sites: Sleep Studies Sleep Management Solutions (SMS) The following services remain fax requests ( ): Transportation (ambulance) Out-of-network provider requests. Benefit exceptions Authorization status Health Trio Status NHPNet Status Edit Functionality Yes or No PEND PEND or MEDREVIEW No/Yes* APPROVED APPROVED Yes CANCELLED CLOSED No NOT CERTIFIED DENIED No * If authorization in HT reflects PEND, it can only be edited if it is in MEDREVIEW status in NHPNet. p. 3

4 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. 4

5 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. 5

6 Desktop Procedure for Inpatient Authorization Submission into Health Trio Create Admission Request Required fields are denoted with this small sphere ( ) next to field name. 1. Click on the Admission tab at top of screen. p. 6

7 2. Enter member s NHPID or last name, and click Search. 2a. Select member s active enrollment segment for DOS you are submitting. See print screen below. 2a - Member may have more than one 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 Requesting Provider s name or NPI, click Search and select provider. Requesting Provider will see their name/site as the default unless the provider has access to more than one provider site, then they will see a drop-down with the sites they have access to. 4. Enter Requesting Provider s contact name and phone number. - 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 the primary. 6. Enter Servicing Provider s name or NPI, and click Search. -, The facility name and contact information must go in the Servicing Provider fields. Surgeon s name must be submitted in the Remarks section. 7. Enter Servicing Provider s contact name and phone number. - Area code is required. 8. Enter the Requested Service using the drop-down menu. Hospice Maternity The following data must be included in the Remarks section: baby s delivery date, weight, gestational age, delivery type, and sex.) Medical (Use for Acute Inpatient Adult & Pedi) Newborn Care* Use for sick newborn, enter auth under mom s ID if baby isn t enrolled yet. The following data must be included in the Remarks section: baby s delivery date, weight, gestational age, delivery type, and sex. Oral Surgery Rehabilitation Skilled Nursing Facility Surgical Transplants p. 7

8 9. Enter procedure code and units - Units field will not appear until a procedure has been selected. Service Type Additional Code Requirements Hospice Revenue (0125,0135, 0155) Maternity* Revenue (0122, 0132,0152, or ) Medical (Adult & Pedi Acute Inpt.) Revenue ( or ) Newborn Care (Use for Sick Newborn)* Revenue (0174, 0175 Sick Newborn) Oral Surgery (Inpatient) CPT or HCPCS Code (i.e., D7140, D7210, D7230, D7240, D9220, D9220, D9241, D9242) Rehabilitation Revenue (0128, 0138, 0158) Skilled Nursing Facility Revenue (0129) Surgical Inpatient Transplant (Inpatient) CPT Code only CPT or Revenue *For Newborns (add to mom s authorization) and Sick Newborns, the following information is still required by NHP and should be entered in the Remarks section: Baby delivery date Weight of baby Weeks of gestation Deliver Type (Vaginal or Cesarean) Sex 10. Enter start date and end date. 11. Remarks (Required field) Use for brief clinical, Level of Care (initial or changes), Surgeon s name and contact information or other information. - There is a 225-character limit. - To attach clinical documentation to an authorization, see View or Attach Documentation to an Existing Service Request on page 15. If attaching a document in NHPNet, please indicate so in the Remarks section of Authorization in Health Trio. 12. Submit. - If an Inpatient stay ends up as an Observation or SDC, a separate authorization must be entered under the outpatient template for that service type with a remark Inpatient to OBV or Inpt. to SDC and the OBV or SDC authorization number noted. - For intial Level of Care (LOC) and LOC changes, enter in the Remarks section. p. 8

9 Response Screen Member s name & NHP ID Member s p. 9

10 Revisions Edit a Service Request (Use for Concurrent Review) 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. A Service request may only be edited when the referral or authorization is in the Approved or Pended status. - If the authorization in HT reflects Pend, it can only be edited if it is in MedReview status in NHPNet. p. 10

11 To edit the authorization, click on the authorization number under the Service Request Number column. 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. 11

12 Authorization Revision (Concurrent Review) Rules Only the following fields can be edited in a Authorization: Procedure quantity Additional procedure code(s) (only for SDC or Inpatient Surgical) Remarks (example: Level of Care change) When requesting additional units, the original units must be deleted in the Procedure Code Quantity field and populated with only the additional units requested at this time. Original requested units p. 12

13 Original request units deleted Additional units requested If incorrect Service Type was requested (example: Rehabilitation vs. Skilled Nursing Facility), user will need to enter a new authorization and enter the following in the remarks section: Incorrect Service type in auth #. Please close this auth. NHP will close the incorrect authorization and process new request. p. 13

14 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 sent by NHP. Member Name Member Name & NHP ID p. 14

15 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. Choose Click here and it will take you to the Authorization and Referral screen below User may view an authorization by: Authorization or Referral ID Viewing Authorization and Referrals for a member Viewing Authorization and Referrals for this site p. 15

16 To attach documentation, click on Submit Documentation. Attach document with the Browse button. Enter a description as shown below. p. 16

17 Once a document is attached, it will appear at the bottom of the authorization view screen. More documents may be attached at any time. If you are unable to submit your documentation electronically, please fax it to This is the only fax number for submitting clinical support documentation. p. 17