CERECONS. Provider Training

Size: px

Start display at page:

Download "CERECONS. Provider Training"

Ferdinand Morrison
5 years ago
Views:

1 CERECONS Provider Training February 2012

2 Table of Contents 1. Physician Dashboard 2 Eligibility Highlights 2 Clinical Alerts 3 Referral Alerts and Stats 4 Group Information 5 2. Edit Profile 6 3. Eligibility Module 6 Eligibility Look Up 6 Eligibility Listing 7 4. Member Face Sheet 8 Demographics and Eligibility 8 Problem List and Claim History 9 Flow sheet and Labs 10 Referral Data 11 Referral Detail Referrals Module 12 Referral Status 12 Referral Listing 13 Referral Submission 14 Referral Auto-Approval Claims Module 18 Claim Status 19 Claim Detail N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

Member count for the PCP will be displayed graphically in increments of 20 for the current month and last four months.

3 Physician Dashboard The Physician Dashboard provides a snapshot of the various modules currently being used by the provider. Some of the main sections on the dashboard include: 1. Eligibility Highlights This section provides a summary of eligible membership. Member count for the PCP will be displayed graphically in increments of 20 for the current month and last four months. The actual numerical member to totals will be displayed above the graph N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

4 Please note that if your doctor is a specialist, no eligibility highlights will be displayed as no members will be assigned. Only primary care physicians will be assigned members by your managed care group. You may hide this graph from view by clicking on the button to minimize. 2. Clinical Alerts Clinical alerts are established by your managed care group to assist you in providing the best patient care possible CERECONS will scan your members for procedures that may be due based upon past procedure and diagnosis codes present in the record. This will assist the provider with all P4P reimbursements. CERECONS will give you a breakdown using rules created-- how many patients are overdue for a service/how many patients meet the rule criteria. Example: Routine checkups for female infants this provider has 353 patients who meet the criteria and out of that 353, 183 patients are overdue for this exam. On drilling down the numerator or denominator, you will see a list of all patients which can be sorted by status to view members that either met or didn t meet the set criteria. Click on to link to the member s face sheet for more information N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

3. Referral Alerts and Stats The Referral Alerts section of your dashboard will display any messages that have been sent by your managed care company on a particular referral.

Click on any of the numbers to drill down to view a list of members meeting the alert criteria The Referral Stats section will allow you to drill down to all referrals to view status or send a

5 3. Referral Alerts and Stats The Referral Alerts section of your dashboard will display any messages that have been sent by your managed care company on a particular referral. This may include requests for documentation, questions about the referral or to alert you on changes that have been made on your referral. Click on any of the numbers to drill down to view a list of members meeting the alert criteria The Referral Stats section will allow you to drill down to all referrals to view status or send a comment to the managed care group on a particular referral 4. Group Information The group information icon will display any messages or attachments from the medical management group that are not related to a patient To view the attachment click on the form icon. Forms will be downloaded for easy viewing and printing N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

6 Edit Profile On the dashboard please click on the Edit Profile button Retype over existing information and click on Save Any changes made to this page will require you to change your password N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

Eligibility Module Eligibility Look Up Click on the Eligibility tab on the dashboard to look up eligibility on a certain member Enter any or all filter fields to search for a member; After

7 Eligibility Module Eligibility Look Up Click on the Eligibility tab on the dashboard to look up eligibility on a certain member Enter any or all filter fields to search for a member; After entering the filters, click on Submit to view a list of all members that fit the search criteria N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

8 Eligibility Listing After submitting the search criteria, a list of all members meeting the criteria are displayed. If the patient is eligible, the record is marked with a green icon and if the patient is inelgible, the record is marked with a red icon. Patient details can be viewed in a pop-up window by clicking on the Patient ID Use the tab to find members that were not listed using the regular search criteria. icon represents the clinical alerts associated to that patient. The number beside the icon indicates the number of clinical alerts available on this patient record Click on the icon to view member eligibility history N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

Member Face Sheet [Demographics & Eligibility] View member demographic and Eligibility information on this section of the face sheet. Click on to add any notes to the patient record.

9 Member Face Sheet [Demographics & Eligibility] View member demographic and Eligibility information on this section of the face sheet. Click on to add any notes to the patient record. This will be saved under the Notes section and can be viewed anytime by clicking on it. Clinical alerts pertaining to the patient are also displayed in this section N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

Member Face Sheet [Problem List and Claim History] All of the member s diagnosis information is stored in the Problem List section of the face sheet. On page load it lists the 5 most recent diagnoses.

10 Member Face Sheet [Problem List and Claim History] All of the member s diagnosis information is stored in the Problem List section of the face sheet. On page load it lists the 5 most recent diagnoses. To view more, click on to view historical diagnosis information The Claim history section displays all claim related information on the patient. Click on to add any attachments to the claim. Similar to Problem Lists, click on to view information on older claims N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

11 Member Face Sheet [Flow Sheet and Labs] Patient s Vitals for an office visit and Labs are displayed in the Flow Sheet section of the face sheet. The information is displayed in columns with each column being a new encounter date. Click on icon to add vitals for a new date. This will open a pop-up window where all information can be entered and saved. Once saved, it will get displayed on the flow sheet under a new date column. The Labs section displays all lab information. Similar to the Vitals section, new entries are displayed under a new date column. Click on All to view all labs or click on any of the panels [Lipid, Renal, Diabetes] to see labs associated to that panel To view older or newer vitals or labs click on the arrows next to the column date N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

A specific referral can be searched using the Search tool by entering referral number, status or specialty.

12 Member Face Sheet [Referrals] The Referrals section on the face sheet displays information on all referrals associated to this member. Click on to attach documentation to the referral. Click on to open referral details. A specific referral can be searched using the Search tool by entering referral number, status or specialty. Referral Details The Referral Details page displays all the information entered during referral submission. Comments can be added to the referrals at the bottom of the screen N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

Referrals Module Referral Status Under the Referrals tab, click on Referral Status to view status on all submitted referrals Note: PCP s can only search for and refer only their members.

13 Referrals Module Referral Status Under the Referrals tab, click on Referral Status to view status on all submitted referrals Note: PCP s can only search for and refer only their members. If you are a specialist, you can search for and refer any member eligible with the Medical Group. But specialists will have to provide search information that will uniquely identify the member (for example, Patient ID, or SSN, or a combination of Patient First and Last Name and Birth Date) If your search matches any records, they will be displayed as soon as you hit Search. If no matches are found, an error message will be displayed, and you will have to try again with different search information. Occasionally, owing to inaccuracies in health plan data, names are misspelled, or Birth Dates are reported inaccurately. So if your search does not return any matches, try searching for the patient by clearing out all fields and just entering the Patient ID / SSN. The default number of records per page is 20. The number of results for each page can be modified by specifying the desired number of records per page and pressing the Go button at the bottom of the page. On the right are navigations buttons to go to the first, previous, next and last page respectively. In order to go to a specific page you can enter the desired page and press the Go button N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

Referrals Listing To submit a referral click on Submit Online Referral under the Referrals tab. Search for a member by entering member information such as Patient ID, Last Name, First Name etc.

14 Referrals Listing To submit a referral click on Submit Online Referral under the Referrals tab. Search for a member by entering member information such as Patient ID, Last Name, First Name etc. Once a member is found and listed, click on the pink button to refer an eligible member. If the member is not eligible, a referral can still be submitted by click on the grey button. Based on the member s current eligibility status, a disclaimer will be displayed and will either proceed to the referral submission page or it will prompt you to contact the group for further information N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

Referral Submission Page CERECONS pre-fills Patient Details (Demographics and PCP information) and Referring Physician Details for all referrals.

15 Referral Submission Page CERECONS pre-fills Patient Details (Demographics and PCP information) and Referring Physician Details for all referrals. Specialty: In order to submit the referral, you must specify the specialty to which you are referring the member. All the specialties appear in a list under the Referred Provider Details section. You can view the list by clicking on the arrow next to the list. Click on a specialty to select it. By default, no specialty is selected, so you must complete this step. Referred Provider: This can be completed only after the previous step (i.e., after a specialty is selected). When a specialty is selected, the Referred provider field (the box next to the specialist field) is populated by a list of all the specialists contracted with the Medical Group under that specialty. It is sorted by specialist last name, and it defaults to the first specialist on the list N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

Retro Referral: Check this box if you are submitting a referral for a service date in the past. Once this is clicked you will be required to select a service date which will always be in the past.

16 Retro Referral: Check this box if you are submitting a referral for a service date in the past. Once this is clicked you will be required to select a service date which will always be in the past. If the box is left unchecked, it will be treated as a regular referral. Procedural and Diagnosis Codes: You need to submit at least one Physicians Current Procedural Terminology (CPT ) Code and one Diagnosis (ICD-9) Code in order to be able to submit the referral. Follow the steps outlined below to add / delete codes: Click on the Add CPT Code button or the Add ICD-9 Code button to pull up the appropriate wizard. Enter the Code or Description in the search box provided and hit List Codes. If your search matches any codes, they are returned in a list. Be sure to make your search specific if your search matches more than 500 records, an error message is returned. To select a code, click on the arrow next to the list of codes to view the entire list, and click on the appropriate code. If you wish to go back and search for a different code, click on the Search Codes button. For CPT Codes, you will need to enter the number of services / units associated with the code N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

17 Click on the Add Code button to add the code. This will close the wizard and add the code to the referrals form. Number of services / units is displayed in brackets next to the CPT Code. To delete a code you have added, simply click on the code to highlight it and click the Delete button below the appropriate field. Clinical Symptoms/ Findings: You will need to complete this field with specific case and patient information, including patient height, weight, case history, labs and pertinent work up to date. In addition to the mandatory fields, there are 3 optional fields that can be used to provide administrators with additional data which will help them action the referral in a timely manner: Priority: Priority can be set to 3 different values Routine (for referrals that should be approved within 48 hours), Urgent (for referrals that should be approved on the same day) and Stat (for referrals that should be approved in 4 hours). Default selection is routine. This can be changed by clicking the arrow next to the field to view all priorities, and clicking on the appropriate value. Place of Service: Place of Service can be set to Office, Home, Inpatient, Outpatient and Other Unlisted Facility. Default selection is Office. To change this, click on the arrow next to this field to view the entire list, and click on the desired Place of Service value to select it. Treatment Plan: This field is a text field, and can be used to enter the Treatment Plan for the patient. Once you have completed all the relevant fields, submit the referral by clicking Submit Referral. A message appears to inform you that the referral submission was successful. Once this message appears, do not attempt to use the browser Back button to go back and submit the referral again. You will be redirected to the Eligibility Search page if this occurs. Auto-Referrals: Your Medical Group may have auto-approval rules set up for Referrals. If they do, your referral will be automatically approved if it is a referral for specific procedures N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

Referral Auto Approval If a referral meets a Referral Intelligence Rule set up by the administrator, it will get approved automatically and you will receive a notification of the

18 Referral Auto Approval If a referral meets a Referral Intelligence Rule set up by the administrator, it will get approved automatically and you will receive a notification of the same You can print, manage and add attachments to the referral here as well N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

19 Claims Module The Claims module can be accessed by clicking on the Claims tab on the dashboard. Use the left side menu bar to submit online claims, upload claim batched or view submitted claim batches N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

20 Claim Status You can search for a particular claim by entering in search criteria in the Advanced Search tab Click on icon to open the claim details page N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

Claim Detail An electronic version of your medical group's EOB will be displayed on every PAID claim. Click on View Explanation of Benefits View your EOB.

21 Claim Detail An electronic version of your medical group's EOB will be displayed on every PAID claim. Click on View Explanation of Benefits View your EOB. This EOB will stay with the original claim and may be printed N Riverview Drive, Suite 320, Anaheim Hills, CA support@uius.com cerecons.com

Blue Care Network s New e-referral Tool Frequently Asked Questions

Blue Care Network s New e-referral Tool Frequently Asked Questions September 2014 Overview Blue Care Network is introducing a new e-referral system for managing referral and authorization requests. This