ProviderConnect Registered Services Autism Service Provider User Manual

Transcription

1 ProviderConnect Registered Services Autism Service Provider User Manual Created 9/1/17

2 Table of Contents Introduction... 3 Accessing ProviderConnect... 4 ProviderConnect Basics... 6 Features... 8 Registration for Behavioral Assessment, Treatment Plan and Program Book Development... 9 Registration for Service Delivery, Observation & Direction and Autism Services Group Viewing and Printing Authorizations Completing Discharges Appendix A: Behavioral Assessment, Treatment Plan & Program Book Development

3 Introduction Introduction The ProviderConnect application provides a variety of self-service functions to help providers access and view information about members and authorizations. For CT BHP providers, additional functionality is available including: Obtaining authorizations for the CT BHP Behavioral Assessments, Treatment Plan and Program Book Development Obtaining authorization for Service Delivery, Observation & Direction and Autism Services Group Viewing and Printing Authorizations Completing Discharges What is Covered in this Module? This module covers general functions within ProviderConnect as well as requests for Autism Service providers, which includes the following key functions: Registration of Behavioral Assessments, Treatment Plan and Program Book Development authorization requests for Autism Services Registration of Service Delivery, Observation & Direction and Autism Services Group Viewing and Printing Authorizations Completing Discharges Training Objectives As a result of this training module, you will be able to: Log in to ProviderConnect Search for and view Member records. Complete a request for Behavioral Assessments, Treatment Plan and Program Book Development 3

4 Accessing ProviderConnect Obtaining an ID and Password CT BHP ProviderConnect User Manual Autism Services In order to obtain a ProviderConnect login ID and password, complete the following steps. 1. Go to the CT BHP website at 2. Click on the For Providers button. 3. Under the Templates section, click on the Online Services Account Request Form hyperlink. 4. Complete the form and fax it back to the Provider Relations department at (855) Completed forms can also be scanned and ed back to Provider Relations at ctbhp@beaconhealthoptions.com. 5. User ID s and passwords will be created within 48 hours. Once the ID and password are created, you will be sent an with your ProviderConnect login details. 6. If you have any questions, feel free to contact the CT BHP Provider Relations department at

5 Accessing ProviderConnect, continued Logging In The ProviderConnect web application can be found on the CT BHP website: 1. Go to 2. Click on For Providers. 3. Click on Log In. 4. Enter User ID and Password. 5. Click Log In. 5

6 ProviderConnect Basics CT BHP ProviderConnect User Manual Autism Services Searching for and Viewing Member Records One function that is used often to for various ProviderConnect functions is searching and viewing member records. Below are the key actions for completing this step. Any field with an asterisk indicates that the field is required. 1. Click Specific Member Search from the navigational bar or Find a Specific Member on the Home page. 2. Enter values for the Member ID and Date of Birth a. Note: The As of Date (MBR Eligibility Date) will auto-populate with today s date. To search a previous eligibility date, users can enter a previous date. 6

7 ProviderConnect Basics, continued CT BHP ProviderConnect User Manual Autism Services Review Members record details 3. Demographics (Displays basic member information (i.e. address, phone, etc.) 4. Enrollment History (Displays active and expired enrollment records for member 5. COB (Displays information on other insurance policies) 6. Additional Information (Displays claims mailing address for the member) 7. View Member Auths (Displays Member specific authorizations) 8. Enter Auth/Notification Request (Initiates the Request for Services process) 9. View Clinical Drafts (Display member specific Clinical Drafts) 10. View Referrals (For Residential/Group Home Providers Only) Enter Member Reminders through View Behavioral Analysis Date functions are currently not utilized for the CT BHP Providers These functions should not be accessed and information should not be entered into any of these categories. 7

8 Features CT BHP ProviderConnect User Manual Autism Services Saving Requests as Drafts While working with requests for authorizations in ProviderConnect, providers have the ability to save a request as a draft in the event that they cannot complete it at the time the request was started. Saved drafts can be viewed and opened by providers from the View Clinical Drafts screen accessible from the ProviderConnect homepage. Saved drafts are available for completion and submission for 30 days from the initial date the record was saved. If the record is not submitted within the 30 days, it is automatically expired. When a record is saved as a draft, it is NOT available for CT BHP clinical staff to review. 8

9 Behavioral Assessments, Treatment Plan and Program Book Development Registration Requests 9

10 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development Key Step 1: Initiate a Request for Authorization The first key step is to initiate the request for authorization function, which starts from the ProviderConnect Homepage. The function can also be initiated when the Member record is located first and then the Enter an Auth Request button is clicked. Below are the key actions for completing this step. Any field with an asterisk indicates that the field is required. 1. Click enter an Authorization Request link from either the left navigational or Home page of ProviderConnect. 2. Review the Disclaimer and click the Next Button. 10

11 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. 3. Search for Member Record a. Enter Member s Medicaid ID and Date of Birth b. Click Next 4. Click the Next button on the Member record to continue. 5. The Select Service screen will display 6. Locate and select the Service Address/Vendor. For Clinics and Group Practices users should always ensure they are picking the correct vendor location for authorization of services. Group Practice users should ensure that they are selecting the appropriate address, followed by the correct licensure level for authorization requests (i.e 123 Main St. BCBA, 123 Main St. LCSW). 7. Click the radio button next to the Service Address to select record. The record selected will be attached to the request and authorization that will be created. 8. Click the Next button to continue. The Requested Service Header will display. 11

12 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. Key Step 2: Complete Initial Entry Request Screen The second key step is to complete the initial entry screen of the request where the requested start date of the service is entered and the specific level of care and service is selected. This screen displays for all types of requests. However, the information entered determines which clinical screens will display and which authorization parameters will be applied to the request. Any field with an asterisk indicates that the field is required. 9. Enter the Requested Start Date (The Requested Start Date is the date for the authorization to begin in order to cover requested services.) 10. Select the Level of Service = Outpatient/ Community Based. (When the level of service is selected, the screen will update with the required fields specific to the level of service.) 11. Select the Type of Service = Mental Health 12. Select the Level of Care = Outpatient 13. Select the Type of Care = ABA Assessment 14. Click Next 15. Click OK on the pop up window that displays. Attach a Document:This function is included in the next registration request screen. Users completing requests for Behavioral Assessments, Treatment Plan and Program Book Development should NOT attach documentation at this time but in the registration request. 12

13 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. Key Step 3: Complete the Clinical Screens For Behavioral Assessments, Treatment Plan and Program Book Development requests, the clinical screen workflow will display. This workflow consists of five (2) screens. 1. ABA Assessment 2. Requested Services 3. Results Below is information for completing each screen. Key Step 3: Complete the Clinical Screens - Tips for Working through the Clinical Screens The screens will display in the order listed above when the Next button is clicked within each screen. Requests are completed in order. All required fields are completed to move to the next screen. Previous screens are accessed by clicking the Back button. However, you must click the Next button to proceed forward. Within any clinical screen the request can be saved as a draft by clicking the Save Request as Draft button within the screen header. IMPORTANT NOTE: Saving Requests as Drafts Once the clinical screens in ProviderConnect are accessed, providers have the ability to save a request as a draft in the event that they cannot complete it at the time the request was started. Users can click Save Request as Draft on the top right of the screen. Saved drafts can be viewed and opened by providers from the View Clinical Drafts screen accessible from the ProviderConnect homepage. (See pg 9.) 13

14 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. Key Step 4: Complete the Clinical Screens ABA Assessment Screen The Type of Services screen is the only screen that will display after the Initial Entry screen. Much of the information is required for completion on this screen. Documentation of Primary Behavioral Condition is required. Provisional working condition and diagnosis should be documented if necessary. Documentation of secondary co-occurring behavioral conditions that impact or are a focus of treatment (mental health, substance use, personality, intellectual disability) is strongly recommended to support comprehensive care. Authorization (if applicable) does NOT guarantee payment of benefits for these services. Coverage is subject to all limits and exclusions outlined in the member s plan and/or summary plan description including covered diagnoses. Below are the key actions for completing this screen. Any field with an asterisk indicates that the field is require Step Action 1 Are you requesting ABA Services for a member with a behavioral health diagnosis? Click Yes 2 Enter the Name of the Professional who gave the diagnosis, the Licensure Type of the Professional and the Date of the diagnostic assessment/diagnosis. 3 Attach a Document - Behavioral Assessments, Treatment Plan and Program Book Development require additional documentation. Documentation samples provided in Appendix A of this user manual. Attached documentation should NOT be a copy of the Diagnostic Evaluation. See Appendix A for Templates and Examples of Documentation for Behavioral Assessments, Treatment Plan and Program Book Development. 4 Choose ASSESMENT/EVAL from the Document Description Drop down Menu. 5 Click Upload File 14

15 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. 1. A pop up window to Upload File window will appear. 2. Click Browse. a. Search for the file/document you want to attach. b. Double click on the file. 3. The pop up window will now list the file chosen. 4. Click Upload. 5. The attached file will be listed on the page. a. If the wrong file was selected users can click the checkbox next to the document, click Delete and Repeat steps Click the Next Button a. If a document has not been attached, a warning message will pop-up to confirm if you want to proceed without attaching a document. Click the OK button to proceed. 15

16 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. Step Action 6 *The Primary Diagnostic Category 1 is the main diagnosis (i.e F84.0) 7 Enter the partial Diagnosis Code 1 (see image below) or a brief Description and select the hyperlink above the text field. System users can enter a partial diagnosis and then click on the hyperlink to view a filtered list of ICD-10 codes that match their search criteria. Once a user clicks on the appropriate code in any of the pop-up windows, all other fields will populate. 8 System users then enter a Primary Medical Diagnostic category. Autism Service Providers can select None or Unknown from the Diagnostic Category. No Diagnosis Code or Description are needed if the selection is None or Unknown. Step Action 9 System users then enter a Primary Medical Diagnostic category. Autism Service Providers can select None or Unknown from the Diagnostic Category. No Diagnosis Code or Description are needed if the selection is None or Unknown. 16

17 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. Step Action 10 Social Elements Impacting Diagnosis: To complete this section, simply click the check boxes for any of the factors that impact the member. It is okay to select more than one check box. At least 1 check box must be selected. 11 Users entering registration requests for Behavioral Assessments, Treatment Plan and Program Book Development must choose Other Psychosocial and Environmental Problems. When Other Psychological and Environmental Problems is selected, an open text field will open and require an entry. This text field should be used for the following: 1. Contact Name and Telephone Number of requestor. CT BHP ASD Clinical staff may have to outreach to the requestor directly for additional information. Please include phone extension, if applicable. 2. Requested level of care, time frame and units being requested (if not already outlined in the attached documentation). 3. For concurrent reviews: Which assessment tools are being utilized? Why now? What has driven the need for reassessment? 12 The next section is named Functional Assessment. Users are not required to enter any information in this section as it is optional. 13 Click Next at bottom of page 17

18 Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. Key Step 5: Entering Requested Services Once the Next button is clicked, the Requested Services Screen will display. The Requested Services Screen allows ASD providers to enter a listing of the services and modifiers that they are requesting in this registration. Step Action 1 Click on the Click Here to Add or Modify Service Codes Step Action 2 Choose the service or services that are being requested H0031 is for ABA Behavioral Assessments H0032 TS is for APB Treatment Plan/Program Book Development 3 Click Save Step Action 4 ENTER 0 in the Visits/Units Column for each Service Requested The Requested level of care, time frame and units being requested should be outlined in the Other Section of Social Factors or in the attached documentation. 5 Click Submit at bottom of screen. Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. 18

19 Key Step 6: Submit Request and Confirm Submission Once the Submit button is clicked, the submission screen will display. Behavioral Assessments, Treatment Plan and Program Book Development, requests will be pended to the CT BHP ASD Clinical Team for review. Pended Requests Step Action 1 Confirm submission of request. o Status will indicate Pended at the top of the screen with a message indicating that the request requires further review. The Results screen provides a summary of information about the request as well as the CT BHP authorization number (U0######). 2 Print the request. Click the Print Authorization Result button to print a copy of the Results page. Click the Print Authorization Request button to print a copy of all the screens/fields completed for the request, including the clinical screens and the Results page. 3 Download the request. Click the Download Authorization Request button to save a copy of the request either in pdf format or xml. NOTE: THIS WILL BE THE ONLY OPPORTUNITY FOR PROVIDERS TO DOWNLOAD and save/print a copy of the authorization request. 4 Exit the Request for Authorization function. Click the Return to Provider Home to exit the Request for Authorization function. 5 Users may proceed with another menu function on the ProviderConnect homepage or log out of the system. NOTE: Autism Service Providers Behavioral Assessments, Treatment Plan and Program Book Development Approved requests for Behavioral Assessments will result in 3-month authorization for up to 10 units/hours. Approved requests for Treatment Plan Development will result in a 90-day/1 unit authorization. (Re-registration allowed prior to the 90-day end date and based on medical necessity). Approved requests for Program Book Development will result in a 3-month/3 unit authorization. (Re-registration allowed prior to the 90-day end date and based on medical necessity). 19

20 Service Delivery, Observation & Direction and Autism Services Group Registration Requests 20

21 Completing a Registration Request for Service Delivery, Observation & Direction and Autism Services Group Key Step 1: Initiate a Request for Authorization What is Covered in this Module? The first key step is to initiate the request for authorization function, which starts from the ProviderConnect Homepage. The function can also be initiated when the Member record is located first and then the Enter an Auth Request button is clicked. This module covers general functions within ProviderConnect as well as requests for Autism Service providers, which includes the following key functions: Registration of Service Delivery, Observation & Direction and Autism Services Group 1. Click enter an Authorization Request link from either the left navigational or Home page of ProviderConnect. 2. Review the Disclaimer and click the Next Button. 21

22 Completing a Registration Request for Service Delivery, Observation & Direction and Autism Services Group, cont. 3. Search for Member Record a. Enter Member s Medicaid ID and Date of Birth b. Click Next 4. Click the Next button on the Member record to continue. 5. The Select Service screen will display 6. Locate and select the Service Address/Vendor. NOTE: For Clinics and Group Practices users should always ensure they are picking the correct vendor location for authorization of services. Group Practice users should ensure that they are selecting the appropriate address, followed by the correct licensure level for authorization requests (i.e 123 Main St. BCBA, 123 Main St. LCSW). 7. Click the radio button next to the Service Address to select record. The record selected will be attached to the request and authorization that will be created Click the Next button to continue. The Requested Service Header will display.

23 Completing a Registration Request for Service Delivery, Observation & Direction and Autism Services Group, cont. Key Step 2: Complete Initial Entry Request Screen The second key step is to complete the initial entry screen of the request where the requested start date of the service is entered and the specific level of care and service is selected. Any field with an asterisk indicates that the field is required. 1. Enter the Requested Start Date (The Requested Start Date is the date for the authorization to begin in order to cover requested services.) For Concurrent Service Delivery Requests: o Start date should be first date after expiration date of previous authorization (For example: if today is 9/5/18 and authorization ends for 9/14/18, requested start date should be 9/15/18. o We request submissions days prior to authorization expiration date for time to review. 2. Select the Level of Service = Outpatient/ Community Based. (When the level of service is selected, the screen will update with the required fields specific to the level of service.) 3. Select the Type of Service = Mental Health 4. Select the Level of Care = Outpatient 5. Select the Type of Care = ABA Services 6. Attach a Document NOTE: This function is included in the next registration request screen. Users completing requests for Behavioral Assessments, Treatment Plan and Program Book Development should NOT attach documentation at this time but in the registration request. 7. Click Next 8. Click OK on the pop up window that displays. 23

24 Completing a Registration Request for Service Delivery, Observation & Direction and Autism Services Group, cont. Key Step 3: Complete the Clinical Screens For Service Delivery, Observation & Direction and Autism Services Group requests, the clinical screen workflow will display. This workflow consists of (2) screens. 1. ABA Services 2. Requested Services Below is information for completing each screen. Key Step 3: Complete the Clinical Screens - Tips for Working through the Clinical Screens The screens will display in the order listed above when the Next button is clicked within each screen. Requests are completed in order. All required fields are completed to move to the next screen. Previous screens are accessed by clicking the Back button. However, you must click the Next button to proceed forward. Within any clinical screen the request can be saved as a draft by clicking the Save Request as Draft button within the screen header. IMPORTANT NOTE: Saving Requests as Drafts Once the clinical screens in ProviderConnect are accessed, providers have the ability to save a request as a draft in the event that they cannot complete it at the time the request was started. Users can click Save Request as Draft on the top right of the screen. Saved drafts can be viewed and opened by providers from the View Clinical Drafts screen accessible from the ProviderConnect homepage. (See pg 9.) 24

25 Completing a Registration Request for Service Delivery, Observation & Direction and Autism Services Group, cont. Key Step 4: Complete the Clinical Screens ABA Services Screen The ABA Services screen is the only screen that will display. Much of the information is required for completion on this screen. Documentation of Primary Behavioral Condition is required. Provisional working condition and diagnosis should be documented if necessary. Documentation of secondary co-occurring behavioral conditions that affect or are a focus of treatment (mental health, substance use, personality, intellectual disability) is strongly recommended to support comprehensive care. Authorization (if applicable) does NOT guarantee payment of benefits for these services. Coverage is subject to all limits and exclusions outlined in the member s plan and/or summary plan description including covered diagnoses. Step Action 1 Are you requesting ABA Services for a member with a behavioral health diagnosis? Click Yes or No 2 If yes, complete the following if no, move to Step 5 3 If previously submitted check the box for Already submitted. 4 Enter the Name of the Professional who gave the diagnosis, the Licensure Type of the Professional and the Date of the diagnostic assessment/diagnosis. 5 Attach a Document: This function is included at the bottom of the ABA Services screen. Users completing requests for Service Delivery, Observation & Direction, and Autism Services Group should NOT attach documentation at this time but at the bottom of the screen. (STEP 20) 25

26 Completing a Registration Request for Service Delivery, Observation & Direction and Autism Services Group, cont. Step Action 6 *The Primary Diagnostic Category 1 is the main diagnosis (i.e F84.0) 7 Enter the partial Diagnosis Code 1 (see image below) or a brief Description and select the hyperlink above the text field. System users can enter a partial diagnosis and then click on the hyperlink to view a filtered list of ICD-10 codes that match their search criteria. Once a user clicks on the appropriate code in any of the pop-up windows, all other fields will populate. 8 System users then enter a Primary Medical Diagnostic category. Autism Service Providers can select None or Unknown from the Diagnostic Category. No Diagnosis Code or Description are needed if the selection is None or Unknown. 9 System users then enter a Primary Medical Diagnostic category. Autism Service Providers can select None or Unknown from the Diagnostic Category. No Diagnosis Code or Description are needed if the selection is None or Unknown. 26

27 Completing a Registration Request for Service Delivery, Observation & Direction and Autism Services Group, cont. Step Action 10 Social Elements Impacting Diagnosis: To complete this section; simply click the check boxes for any of the factors that affect the member. It is okay to select more than one check box. For ASD Services, users must select Other Psychosocial and Environmental Problems (See next step) 11 NOTE: Users entering registration requests for Service Delivery, Observation & Direction and Autism Services Group must choose Other Psychosocial and Environmental Problems. When Other Psychological and Environmental Problems is selected, an open text field will open and require an entry. This text field should be used for the following: 4. Contact Name and Telephone Number of requestor. CT BHP ASD Clinical staff may have to outreach to the requestor directly for additional information. Please include phone extension, if applicable. 5. Requested level of care, time frame and units being requested (if not already outlined in the attached documentation) 12 The next section is named Functional Assessment. Users are not required to enter any information in this section as it is optional. 13 Is member receiving other professional services? Click Yes or No 14 If yes Check all Services that Apply 15 Is member taking any medication? Click Yes or No 27

28 Completing a Registration Request for Service Delivery, Observation & Direction and Autism Services Group, cont Step Action 16 If yes, list the name, dosage, side effects (if any) and whether the member is compliant in the Narrative Entry open text field. 17 Click the radio button for the appropriate rating for Current Impairments: Danger to Self Anxiety Danger to Others Psychosis/Hallucinations/Delusions Mood Disturbance (Depression or Mania) Impulsive/Reckless/Aggressive Behavior 18 Click the radio button for the appropriate rating for Current Skills Impairments: Cognitive/Pre-Academic Skills Language/Communication Skills Reduction of Interfering Behaviors Safety Skills Social Skills Adaptive and Self-Help Skills Play and Leisure Skills Coping and tolerance Skills Community Integration Other (specify in report) 19 Please outline areas of progress since last review, as well as areas that need to be focus of future treatment. If there has been a lack of progress, gap in services, please indicate the actions to adjust or change treatment plan to address the lack of progress or barriers to progress. Include a summary of the Transitional/Discharge Plan and any additional resources or referrals that are needed for the member or their family. 20 Attach a Document - Service Delivery, Observation & Direction and Autism Services Group require additional documentation. Attached documentation should NOT be a copy of the Diagnostic Evaluation. For Initial Service Delivery requests, after completing FBA/BIP, the reports must be attached to the request. For Concurrent Service Delivery requests, progress reports (and updated BIP if applicable) must be attached for review. 21 Choose ASSESMENT/EVAL from the Document Description Drop down Menu. 22 Click Upload File 28

29 Completing a Registration Request for Service Delivery, Observation & Direction and Autism Services Group, cont. 1. A pop up window to Upload File window will appear. 2. Click Browse. a. Search for the file/document you want to attach. b. Double click on the file. 3. The pop up window will now list the file chosen. 4. Click Upload. 5. The attached file will be listed on the page. a. If the wrong file was selected users can click the checkbox next to the document, click Delete and Repeat steps Click the Next Button a. If a document has not been attached, a warning message will pop-up to confirm if you want to proceed without attaching a document. Click the OK button to proceed. ATTACHED DOCUMENTATION SHOULD ONLY INCLUDE INFORMATION ON THE CLIENT FOR WHICH YOU ARE SEEKING AUTHORIZATION. ATTACHED DOCUMENTATION CANNOT CONTAIN ANY PERSONAL HEALTH INFORMATION FOR ANY OTHER CLIENT IN YOUR PRACTICE. CHECK ATTACHMENTS TO ENSURE THAT THE DOCUMENTATION IS SPECIFIC TO THIS CLIENT AND THIS CLIENT ONLY! 29

30 Completing a Registration Request for Service Delivery, Observation & Direction and Autism Services Group, cont. Key Step 5: Entering Requested Services Once the Next button is clicked, the Requested Services Screen will display. The Requested Services Screen allows ASD providers to enter a listing of the services and modifiers that they are requesting in this registration. Step Action 1 Click on the Click Here to Add or Modify Service Codes Step Action 2 In the Pop Up Window Choose the service or services that are being requested H0046 is for AOD 10% or more of Service Delivery by Technician H2014 is for ABB - Service Delivery by Clinician which includes: NOTE: THIS SERVICE ALSO INCLUDES THE FOLLOWING ADDITIONAL CODES THAT ARE UTILIZED AT THE TIME OF BILLING: 0364T - Service Delivery by Technician (First 30 minutes of any date of service) & 0365T - Service Delivery by Technician (Each additional 30 minutes of technician time.) 0372T is for ASG Group Intervention 3 Click Save 30

31 Completing a Registration Request for Service Delivery, Observation & Direction and Autism Services Group, cont. Step Action 4 ENTER 0 in the Visits/Units Column for each Service Requested The Requested level of care, timeframe and units requested should be outlined in the Other Section of Social Factors or in the attached documentation. Step Action 5 Click Submit at bottom of screen. 31

32 Completing a Registration Request for Service Delivery, Observation & Direction and Autism Services Group, cont. Key Step 6: Submit Request and Confirm Submission Once the Submit button is clicked, the submission screen will display. Service Delivery, Observation & Direction and Autism Services Group, requests will be pended to the CT BHP ASD Clinical Team for review. Pended Requests Step Action 1 Confirm submission of request. o Status will indicate Pended at the top of the screen with a message indicating that the request requires further review. The Results screen provides a summary of information about the request as well as the CT BHP authorization number (U0######). 2 Print the request. Click the Print Authorization Result button to print a copy of the Results page. Click the Print Authorization Request button to print a copy of all the screens/fields completed for the request, including the clinical screens and the Results page. 3 Download the request. Click the Download Authorization Request button to save a copy of the request either in pdf format or xml. NOTE: THIS WILL BE THE ONLY OPPORTUNITY FOR PROVIDERS TO DOWNLOAD and save/print a copy of the authorization request. 4 Exit the Request for Authorization function. Click the Return to Provider Home to exit the Request for Authorization function. 5 Users may proceed with another menu function on the ProviderConnect homepage or log out of the system. 32

33 Viewing and Printing Authorization(s) in the ProviderConnect System 33

34 Viewing and Printing Authorization(s) in the ProviderConnect System Key Step 1: Viewing Authorization Inofrmation in ProviderConnect The ProviderConnect application allows users to view authorization details and print authorization letters for any completed authorization request. These functions can be initiated though the Authorization Listing on the Home page or. Below are the key actions for completing these functions Option 1: Using the Authorization Listing Function: 1) Once logged into the ProviderConnect homepage, click on the Authorization Listing link. 34

35 Viewing and Printing Authorizations, cont. CT BHP ProviderConnect User Manual Autism Services 2) Enter CT (in capitals) followed by the Member s Medicaid ID (i.e. CT ) in the Member ID field if searching for a specific member s authorization. a. To view all of the authorizations for your facility practice, do not enter the Member ID and proceed to the next step. 3) Then, click View All or Search to view the client s authorization(s). 4) The Authorization Search Results screen will appear. Click on the blue hyperlink for the authorization that you would like to view. 35

36 Viewing and Printing Authorizations, cont. CT BHP ProviderConnect User Manual Autism Services TIP: Please note that when searching all Authorizations, the search results header allows users to sort the results by clicking on the desired category. Click on the header title (i.e. Auth#, Member ID, Member Name, etc) once for descending results & click twice for ascending. We recommend that users sort by either Member Name or Service (LOC) Only results will be visible at a time. Users can click Next to view the Next authorization lines. 5) The Auth Summary screen will now be visible. On this screen, information such as Member ID, Name, Authorization #, Authorization Status, and Admit Date can be viewed. 36

37 Viewing and Printing Authorizations, cont. CT BHP ProviderConnect User Manual Autism Services 6) By clicking on the Auth Details Tab, it is possible to view the Submission Date, Type of Treatment, Dates of Service, Visits Requested/Approved, Units Already Used, and Status. Also, by clicking on the Authorization Letter icon, a PDF of the authorization letter can be viewed. Option 2: Through the Specific Member Search Function: 1. Once logged into the ProviderConnect homepage, click on the Specific Member Search link. 37

38 Viewing and Printing Authorizations, cont. CT BHP ProviderConnect User Manual Autism Services 2. On the Eligibility and Benefits Search page, enter the Member ID and the Date of Birth, then click Search. 3. The next screen shows the demographics information for the member along the top of the page. Click on the View Member Auths button. 38

39 Viewing and Printing Authorizations, cont. CT BHP ProviderConnect User Manual Autism Services 4. Once the View Member Auths button is clicked, the screen will drop down to display additional information. Click the Search button. 5. The Authorization Search Results screen will appear. Click on the blue hyperlink for the authorization that you would like to view. 39

40 Viewing and Printing Authorizations, cont. CT BHP ProviderConnect User Manual Autism Services 6. The Auth Summary screen will now be visible. On this screen, information such as Member ID, Name, Authorization #, Authorization Status, and Admit Date can be viewed. 7) By clicking on the Auth Details Tab, it is possible to view the Submission Date, Type of Treatment, Dates of Service, Visits Requested/Approved, Units Already Used, and Status. Also, by clicking on the Authorization Letter icon, a PDF of the authorization can be viewed. 40

41 Completing Discharge Information for ASD Services 41

42 Completing Discharge Information for ASD Services Key Step 1: Navigating to the Discharge Information Page ASD Providers will enter discharge information on client s that are no longer receiving behavioral health services by utilizing the Discharge function on the client s authorization summary page.the first key step is to search for the client s existing authorization, which can be initiated when the Specific Member Search button is clicked. NOTE: Discharge summaries do not allow attachments of discharge summaries. ASD Providers should still still the Beacon Clinical Care Manager to let them know you have discharged (and if a new provider is needed) AND keep a record of the summary in your chart for chart reviews 1. Click Specific Member Search from the navigational bar or Find a Specific Member on the Home page 2. Enter values for the Member ID and Date of Birth a. Note: The As of Date (MBR Eligibility Date) will auto-populate with today s date. To search a previous eligibility date, users can enter a previous date. 3. Click Search 42

43 Completing Discharge Information for ASD Services, cont. 4. Click View Member Auths 5. Once the screen expands, Click Search 6. Click the Authorization Link on the Authorization you are requesting additional units for. 7. On the Authorization Summary page, click Complete Discharge Review 43

44 Completing Discharge Information for ASD Services, cont. Key Step 6: Complete the Discharge Information Screen The Discharge Information screen provides essential information about the client s discharge from services. Step Action 1 Enter the *Actual Discharge Date (mmddyyyy) 2 The Primary BH Diagnosis, Primary Medical Diagnosis and the Social Elements Impacting Diagnosis will be auto-completed based on your previous authorization Step Action 3 Under the Functional Assessment Section: Click the radio button for Discharge Condition: Improved, No Change, Worse or Unknown Click the radio button for Type of Discharge: Planned or Unplanned 4 Select (1) item for Discharge Reason No further treatment indicated = Successful discharge Member dropped out = Family does not want ABA services Medication Management follow up only Transfer to more intensive Level of Care = Residential Referral to other outpatient service(s) = Parent/Family request other provider Member no longer eligible or moved = Member aged out of HUSKY, Switched to HUSKY B, Moved out of state or within state and you are unable to continue treatment Other = When provider reaches impasse with family and discharge needed and choose other 44

45 Step CT BHP ProviderConnect User Manual Autism Services Completing Discharge Information for ASD Services, cont. Action 5 Click the radio button for the appropriate rating for Current Risks: MEMBER S RISK TO SELF * MEMBER S RISK TO OTHERS * Complete additional required information when the rating is a 2 or 3 (i.e. Ideation, Intent, Plan, Means, Current Serious Attempts, etc) 6 Click the radio button for the appropriate rating for Current Impairments: MOOD DISTURBANCES (DEPRESSION OR MANIA)* WEIGHT LOSS ASSOCIATED WITH AN EATING DISORDER* Complete additional required information when the rating is a 2 or 3 (A sub-section will expand to display the fields that need to be completed) ANXIETY* MEDICAL/PHYSICAL CONDITIONS* PSYCHOSIS/HALLUCINATIONS/DELUSIONS* SUBSTANCE ABUSE/DEPENDENCE* THINKING/COGNITION/MEMORY/CONCENTRATION PROBLEMS* JOB/SCHOOL PERFORMANCE PROBLEMS* IMPULSIVE/RECKLESS/AGGRESSIVE BEHAVIOR* SOCIAL FUNCTIONING/RELATIONSHIPS/MARITAL/FAMILY PROBLEMS* ACTIVITIES OF DAILY LIVING PROBLEMS* LEGAL* 7 Click the radio button for the appropriate rating for ABILITY TO SELF-ADMINISTER MEDS W/O ASSISTANCE OR SUPERVISION* ABILITY OF FAMILY/NATURAL SUPPORTS.OTHER TO SUPERVISE MEDICATIONS* 8 Check all applicable options for Notified of Discharge* If choice is Other indicate notifications in the specify text box. 9 Click the Save Discharge Information button. The Determination Status screen will display next indicating that Discharge has been completed. 10 Print the request. Users can Click the Print Discharge Result button to print a copy of the Results page. 11 Exit the Discharge Completed page. Click the ProviderConnect Home to exit the Discharge Information Screen and return to the Home Page. PLEASE NOTE: Discharge summaries do not allow attachments of discharge summaries. ASD Providers should still still the Beacon Clinical Care Manager to let them know you have discharged (and if a new provider is needed) AND keep a record of the summary in your chart for chart reviews 45

46 Appendix A: Documentation Templates Behavioral Assessments, Treatment Plan and Program Book Development 46

47 HAPPY KIDS AND FAMILIES ORGANIZATION 123 Play Street Wonderful, CT Member Name Wonder Kid Member DOB Member ID DATE OF REQUEST Name of clinician and license (LCSW; BCBA; Ph.D) Service Type Code Hours/unit request Behavioral assessment/fba H0031 up to 10 hours for initial Treatment plan/bip H (can happen every 90 days) Program book H0032ts (up to 3 hours) can happen every 90 days Statement of purpose and what assessment tools you will be using during the assessment process Date range Signature 47

48 HAPPY KIDS AND FAMILIES ORGANIZATION 123 Play Street Wonderful, CT Member Name Super Child Member DOB 11/13/1999 Member ID : DATE OF REQUEST 8/1/18 Name of clinician and license (LCSW; BCBA; Ph.D) Service Type Code Hours/unit request Treatment plan/bip H (can happen every 90 days) Program book H0032ts (up to 3 hours) can happen every 90 days Clinical rationale for need at this time and date range needed. For Example: Super Child has made significant behavioral growth and mastered several skill acquisition targets, which is driving the need for updated treatment planning and program creation. 48

49 ABC ASD Group Practice 123 High Street Hometown, CT Name of Client DOB Address Clinician Overseeing Case Anita Services 05/05/ Service Way Nice, CT Oh Susana, BCBA Background Information: Anita has a current diagnosis of Autism given by Dr. Diagnosis on March 3th, Anita has had a history of significant behavioral concerns that include, but are not limited to, noncompliance, limited attending, repetitive behaviors, and aggression on a daily basis. Anita demonstrates a history of aggression across all settings that includes, but is not limited to pushing, pulling hair, and pinching. Anita demonstrates a history of noncompliant behaviors, and has difficulty following more than a one-step direction. Anita demonstrates repetitive behaviors such as hand flapping when excited or bored. Anita communicates using one word phrases Anita demonstrates limited social skills that included, but are not limited to eye contact, shared enjoyment, imitation, joint attention, functional play, and restricted and repetitive play behaviors based on results from a recent ADOS. Assessment Request: 10 hours of time for a comprehensive FBA- using components of the VB-MAPP, and Vineland, as well as file review, parent interview, and direct observation. An additional 1 unit to create a behavior intervention plan, as well as 3 units for program book. Service Type Code Hours/units requested Behavioral H Assessment/FBA Treatment H Plan/BIP Program book H0032- TS 3 Proposed Date of Completion: January 16 th,

50 Concurrent Review Request Template ABC ASD Group Practice 123 High Street Hometown, CT Name of Client DOB Address Clinician Overseeing Case Anita Services 05/05/ Service Way Nice, CT Oh Susana, BCBA Background Information: Anita has been receiving services since January 18 th, 2018 Services have been delivered by a technician for 10 hours per week, with 1 hour Observation & Direction by BCBA, and 1 hour per week direct by BCBA. Assessment Request: 2 hours of time for an update to the VB-MAPP are requested at this time as Anita has mastered many of the Level 1 objectives. An additional 1 unit to update her behavior intervention plan, as well as 3 units for updates to the program book. Service Type Code Hours/units requested Behavioral H Assessment/FBA Treatment H Plan/BIP Program book H0032- TS 3 50