Process Document Provider Intake: Member Paneling Tool

Transcription

1 Process Document Provider Intake: Paneling Tool Last Edited By Jack Wojciehowski, Senior Business Analyst Last Edited Date 02/20/2017 Overview Providers will now have the ability to manage their member panels online using the Paneling tool within the Provider Intake application. Additions, transfers, and termination of member associations can be submitted through this portal and will be updated in the Mercy Maricopa information systems at the end of each day. This document describes the online submission process and includes links and embedded information to assist providers. Medicaid Web Portal In order to access the Paneling tool, users must have permissions to the Medicaid Web Portal. Each provider organization should have at least one user identified as a Portal Administrator. The Administrators are responsible for maintaining user permissions for their organization. This includes registering new users and deactivation of accounts for users that have left the organization or otherwise should no longer have permissions. Contact your Provider Relations Liaison should you need help identifying the Administrator for your organization. Provider Intake Several tools are available on the Medicaid Web Portal, but Provider Intake is the application used to view, manage and submit Provider Roster transactions. The link for Provider Intake is located in the Health Tools menu. The link will open the Provider Intake landing page in a new browser window. From this page you can access the Provider Rosters tab located at the bottom of the left hand menu. Page 1 of 16

2 Take note of the agency information under the user name at the top of the page. This indicates the location/site you are representing. Users will have access to provider rosters associated with all sites/teams related to their provider organization. Page 2 of 16

3 Paneling Select the Paneling option from the left-hand menu. Choose Roster Type and Site/Team The first step to managing your paneled members online is to choose the Roster Type and the Site/Team you would like to view. If your provider organization is associated with both an Assigned Behavioral Health Clinic (ABHC) and an ACT Team you will see both choices in the Choose Roster Type drop down. Only one roster type can be selected/managed at a time. If your provider organization does not have an association to either an ABHC or ACT Team then you will see the following message. Page 3 of 16

4 If you feel this is incorrect please contact MMIC Health Plan Operations to resolve the issue. Once you have selected your roster type you must then select the Site/Team roster you would like to manage. By choosing the Select All (Export Only) option from the dropdown and clicking NEXT you will be able to export an excel spreadsheet of combined rosters based on your chosen roster type for all sites within your provider organization. You can select Save As during the export to name this file what you would like. With the Select All (Export Only) selection no further action can be taken. The primary purpose of this export is to provide a useful tool for comparing what is on record with MMIC to your internal information systems. If you are ready to make updates to a particular Site/Team roster then select your choice from the Choose Site/Team dropdown and click Next. REPORT VIEW Once you have set your Report Parameters and clicked Next your roster member detail will be displayed in the REPORT VIEW grid and will be ordered alphabetically by member last name. Your chosen site will be displayed in the Selected Site/Team field just above the report grid. You may export the roster details to an excel spreadsheet for this specific site by clicking the Export button. Page 4 of 16

5 ABHC Transactions Certain actions will be limited depending on the selected roster type. For ABHC Rosters, providers will be able to perform transfers between clinics and can also add new members who currently do not have an Assigned Behavioral Health Clinic. Terminations for ABHCs are not permitted. For ABHC transactions the grid will display the following detail for each member assigned to the roster: AHCCCS ID, NTXIX ID, DOB, Name, Benefit Plan, ACT Team (if applicable), and PCP. Transfers: If you would like to transfer a member to another ABHC within your provider organization or outside of the organization you may do so by clicking on the arrow icons in the first column of that member record. NOTE: if a member is associated with an ACT clinic the icon will not be visible. Providers will be unable to transfer a member with an ACT Team assignment while managing their ABHC Roster. Once the Transfer arrow icon has been selected for a member you will see the member detail populated in the Information section below the grid. The detail includes: AHCCCS ID, Last Name, First Name, Date of Birth, Roster Effective Date, Roster Term/Transfer Date, Site, Transaction Type, and Receiving Site (Transfers Only). Page 5 of 16

6 There are only two editable fields on an ABHC transfer transaction. First, providers must enter the Roster Term/Transfer Date. This date must represent the last day of assignment to the relinquishing ABHC site. MMIC will restrict the date field to 14 days prior to the current date. NOTE: if the date provided does not fall within the member s current enrollment span then the user will be returned the error: "The effective date does not fall within the member's current enrollment span. Please contact Enrollment PCP Alignments_Updates@Aetna.com to complete transaction". Due to the complexity of these types of scenarios a manual correction by MMIC enrollment staff is necessary. In the please use the following format to communicate the request: AHCCCS ID First Name Last Name DOB Add, Term (ACT Team Only), or Transfer Effective Date Relinquishing (represent the Site last day of assignment to the relinquishing site) Receiving Site Next, providers must choose a site from the Receiving Site (Transfers Only) dropdown. Your selection will indicate which site your member will be transferring to. Click Submit to complete. Once submitted you will see a Transaction Successful message on the top of the screen and a yield icon next to the member record that was changed. This icon will indicate any record that has been updated on the current day. If you try and select either the transfer or term icons for a member record that has a yield sign you will be prompted with a message This member record has been updated today. Would you like to override? You may choose to proceed or cancel. Only the most recent transaction for a member on a given day will load into the MMIC internal system. Page 6 of 16

7 Additions: If you are providing services to a member that is not included on your roster you may add them by first clicking the Add button below the roster grid. Upon clicking Add a new search window will appear. Providers can search for members using AHCCCS ID or by First Name, Last Name, and DOB. An effective date must also be entered when using either search option. This date would represent the day you would like the member to be active on your ABHC roster. MMIC will allow a past date of no more than 14 days. After all fields are entered click the Search button Page 7 of 16

8 Search results matching your criteria will be displayed below the search fields. matches will only be hyperlinked if the member is enrolled in an SMI benefit plan that overlaps with the effective date that was provided in the search. If the hyperlinked member you have select is currently assigned to another ABHC you will be receive the following prompt. Page 8 of 16

9 If OK is selected you will be returned to the Provider Rosters homepage and the selected member detail will be populated in the Information section but the Transaction Type will be a Transfer instead of an ADD. Clicking Cancel will return you back to the search page. If the hyperlinked member is not currently assigned to an ABHC you will be returned to the Provider Rosters homepage and the selected member detail will be populated in the Information section. Page 9 of 16

10 There are only two editable fields on an ABHC add transaction. First, providers must enter the Roster Effective Date. This date must represent the first day of assignment to the new site. NOTE: if the date provided does not fall within the member s current enrollment span then the user will be returned the error: "The effective date does not fall within the member's current enrollment span. Please contact Enrollment PCP Alignments_Updates@Aetna.com to complete transaction". Due to the complexity of these types of scenarios a manual correction by MMIC enrollment staff is necessary. In the please use the following format: AHCCCS ID First Name Last Name DOB Add, Term (ACT Team Only), or Transfer Effective Date Relinquishing (represent the Site last day of assignment to the relinquishing site) Receiving Site Next, providers must choose from the Site dropdown to indicate which ABHC site within your provider organization that the member will be assigned. Click Submit to complete. Page 10 of 16

11 ACT Transactions For ACT Rosters, providers will be able to perform transfers between clinics and can also add new members who currently do not have an ACT Team Assignment. However, unlike ABHC roster management, providers will be able to submit terminations for ACT Team Assignments. For ACT transactions the grid will display the following detail for each member assigned to the roster: AHCCCS ID, NTXIX ID, DOB, Name, Benefit Plan, ABHC, and PCP. Transfers: If you would like to transfer a member to another ACT Team within your provider organization or outside of the organization you may do so by clicking on the arrow icons in the first column of that member record. NOTE: When a member is transferred from one ACT Team to another then MMIC will also move the members ABHC affiliation to the ABHC site associated with the new ACT Team. Once the Transfer arrow icon has been selected for a member you will see the member detail populated in the Information section below the grid. The detail includes: AHCCCS ID, Last Name, First Name, Date of Birth, Roster Effective Date, Roster Term/Transfer Date, Site, Transaction Type, and Receiving Site (Transfers Only). Page 11 of 16

12 There are only two editable fields on an ACT transfer transaction. First, providers must enter the Roster Term/Transfer Date. This date must represent the last day of assignment to the relinquishing ACT team. NOTE: if the date provided does not fall within the member s current enrollment span then the user will be returned the error: "The effective date does not fall within the member's current enrollment span. Please contact Enrollment PCP Alignments_Updates@Aetna.com to complete transaction". Due to the complexity of these types of scenarios a manual correction by MMIC enrollment staff is necessary. In the please use the following format: AHCCCS ID First Name Last Name DOB Add, Term (ACT Team Only), or Transfer Effective Date Relinquishing (represent the Site last day of assignment to the relinquishing site) Receiving Site Next, providers must choose a site from the Receiving Site (Transfers Only) dropdown. Your selection will indicate which site your member will be transferring to. Click Submit to complete. Once submitted you will see a Transaction Successful message on the top of the screen and a yield icon next to the member record that was changed. This icon will indicate any record that has been updated on the current day. Page 12 of 16

13 If you try and select either the transfer or term icons for a member record that has a yield sign you will be prompted with a message This member record has been updated today. Would you like to override? You may choose to proceed or cancel. Only the most recent transaction for a member on a given day will load into the MMIC internal system. Terminations Providers have the ability to term ACT Team associations by clicking on the red X next to the member detail in the first column of the report grid. The member detail will be populated in the Information section below the grid. The only editable field will be the Roster Term/Transfer Date field. This date must represent the last day of assignment to the relinquishing ACT team. Once this date has been entered you can click Submit to complete. As previously mentioned, a yield icon will appear next to the member record once the transaction is successful. Page 13 of 16

14 Additions: If you are providing services to a member that is not included on your ACT roster you may add them by first clicking the Add button below the roster grid. Upon clicking Add a new search window will appear. Providers can search for members using AHCCCS ID or by First Name, Last Name, and DOB. Unlike ABHC transactions, ACT Team additions will not require an effective date to be entered. After all fields are entered click the Search button Page 14 of 16

15 Search results matching your criteria will be displayed below the search fields. matches will only be hyperlinked if the member is enrolled in an SMI benefit plan. If the search returns a record that matches your member then click on the hyperlinked name. If the hyperlinked member you have selected is currently assigned to another ACT team you will be receive the following prompt. Page 15 of 16

16 If OK is selected you will be returned to the Provider Rosters homepage and the selected member detail will be populated in the Information section but the Transaction Type will be a Transfer instead of an ADD. Clicking Cancel will return you back to the search page. If the hyperlinked member is not currently assigned to an ACT Team will be returned to the Provider Rosters homepage and the selected member detail will be populated in the Information section. There are only two editable fields on an ACT add transaction. First, providers must enter the Roster Effective Date. This date must represent the first day of assignment to the new site. NOTE: if the date provided does not fall within the member s current enrollment span then the user will be returned the error: "The effective date does not fall within the member's current enrollment span. Please contact Enrollment PCP Alignments_Updates@Aetna.com to complete transaction". Due to the complexity of these types of scenarios a manual correction by MMIC enrollment staff is necessary. Next, providers must choose from the Site dropdown to indicate which ACT Team within your provider organization that the member will be assigned. Click Submit to complete. QB 2520 Page 16 of 16