Aerial iexchange Users Guide

Transcription

1 Aerial iexchange Users Guide

2 How to Run the Util\\\ \user Disclaimer How to reach us Copyright Information contained in this document is subject to change without notice and does not present a commitment on the part of Medecision Inc. This document is under copyright. You may not modify, change, or reproduce this document, in whole or in part, by photocopying, electronic publishing, or any other means, without expressed written permission from Medecision Inc. Our Customers may, however, reproduce this document in whole or in part for in-house distribution only. Send any comments or suggestions regarding this publication to: Medecision, Inc. 601 Lee Road Chesterbrook Corporate Center Wayne, PA Attn: Documentation Fax: (610) Documentation@Medecision.com Copyright 2014 Medecision Inc. All rights reserved. Printed in U.S.A. Medecision is a trademark of Medecision, Inc. Other Medecision product names and logo are also trademarks or registered trademarks of Medecision, Inc. Other product and brand names are trademarks of their respective owners.

3 Table of Contents GETTING STARTED... 4 Overview... 4 Audience... 4 What's New in This Guide... 5 Terminology... 5 Tasks You Can Perform in Aerial iexchange... 6 Creating New Requests... 7 Requesting an Extension... 7 Performing Various Searches... 7 Viewing Treatment Updates... 8 Administrative Tasks... 8 Basics... 8 Using the Mouse and Keyboard... 8 Printing... 8 Timing Out... 9 Security... 9 Using the Browser... 9 Accessing Online Help... 9 Logon to Aerial iexchange... 9 If You Have Trouble Logging On Reset Password Accessing Aerial iexchange Starting Point Page Selecting a Payer Clinical Review AERIAL IEXCHANGE MAINTENANCE Overview Accessing Preferences Changing your Password Aerial iexchange Administration Group Administration Account Administration Submitting Providers Frequent Providers Frequent Procedures Frequent Diagnoses Edit User Profile MANAGING REQUESTS Overview Inpatient Requests Entering a New Inpatient Request Inpatient request entry General Information Inpatient request entry Services Information Inpatient Request Preview Inpatient Request Confirmation Copyright 2014 Medecision, Inc. i

4 MCG (Formerly Milliman Care Guidelines) CareWebQI Access MCG (Formerly Milliman Care Guidelines) CareWebQI Access Request Review Questionnaire Clinical Review Request Review Questionnaire Request Questionnaire Inpatient Request Extensions Entering an Inpatient Request Extension Other Requests Entering an Other Request Other Request Entry General Information Other Request Entry Services Information Other Request Preview Additional Other Services Entry Other Request Confirmation Other Request Extensions Entering an Other Request Extension Prior Auth Request Prior Auth Request General Information Prior Auth Request Service Information Referral Requests Entering a Referral Request Referral Request Entry General Information Referral Request Entry Services Information Referral Request Preview Referral Request Confirmation Referral Request Extensions Entering a Referral Request Extension Behavioral Health Requests Overview Entering a New Inpatient Behavioral Health Request for DSM IV Inpatient Behavioral Health General Information for DSM IV Inpatient Behavioral Health Services Information for DSM IV Inpatient Behavioral Health Preview for DSM IV Inpatient Behavioral Health Confirmation for DSM IV Entering an Inpatient Behavioral Health Request Extensions Inpatient Behavioral Health Preview Inpatient Behavioral Health Extension Confirmation for DSM IV Entering a New Other Behavioral Health Request for DSM IV Additional Other Behavioral Health Services Entry for DSM IV Other Behavioral Health Preview for DSM IV Other Behavioral Health Confirmation for DSM IV Extending an Other Behavioral Health Request for DSM IV Other Behavioral Health Extension Preview for DSM IV Entering a New Referral Behavioral Health Request for DSM IV Referral Behavioral Health Preview for DSM IV Referral Behavioral Health Confirmation for DSM IV Extending a Referral Behavioral Health Request for DSM IV Referral Behavioral Health Extension Confirmation for DSM IV MANAGING TREATMENT UPDATES Overview Copyright 2014 Medecision, Inc. ii

5 Categories of Treatment Updates Updates for Submitting Providers Updates for Facilities and Servicing Providers Updates for the Primary Care Physician Treatment Updates Notification Treatment Update Summary Viewing New Updates for Submitting Providers Viewing Updates for Facilities and Servicing Providers Viewing Updates for Primary Care Physician Mark as Read or Unread Accessing the Treatment Update Details Page Treatment Update Search PATIENT CLINICAL SUMMARY Overview Accessing the Patient Clinical Summary Patient Clinical Summary Report Details HEALTH SUMMARY Overview Accessing the Health Summary Health Summary Report Details Navigating the Report Printing a PDF Report PERFORMING SEARCHES Overview Member Search Member Search from Request Entry Page Member Search Result View Member Details View Existing Requests Treatment Search Summary Page Treatment Search Access Treatment Search from Navigation Menu Treatment Search Summary Treatment Search Details Notes Adding Notes Provider Search Accessing Provider Search from the Navigation Menu Diagnosis Search Performing a Diagnosis Search Procedure Search Performing a Procedure Search Copyright 2014 Medecision, Inc. iii

6 Chapter 1 Getting Started In This Chapter Overview... 4 Audience... 4 What's New in This Guide... 5 Terminology... 5 Tasks You Can Perform in Aerial iexchange... 6 Basics 8 Accessing Aerial iexchange Clinical Review Overview Aerial iexchange is a Web-based multi-payer solution that allows physicians and other health care providers to quickly and easily submit transactions to payers. It supports the direct processing of inpatient and outpatient authorizations, referrals, and treatment updates. Aerial iexchange uses the Internet to create a two-way link between health care providers and the managed care organization to exchange care management data. An integral part of the Medecision product suite, Aerial iexchange enables providers to quickly and easily submit transactions to the managed care organizations (payer), using automated business rules to make approval processing faster and easier. Audience This manual is for two types of users: Personnel at a provider s office or facility responsible for submitting inpatient, other and referral requests to managed care organizations Copyright 2014 Medecision, Inc. 4

7 Getting Started Personnel at a provider s office who are responsible for Aerial iexchange maintenance which includes setting, changing, or inactivating user IDs and passwords, maintaining a list of associated providers, and determining the most frequently used diagnoses and procedures for a particular provider office. What's New in This Guide The following table lists key changes to the document for the current release. New Features and Updates Where to Find More Information Electronic Provider Access gives out-of-area providers the same access to pre-service review functionality. N/A Terminology The following table defines some of the key terminology used in this manual. Term Definition Inpatient request Other request Referral request An inpatient request is an Aerial iexchange transaction that you perform to submit a request for an inpatient length of stay and associated treatments. The business rules that the payer has set up determine if your request is approved or pended for further review by the payer. Other request is an Aerial iexchange transaction that you perform to submit a request for non-inpatient treatments. Use other requests for all non-referral treatments not requiring a length of stay. The business rules that the payer has set up determine if your request is approved or pended for further review by the payer. A referral request is an Aerial iexchange transaction that you perform to submit a request for referral treatments. The business rules that the payer has set up determine if your request is approved or pended for further review by the payer Copyright 2014 Medecision, Inc. 5

8 Getting Started Term Definition Prior authorizations Clinical Review Member search Provider search Treatment search Treatment Updates A prior authorizations is an Aerial iexchange transaction that allows you to request prior authorization for a particular service where the date of treatment or the treatment setting may be unknown at the time of submission. Clinical review is an Aerial iexchange transaction that provides the ability to capture and review additional information from a clinician on the initial request. A member search is an Aerial iexchange transaction that allows you to search by member ID or depending on the payer you selected, by last name and date of birth to view detailed member information. A provider search is an Aerial iexchange transaction that allows you to search by provider ID or provider name for provider information. A treatment search is an Aerial iexchange transaction that allows you to search by member ID, treatment range, request ID or clinical review. After performing a treatment search you may choose to extend a service depending on the payer selected. Treatment updates are Aerial iexchange transactions that notify you of changes made to requests you have submitted to payers. Tasks You Can Perform in Aerial iexchange This User Guide describes the various tasks that can be performed in Aerial iexchange. The tasks that you are able to perform can vary depending on: Whether you are logged in as a provider user or as a payer user. For additional information about payers users see the Aerial iexchange MCO User Guide. The payer you select (applies to provider users only). Your user authorization level. The tasks that can be performed in Aerial iexchange can be grouped into the following categories: Copyright 2014 Medecision, Inc. 6

9 Getting Started Creating New Requests When you create a new request, you are submitting a request to a payer for treatments to be performed. The business rules that the payer has set up will determine if your request is approved or pended for further review by the payer. Aerial iexchange provides the ability to enter inpatient, other, referral requests and prior authorizations. Your ability to perform each of these tasks may vary depending on the payer you select. See the section of this guide for more information. Requesting an Extension When you request an extension, you are submitting a request to a payer for the extension of a treatment such as adding additional units or days. In some cases, you can also add additional services and diagnoses as well as other information. The business rules that the payer has set up will determine if your request is approved or pended for further review by the payer. Aerial iexchange provides the ability to request extensions on inpatient, other or referral treatments. Your ability to perform each of these tasks may vary depending on the payer you select. See the section of this guide. Performing Various Searches Aerial iexchange provides you with the ability to: Search for existing treatments Search for members (verify eligibility) Search for providers Search for diagnosis codes Search for procedure codes See the Performing Searches section of this guide for more information Copyright 2014 Medecision, Inc. 7

10 Getting Started Viewing Treatment Updates Aerial iexchange can notify you of changes made to requests you have submitted to payers. Your ability to view treatment updates may vary depending on the payer you have selected. See the Managing Treatment Updates section of this guide. Administrative Tasks If you have the correct authorization level, you can perform a variety of administrative tasks in Aerial iexchange. See the Aerial iexchange Maintenance section of this guide. Basics Using the Mouse and Keyboard You can use the TAB key to move from field to field, or click in each field with your mouse. If using the keyboard, you can expand drop-down lists such as the Diagnosis List by holding down the ALT key and then using the up and down arrow keys. You can type the first letter of the diagnosis that you want. Pressing the same letter key repeatedly scrolls through each diagnosis that starts with that letter. Printing Print friendly pages: Many pages in the Aerial iexchange application contain a link that reads "Print friendly version". Clicking the link opens a new browser window containing a print friendly version of the page you are on. Once the print friendly version of the page you are on displays, click Print this page to print. Standard pages: You can print any Aerial iexchange page by clicking the Print button on your browser. However, it is recommended that you use the print friendly page functionality to print pages when possible. The quality of the printed page is substantially better using less paper and printer toner Copyright 2014 Medecision, Inc. 8

11 Getting Started Timing Out If there is no activity for a pre-determined number of minutes during your Aerial iexchange session, you are "timed out" of the session and your session terminates. When you attempt to perform any action in Aerial iexchange, the logon page displays the following message: "Your session has expired. Please login again." Security To enhance patient privacy, it is recommended that each organization set each Aerial iexchange user s PC screen saver to a wait period of 2-3 minutes of inactivity, and to set the screen saver as password protected. Using the Browser Do not use your browser s Back and Forward buttons to navigate in the Aerial iexchange application or you will lose data. You can use your browser s Back and Forward buttons to navigate in Aerial iexchange online help. Aerial iexchange does not support the use of multiple browser tabs in the same browser window because Aerial iexchange interprets the tabs within the same window as being part of the same session. However, Aerial iexchange supports the use of multiple browser windows since the system can differentiate each window as a distinct session. Accessing Online Help You can access online help at any time by clicking the Help link located at the top of every page. Aerial iexchange provides instructions throughout the system. Each page provides you with a description of what it is used for and what occurs when you use it. Logon to Aerial iexchange Complete these steps to log on to Aerial iexchange as a provider office user. 1. Open your Web browser Copyright 2014 Medecision, Inc. 9

12 Getting Started 2. Type the Aerial iexchange URL (Internet address) you have been given and press ENTER. The Provider login page displays. If your provider group is not registered with Medecision, click the here link to access the Medecision web site registration page. The User ID and Password are case-sensitive. Enter each with the appropriate upper and lower-case letters as used when each was set up. 3. Enter your User ID and press TAB. 4. Enter your iexchange ID and press TAB. 5. Type in your Password. Aerial iexchange masks what you type with dots ( ) Copyright 2014 Medecision, Inc. 10

13 Getting Started 6. Click Login or press ENTER. The Starting point page displays. Use this page to access all available Aerial iexchange functionality. 7. To start again, click Reset: Aerial iexchange clears the fields on the Provider Login window. Change Password The first time you log into the system the Change password page displays. 1. Click OK. 2. Enter your Current Password. 3. Enter a New Password. 4. Enter your new password again in the Confirm New Password field Copyright 2014 Medecision, Inc. 11

14 Getting Started 5. Click Submit. The Password Change Information window displays. 6. Click Continue. The Edit user profile page displays. Note: The Edit user profile page only displays if the password security questions are not set Copyright 2014 Medecision, Inc. 12

15 Getting Started Edit user profile The Edit user profile page enables you to edit your user account profile information and must be completed before entering the system. You can edit your name, add an address and select a password security question and answer. 1. Change your First name, Middle name or Last name. 2. Enter your address. 3. Enter your address again to confirm that the address was entered correctly. It is important to enter a valid address. If you should forget your password a temporary password is sent to this address Copyright 2014 Medecision, Inc. 13

16 Getting Started 4. Click the Security question drop-down list. 5. Select a Security question. 6. Enter the answer to the security question in the Security answer field. It is recommended that the answer to your security question be memorable but not easily guessed by others. The minimum length of characters is four and the answer is not case sensitive. 7. Click Save. You are then logged into the system and returned to the Starting point page. If You Have Trouble Logging On After attempting to log on, you may receive a logon error message indicating that the logon information you have provided is incorrect. You will receive an error message for any of the following reasons: Issue You are not set up as an Aerial iexchange user. Solution Ask your provider group administrator to verify that you have been set up in Aerial iexchange Maintenance with a user ID and password Copyright 2014 Medecision, Inc. 14

17 Getting Started You entered the wrong Aerial iexchange ID, or you typed it incorrectly. You entered the wrong user ID and password or typed them incorrectly. Verify your exact Aerial iexchange ID. You must enter it exactly as it was set up in maintenance. The user ID is case-sensitive. You must enter the appropriate upper and lower-case letters as used when set up in maintenance. Verify your user ID and password. They are both case sensitive. Note: A user s account locks after three unsuccessful logon attempts. When an account is locked, the user cannot log on to the application. The following message displays Error: Logon attempt has been unsuccessful 3 times. This account is temporarily disabled. Contact your system administrator for assistance. Reset Password Follow these steps to reset your password Copyright 2014 Medecision, Inc. 15

18 Getting Started 1. Click the Forgot Password Click here link on the Provider login page Copyright 2014 Medecision, Inc. 16

19 Getting Started The Reset password page displays. 2. Enter your User ID. 3. Enter the iexchange ID assigned to your office Copyright 2014 Medecision, Inc. 17

20 Getting Started 4. Click Next. The Reset password displays. 5. Type in the answer to the security question Copyright 2014 Medecision, Inc. 18

21 Getting Started 6. Click Submit. The Reset password displays. An message with a temporary password is sent to the address given when the user profile was set up. The user cannot respond to the message. For additional information on how to set your user profile see the Logon to Aerial iexchange section of this guide. 7. To return to the login page, click the Provider login link Copyright 2014 Medecision, Inc. 19

22 Getting Started Accessing Aerial iexchange Starting Point Page The Starting Point Page is the first page that displays after you log in. This page contains the following: The Help, Preferences, user s first and last name, user s provider group name and the logout link. The last log in field displays the date and time of the last time you were logged into the system. Hover over the question mark icon and the following message displays: If the date and time of your last login appears suspicious, it is strongly recommended that you immediately change your password by clicking on the Preferences link and that you also report this to your system administrator. If the user is logging in for the first time the date or time. last log in field displays without a The last log in field with date and time of log in continues to display after the user selects the payer or a function to perform. Note: If the user s first and last name or provider group name are displayed incorrectly, contact the administrator to verify that the correct login information is being used. The Aerial iexchange navigation menu. The items on this menu are disabled until you select a payer. The Frequently used payers and Other available payers contains the payers you can access through Aerial iexchange. 1. To view the payer names, hover your mouse over the two fields. For information on how to select a payer, see the Selecting a Payer section. If you do not see the payer in the list, you may need to switch to the other Aerial iexchange application version Copyright 2014 Medecision, Inc. 20

23 Getting Started 2. To switch to the other application version, select the Click here link. Selecting a Payer 1. Hover over Frequently used payers or Other available payers with your mouse. The field expands to the right and displays a drop-down list of available payers. Frequently used payers: The system presents all payers for which your provider group has submitting providers defined. These payers are presented in alphabetical order. Other available payers: The system presents all payers for which your provider group does not have submitting providers defined. You are unable to submit requests for these payers. If you need to submit a requests for one of these payers contact your group administrator. All payers are presented in alphabetical order. 2. To select a payer scroll up or down the list and click the payer s name. If you do not see the payer in the list you may need to switch to the other Aerial iexchange application version Copyright 2014 Medecision, Inc. 21

24 Getting Started 3. To switch to the other Aerial iexchange application version, select the Click here link. The Starting Point Page displays showing the payer you selected. The payer s company name and logo may display in the upper left corner of the page depending on the payer selected. Depending on the payer selected, the Treatment updates, Clinical review, Sponsor bulletin and the Medecision news sections for the selected payer as well as some instructional information for using the page display. If your provider group does not have a submitting provider defined for the selected payer a message displays stating: "There are no submitting providers set up in your provider group for the selected payer. You may be unable to perform some tasks." 4. To select a different payer, click Select a different payer. The Starting point page displays. 5. Follow steps 1 through 2 to select a different payer. The Starting point page displays listing the newly selected payer. 6. To open the task instructions page, select a task from the Aerial iexchange Navigation Menu. Note: The available tasks may vary depending on which payer you select. If the payer you have selected does not support a particular transaction (inpatient, other, or referral transactions) Copyright 2014 Medecision, Inc. 22

25 Getting Started Payer Defined Link You can select the payer defined link (located at the top of the page to the right of the Preferences link) to access a payer defined web site that is external to Aerial iexchange. The name of this link varies by payer and some payers may choose not to display a link. Clinical Review Clinical review provides the ability to capture and review additional information from a clinician on the initial request. When a payer is selected, the system determines if the clinical review functionality is enabled. The system searches for requests awaiting clinical review. If there are requests awaiting clinical review, the system presents a link on the Starting point page which enables you to view those requests. This functionality only applies to inpatient and other requests Copyright 2014 Medecision, Inc. 23

26 Chapter 2 Aerial iexchange Maintenance In This Chapter Overview Accessing Preferences Changing your Password Aerial iexchange Administration Edit User Profile Overview Aerial iexchange administrative maintenance functions are accessed from the Preferences link located on the Starting point page. You must have access to the maintenance options to access them. The maintenance functionality enables the administrator of your provider group to maintain user account administration and frequently used content throughout Aerial iexchange Copyright 2014 Medecision, Inc. 24

27 Aerial iexchange Maintenance Accessing Preferences 1. Click the Preferences link located at the top of the menu bar. The Aerial iexchange Preferences page displays. Changing your Password 1. To change your password, click the Change password link on the Aerial iexchange preferences page. The Change password page displays. The provider office user or provider administrator can choose to change their password at any time by accessing the change password functionality through the Aerial iexchange Preferences link. The Aerial iexchange preferences page is displayed Copyright 2014 Medecision, Inc. 25

28 Aerial iexchange Maintenance 2. Click on the Change password link to display the Change password page. 3. Enter your Current Password. 4. Enter a New Password. The new password must be between 4 and 16 characters in length. The system keeps a record of the passwords the provider staff or provider administrator has used in the past 90 days. If the system recognizes this password has been used within that time frame the message "Error The password used matches a previously used password. Enter a different password" displays. 5. Re-enter the new password in the Confirm New Password field. 6. Click Submit to continue. You receive a message stating that the password has been changed and the next time you log on to the system you need to use the new password Copyright 2014 Medecision, Inc. 26

29 Aerial iexchange Maintenance Aerial iexchange Administration 1. To perform administrative maintenance for your provider group, select the Aerial iexchange Administration link on the Aerial iexchange preferences page. The Aerial iexchange Administrator page displays. The Aerial iexchange Administrator page allows you to edit your provider group and maintain your provider group s user accounts, submitting providers, frequent providers, frequent procedures, and frequent diagnosis Copyright 2014 Medecision, Inc. 27

30 Aerial iexchange Maintenance Group Administration As a provider office user, it is important that the information related to your group stored within Aerial iexchange is accurate and up to date. As a provider office user with Administrative Group Maintenance access, you have the ability to edit information related to your group. Editing Provider Group Information To edit provider group information: 1. From the Aerial iexchange preferences page, click the Aerial iexchange Administration link. The Aerial iexchange Administrator page displays Copyright 2014 Medecision, Inc. 28

31 Aerial iexchange Maintenance 2. Click Edit provider group. The Edit provider group information page displays Copyright 2014 Medecision, Inc. 29

32 Aerial iexchange Maintenance You can add or edit general information related to your group. The following fields are open for entry unless noted. All fields are required unless they are marked optional. Section 1 - Edit the provider group information The Group ID field is automatically entered by the system and cannot be edited. 1. Enter the provider Group name. 2. Enter the provider group Tax ID: Enter the provider group tax identification number. This is a 9-digit numerical field. 3. Enter the provider group national provider identifier or NPI. (optional) 4. Click on the drop down arrow and select an Office specialty. Section 2 - Enter the group s contact information 1. Click on the drop down arrow and select a Prefix. (optional) 2. Enter the contact person s First name. 3. Enter the contact person s Middle name. (optional) 4. Enter the contact person s Last name. 5. Click on the drop-down arrow and select a Suffix. (optional) 6. Enter the contact person s primary Street address Enter the contact person s secondary Street address 2. (optional) 8. Enter the name of the City in which the contact person resides. 9. Click on the drop down arrow and select the State in which the contact person resides. Select Outside the United States or Canada if the individual lives somewhere other than the states and provinces displayed in the list. 10. Enter the contact person s Zip code. 11. Enter the contact person s Phone number. 12. Enter the contact person s Phone extension. (optional) 13. Enter the contact person s Fax number. (optional) Copyright 2014 Medecision, Inc. 30

33 Aerial iexchange Maintenance 14. Enter the contact person s address. symbol and the domain extension must be present and equal to or greater than 2 characters, and cannot exceed 6 characters. Section 3 View Single Sign-on Mapping This section displays the Aerial iexchange partner websites that can access Aerial iexchange through Single Sign-on. This section is view only. 1. Once the appropriate changes are made, click Submit to save your changes. The Aerial iexchange Administration page displays with an Informational message stating that the Group has been updated. 2. Select Cancel to discard your changes and return to the Aerial iexchange Administration page. Account Administration As a provider office user with Administrative Group Maintenance access, you have the ability to add and edit account information for users associated with your group. New users can also be added. User Account Administration To add or edit your group s user account information: 1. From the Aerial iexchange Preferences page, click the Aerial iexchange Administration link. 2. Click User account administration. The User account administration page displays. The User account administrator page displays a listing of all the user accounts currently associated with your provider group. Users are listed by name, User ID, User role, and Current status Copyright 2014 Medecision, Inc. 31

34 Aerial iexchange Maintenance Adding a New Account 1. Click Add user located at the bottom of the User account administration page. The Add user account page displays. 2. Enter the new user s logon and password information. (All fields are mandatory.) Requested user ID: Use this field to assign an ID the user can use to access Aerial iexchange. New password: Enter the password. The new password must be between 4 and 16 characters in length. The system keeps a record of the passwords the provider staff or provider administrator has used in the past 90 days. If the system recognizes this password has been used within that time frame, you will receive the message "Error The password used matches a previously used password. Enter a different password." Confirm new password: Re-enter the password Copyright 2014 Medecision, Inc. 32

35 Aerial iexchange Maintenance The provider office user or provider administrator can choose to change their password at any time by accessing the change password functionality through the Aerial iexchange Preferences link. The Aerial iexchange Preferences page is displayed. 3. Click on the Change password link to display the Change password page. 4. Enter the new user s profile information. (All fields are mandatory unless specified as optional). First name: Type the user s first name. Middle name (optional): Type the user s middle name. Last name: Type the user s last name. Status: Select the user s status from the drop-down list (Active or Inactive). Users can not be deleted. User account privileges: Select the user s role from the drop-down list (Staff or Administrator). It is recommended that administrative roles should only be given to the appropriate staff members. 5. Click Save to add the new user account. The new account is added and the User account administration page displays stating the user has been created Copyright 2014 Medecision, Inc. 33

36 Aerial iexchange Maintenance Editing an Account 1. From the User account administration page, click the radio button next to the account you wish to edit and then click Edit located at the bottom of the page. The Edit user account information page displays. The User ID field cannot be edited. 2. Edit the user s password information if necessary. New password: Assign a new confidential password for the user. Confirm password: Re-enter the password. User must change password: Check this box if you want Aerial iexchange to prompt this user to change the password you are assigning to their account the next time they log in. 3. Edit the user s profile as appropriate Copyright 2014 Medecision, Inc. 34

37 Aerial iexchange Maintenance 4. Click Save to save your changes and return to the User account administration page. The User account administration page displays stating the User has been updated. Click Cancel if you do not want to update the user s account. Submitting Providers Use the Submitting providers function to add, edit, or delete a submitting provider. 1. Click the Submitting providers link on the Aerial iexchange Administrator page. The Submitting provider summary page displays listing all of the providers within your organization. Providers are listed by name, Payer ID, NPI, and Payer. Adding Providers 1. From the Submitting provider summary page, click Add provider. A provider status of 'Inactive' indicates that Aerial iexchange was unable to locate the MCO ID for the provider in the payer's system. Inactive providers do not display in the provider list for treatment request entry or for treatment search for the payer. 2. Refresh providers that have an Inactive status Copyright 2014 Medecision, Inc. 35

38 Aerial iexchange Maintenance 3. Use Delete to remove providers that still have an Inactive status after the refresh Copyright 2014 Medecision, Inc. 36

39 Aerial iexchange Maintenance The Provider search page displays. 4. Click the Payer drop-down menu and select a payer. 5. Click the Search type drop-down menu and select a search type. The three search types available are Provider Name, Provider Payer ID and National Provider ID (NPI). 6. Click the Provider type drop-down menu and select a provider type. The three provider types available are Practitioner, Facility and Group Practice. For additional information on how to perform a Provider Search, see the Provider Search (on page 269) section. 7. Click Submit search Copyright 2014 Medecision, Inc. 37

40 Aerial iexchange Maintenance The Provider search result page displays listing the providers meeting your search criteria. 8. Click Select, located next to the provider name, to select a provider. The Submitting provider details page displays. Click New search to perform a new search Copyright 2014 Medecision, Inc. 38

41 Aerial iexchange Maintenance Click Cancel to return to the Submitting provider summary page. 9. Click the Yes radio button if you want this provider to be the default provider. 10. Enter Additional information to help differentiate providers with the same name. (optional) 11. Click Save to save your entry. The Submitting provider summary page displays stating the provider has been added Copyright 2014 Medecision, Inc. 39

42 Aerial iexchange Maintenance Editing Providers 1. From the Submitting provider summary page, click the radio button next to the provider s name that you want to edit Copyright 2014 Medecision, Inc. 40

43 Aerial iexchange Maintenance 2. Click Edit, located at the bottom of the Submitting provider summary page. The Submitting provider details page displays. 3. Enter the appropriate changes and click Save. The Submitting provider summary page displays stating that the provider has been updated. Frequent Providers Use this section to set up a short list of servicing or attending providers your provider group used most often Copyright 2014 Medecision, Inc. 41

44 Aerial iexchange Maintenance Adding a Frequent Provider 1. From the Aerial iexchange Administrator page, click the Frequent providers link. The Frequent provider summary page displays. This page contains a list of frequent providers currently associated with your provider group. 2. Click Add provider, located at the bottom of the Frequent provider summary page. The Provider search page displays. For instructions on how to perform a Provider search, see Adding Providers in the Submitting Providers (on page 35) section. 3. Click Submit search. The Provider search result page displays listing the providers meeting your search criteria. Click Clear form to clear the form and re-enter information Copyright 2014 Medecision, Inc. 42

45 Aerial iexchange Maintenance Click Cancel to return to the Frequent provider summary page. 4. Click Select located next to the name of the provider. The Frequent provider details page displays. 5. Click the check box next to each list the provider should display in (Attending, Facility or Servicing). 6. Click the Yes radio button if you want the provider to be the default provider in the list. 7. Enter any Additional information that should be displayed with the provider in the list. (Optional) 8. Click Save to save your entry. The Frequent provider summary page displays stating that the provider has been updated Copyright 2014 Medecision, Inc. 43

46 Aerial iexchange Maintenance Editing a Frequent Provider 1. From the Frequent provider summary page, click the radio button next to the provider s name that you want to edit. 2. Click Edit, located at the bottom of the Frequent provider summary page. The Frequent provider details page displays. 3. Enter the appropriate changes and click Save. The Frequent provider summary page displays stating that the provider has been updated. Deleting a Frequent Provider 1. From the Frequent provider summary page, click the radio button next to the provider s name that you want to delete. The Are you sure you want to delete this frequent procedure? message displays. 2. Click OK if you want to delete the provider. The Frequent provider summary page displays stating that the provider has been successfully deleted. Frequent Procedures Use this section to create a list of frequently used procedures. You can add, edit or delete procedures as necessary. Adding a Frequent Procedure 1. From the Aerial iexchange Administrator page, click the Frequent procedures link. The Frequent procedures summary page displays. This page contains a list of the frequent procedures currently associated with your provider group Copyright 2014 Medecision, Inc. 44

47 Aerial iexchange Maintenance 2. Click Add procedure, located at the bottom of the Frequent procedure summary page. The Add frequent procedure page displays. 3. To select the coding classification, click the drop-down menu in the Coding classification field. The options available in the menu depend on the payer selected. 4. Enter a Procedure code and Procedure description. It is recommended that you verify the procedure code and description are valid before entering. 5. Click Save to save your entry. The Frequent provider summary page displays. Editing a Frequent Procedure 1. From the Frequent procedure summary page, click the radio button next to the procedure description that you want to edit. 2. Click Edit, located at the bottom of the Frequent procedure summary page. The Edit frequent procedure page displays. The Procedure code cannot be changed. 3. Enter the appropriate changes and click Save. The Frequent procedure summary page displays with the changes Copyright 2014 Medecision, Inc. 45

48 Aerial iexchange Maintenance Deleting a Frequent Procedure 1. From the Frequent procedure summary page, click the radio button next to the procedure description that you want to delete. The Are you sure you want to delete this frequent procedure? message displays. 2. Click OK if you want to delete the procedure. The Frequent procedure summary page displays stating that the procedure has been successfully deleted. Frequent Diagnoses Use this section to create a list of frequently used diagnoses. You can add, edit, or delete diagnoses as necessary. Adding a Frequent Diagnosis 1. From the Aerial iexchange Administrator page, click the Frequent diagnoses link. The Frequent diagnosis summary page displays. This page contains a list of the frequent diagnoses currently associated with your provider group Copyright 2014 Medecision, Inc. 46

49 Aerial iexchange Maintenance 2. Click Add diagnosis, located at the bottom of the Frequent diagnosis summary page. The Add frequent diagnosis page displays. 3. To select the coding classification, click the drop-down menu in the Coding classification field. The options available on the menu depend on the payer selected. 4. Enter a Diagnosis code and Diagnosis description. It is recommended that you verify the diagnosis code and description are valid before entering. 5. Click Save to save your entry. The Frequent diagnosis summary page displays. For instructions on how to delete or edit an entry, see the Frequent Procedures (on page 44) section of this guide. Edit User Profile 1. To edit the user profile, click the Edit user profile link on the navigation menu. The Edit user profile page displays Copyright 2014 Medecision, Inc. 47

50 Aerial iexchange Maintenance Use this page to edit your account profile information. Edit user profile information 1. Enter changes to the First name, Middle name, or Last name. Add or Edit an address 1. Enter changes or add a new address in the address field. The address is needed for password resets. 2. Re-enter the address in the Confirm address field Copyright 2014 Medecision, Inc. 48

51 Aerial iexchange Maintenance Select security question 1. Select a new security question from the Security question drop-down menu. The security question is needed for password resets. 2. Enter a Security answer. The security answer must be at least four characters in length and is not case sensitive. 3. Click Save. The Aerial iexchange Preferences page displays with a message stating your profile has been updated Copyright 2014 Medecision, Inc. 49

52 Chapter 3 In This Chapter Overview Inpatient Requests Inpatient request entry General Information Inpatient request entry Services Information MCG (Formerly Milliman Care Guidelines) CareWebQI.. 64 Clinical Review Request Review Questionnaire Inpatient Request Extensions Other Requests Other Request Entry General Information Other Request Entry Services Information Other Request Extensions Prior Auth Request Referral Requests Entering a Referral Request Referral Request Entry General Information Referral Request Entry Services Information Referral Request Extensions Behavioral Health Requests Overview Entering a New Inpatient Behavioral Health Request for DSM IV Entering a New Other Behavioral Health Request for DSM IV Entering a New Referral Behavioral Health Request for DSM IV Extending a Referral Behavioral Health Request for DSM IV Copyright 2014 Medecision, Inc. 50

53 Overview Aerial iexchange enables you to create and submit a request for treatment to the payer you have selected. Each of the request transactions has its own color code; for example, all inpatient pages are green, referral pages are blue, and other pages are gold. Each of the request transactions includes three steps: entry of data, preview of the entered data, and submission of the data to the payer you have selected. A printfriendly link displays on the request pages for all request types. Through Aerial iexchange, you can create and submit the following types of requests if configured: Inpatient Requests: Create, submit, enter end date and disposition, or reopen a request for inpatient-type treatments. If configured, you are able to create a future request. For information on how to create and submit an inpatient request, see the Entering a New Inpatient Request or Reopen a Request sections of this guide. Other Requests: Create, submit, enter end date and disposition, or reopen a request for non-referral and non-inpatient treatments: for example, home health visits. If configured, you are able to create a future request. For more information, see the Other Requests (on page 85) or Reopen a Request sections in this guide. Prior Auth: Create, submit, enter end date and disposition, or reopen a prior auth request. If configured, you are able to create a future request. For more information on how to create a prior auth request, see Prior Auth Request (on page 107) or Reopen a Request in this guide. Referral Requests: Create, enter end date and disposition, or reopen a request, and submit requests for referral treatments. If configured, you are able to create a future request. For information on how to create and submit a referral request, see the Entering a Referral Request or Reopen a Request sections of this guide. Request Extensions: Some payers allow inpatient, other, and referral extensions. For information on how to extend a request, see the Inpatient Request Extensions, Other Request Extensions, Referral Request Extensions, and the behavioral health request extensions sections of this guide. Behavioral Health Requests: Create and submit requests related to behavioral health type treatments. For information on how to create and submit a behavioral health request, see the Behavioral Health Requests (on page 135) section of this guide Copyright 2014 Medecision, Inc. 51

54 Note: Some payers may not support all the request transactions listed above. The request transactions you can perform may vary depending on the payer you have selected. Inpatient Requests Inpatient requests enable you to submit a request for inpatient treatments to the payer you have selected. Once you submit an inpatient request, you receive immediate results on the outcome status of your request (approved or pended). 1. From the Aerial iexchange navigation menu, select Inpatient. The Inpatient instructions page displays. Depending on the payer you selected, you may be able to select the following options: New Inpatient request Use this page to enter a new inpatient request. Inpatient clinical review Use this link to access the Treatment search page to search for inpatient requests awaiting clinical review. Extend Inpatient request Use this page to access the Treatment search page to search for the existing inpatient or inpatient behavioral health request to be extended. New inpatient behavioral health request Use this link to access the Inpatient behavioral health request page and enter a behavior health request. Entering a New Inpatient Request 1. Click Inpatient located on the Aerial iexchange navigation menu. The inpatient instructions page displays. 2. To create a new inpatient request, click one of the two New inpatient request links. The Inpatient request entry page displays. Inpatient request entry General Information 1. Click New inpatient request from the navigation menu. The Inpatient request entry page displays Copyright 2014 Medecision, Inc. 52

55 Each payer to whom you submit a request can include payer specific fields used to collect additional data. Since these fields can vary in name and function by payer, they have not been documented in this guide. Descriptions and steps on how to complete the more commonly prompted fields are included. Completion of each field is required unless labeled as optional. The Notification date defaults to the current date and cannot be edited. 2. Enter the Member ID number of the member or subscriber. If the ID is unavailable, search for the member. For additional information on how to perform a member search, see the Member Search (on page 236) section of this guide. You may be required to perform a member search to value the member ID depending on the payer selected. 3. Click the Submitting provider drop-down arrow, and select the appropriate submitting provider defined for your provider group. 4. Click the View provider summary link to view the provider details of the selected provider. 5. Click the Facility drop-down arrow, and select a facility defined by your provider group. If the facility is not listed, search for the provider. For additional information on how to perform a provider search, review the Provider Search (on page 269) section of this guide. 6. Click the Treatment setting drop-down arrow, and select the treatment setting. 7. Select Yes or No in the Is this a surgical admission? drop-down list. Depending on the payer, if Treatment type is prompted for, then Is this a surgical admission? is not prompted. Depending on the selected payer, the Review type field displays. Select the appropriate review type for the request. 8. Enter the date the member is to be admitted in the Admit Date field in MM/DD/YYYY format. If you are not sure of the period in which the member's enrollment date allows the member to be admitted, perform a Member Search (on page 236) Copyright 2014 Medecision, Inc. 53

56 Diagnosis and Length of Stay 1. Enter the Primary diagnosis code, or select a diagnosis from the diagnosis short list defined by your provider group. You search for a diagnosis as an ICD9 or ICD10 code. For additional information on how to perform a diagnosis search, see the Diagnosis Search section of this guide. 2. Enter or select any additional diagnoses in the Secondary diagnosis fields. Completion of these fields is optional. 3. In Requested length of stay, enter the number of days requested for this member s stay. The requested length of stay must be in the range of 1 to Click the Attending physician drop-down arrow, and select the appropriate attending physician defined by your provider group. If the physician is not listed, perform a provider search. For additional on how to perform a Provider search, review the Provider Search (on page 269) section of this guide. 5. Click the View provider summary link to view the provider details of the selected provider Some payers may choose not to prompt for attending physician information on the inpatient request entry page. 6. Click the drop-down arrow, and select the LOS (length of stay) Bed Type for the inpatient request (optional). Inpatient request entry Services Information Copyright 2014 Medecision, Inc. 54

57 1. In Section 2 Services information, enter a Principal Service (Procedure) code. You may choose to select a code from the procedure short list defined by your provider group, or search for a procedure code. Depending on the payer selected, you may have the ability to enter or search for a ICD9, ICD10, HCPCS or CPT procedure code. The code entered must use the coding scheme determined by the selected payer. If you do not know the code use procedure search by description to find the code. For additional information on how to perform a procedure search, review Procedure Search. 2. Enter a procedure modifier in the Procedure modifiers field (if available). You can enter up to four procedure modifiers. These fields are optional. The modifier fields display depending on the payer selected. The modifiers must be entered in sequential order. If the codes are not entered in sequential order, the following message displays, Modifier must be entered in sequential order. 3. Enter the Scheduled date (service start date) in MM/DD/YYYY format. If you are not sure of the period in which the member's enrollment date allows the member to be scheduled, perform a Member Search (on page 236). 4. Click the Servicing Provider drop-down arrow, and select the appropriate servicing provider defined for your provider group. If the provider is not listed, perform a Provider search. For additional information on how to perform a Provider search, review Provider Search (on page 269). Some payers may choose not to prompt for servicing provider information on the inpatient request entry page. 5. Click the Servicing provider summary link to view the provider details of the selected provider. 6. Enter or select any additional service procedure codes in the remaining service fields. Completion of the remaining Service fields is optional Copyright 2014 Medecision, Inc. 55

58 7. Enter any notes in the Additional notes section of the inpatient request entry page. Additional note field names vary based on the payer selected and may not always be prompted for. 8. Click Next step to continue. Note: When you click Next step, Aerial iexchange evaluates the entered request data before displaying the Inpatient request preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart Copyright 2014 Medecision, Inc. 56

59 Inpatient Request Preview Summary/Additional criteria The LOS start/end date section contains: The start and end date. The number of Days requested Copyright 2014 Medecision, Inc. 57

60 The projected Status for the length of stay requested. The Additional criteria link. The additional criteria link displays for the length of stay if additional criteria such as information entered by accessing MCG CareWebQI or by completing a Request Review Questionnaire, can affect the review outcome status for the length of stay. If no Additional criteria apply, the Summary/Additional criteria label and the text and icons below it do not display. The Additional criteria column does not display. Note: It is recommended that you preview the entire request before accessing the additional criteria link. Once you access and complete the additional criteria for a length of stay or service, the edit function is disabled for the request. The Service section contains: The Service number. The procedure Code. The procedure's Scheduled date. The number of service Units The projected Status for the service request (depending on the payer selected). The Additional criteria link (depending on the payer selected) displays for the service if additional criteria entered by completing a Request Review Questionnaire can affect the review outcome status for the service Copyright 2014 Medecision, Inc. 58

61 Inpatient request information The Inpatient Request Information section contains the Member, Submitting provider, Facility, Attending physician, LOS request information, and Principal service information entered on the request entry page Copyright 2014 Medecision, Inc. 59

62 Note: The LOS request information and Principal service sections display the diagnosis and procedure ICD9 or ICD10 codes and descriptions depending on the payer selected. CareWebQI only supports ICD9. General information This section lists general information about the request such as payer specific field information and Notes. Other options available: Click Edit to return to the request entry page to make changes. Click Submit to send the request to the payer for consideration and proceed to the request confirmation page. Click Cancel to cancel the request entry. Inpatient Request Confirmation 1. Click the print friendly version link. The print friendly version of the request confirmation displays. 2. Click Print this page. The confirmation page prints to the user designated printer. 3. Click Close to leave the page Copyright 2014 Medecision, Inc. 60

63 The Inpatient request confirmation introduction section and the Request ID number assigned by the system display. 4. Click the Attach file link (depending on the payer selected). The system scrolls down to the Request Attachments section. For additional details on how to attach a file to a request see the Request Attachments (on page 218) section of this Guide. Summary The Summary section contains: The LOS start/end date The number of Days The Status of the request. The Service section contains: The Service number The procedure Code The procedure Scheduled date The number of service Units The Status for the service request (depending on the payer selected) Copyright 2014 Medecision, Inc. 61

64 Inpatient request information The Inpatient Request Information section contains the Member, Submitting provider, Facility, Attending physician, LOS request information, and Principal service information entered on the request entry page Copyright 2014 Medecision, Inc. 62

65 Note: The LOS request information and Principal service sections display the diagnosis and procedure ICD9 or ICD10 codes and descriptions depending on what the payer selected. CareWebQI supports ICD9 and ICD10. Request Attachments The Request Attachments section enables the user to attach a file to the request (depending on the payer selected). For additional details on how to attach a file to a request see the Request Attachments (on page 218) section of this Guide. General information This section lists general information about the request such as payer specific information and Notes. The following options are available: 1. Click New payer to return to the Starting point page and select another payer. 2. Click Top of page to return to the navigation menu Copyright 2014 Medecision, Inc. 63

66 MCG (Formerly Milliman Care Guidelines) CareWebQI MCG CareWebQI provides the ability to seamlessly link the CareWebQI episode management and guideline documentation functionality with Aerial iexchange. MCG CareWebQI allows both payers and providers to identify potential gaps in care. For more information on how to use MCG CareWebQI, see the MCG User s Guide. Access MCG (Formerly Milliman Care Guidelines) CareWebQI If the payer has enabled MCG CareWebQI integration, then you are prompted to access MCG CareWebQI using a link displayed within the Additional criteria box on the inpatient, inpatient request extension, other, and the other request extension preview pages. The Additional criteria box and the Access CareWebQI link is displayed and enabled when inpatient request, inpatient request extension, other request or other request extension preview processing has not resulted in a projected automated approval and when providing additional clinical criteria may result in an automated approval. MCG CareWebQI may only be accessed using Microsoft Internet Explorer version 7, 8 or 9. If you attempt to access MCG CareWebQI using an unsupported version of Internet Explorer, the following message displays: Aerial iexchange has detected that you are currently using a browser version which is not recommended by CareWebQI. For best results CareWebQI recommends that you use Microsoft Internet Explorer 7. Click the link below to access CareWebQI using a non-recommended browser version. The Firefox browser is not supported. If you attempt to access using Firefox, the CareWebQI link does not display and the above mentioned informational message displays. MCG CareWebQI 5.0 supports the ICD10 coding classification. Note: If the MCG CareWebQI application is down, a browser error page displays and you need to restart the browser and log in to iexchange Copyright 2014 Medecision, Inc. 64

67 1. To access Milliman Care Guidelines CareWebQI, click the Access CareWebQI link in the Additional criteria column. The Milliman Care Guidelines CareWebQI Loading page displays stating "Loading CareWebQI, please wait". 2. To return to the request preview page, click Return to Treatment Request Preview. Milliman Care Guidelines CareWebQI Guideline Overview The MCG CareWebQI Guideline Overview page displays. This page contains a menu of guidelines that are based on the diagnosis code. These guidelines may be reviewed and then the most appropriate guideline for the given request may be selected Copyright 2014 Medecision, Inc. 65

68 If more than one guideline is accessed during the MCG CareWebQI review, the system uses information from the first guideline accessed to populate the LOS days or units, status and status reason for the request. The Episode Overview link (shown at the upper right corner of the illustration) is available only when you are in documentation mode. If you have launched the Milliman Care Guidelines CareWebQI by mistake follow these steps to return to the request preview page: 1. Click the Episode Overview link. The MCG CareWebQI displays with no Guidelines displaying. 2. Click Exit Episode. The request preview page displays with the MCG CareWebQI link enabled. Depending on the products the payer has licensed, you may have access to one or more of the following products in documentation mode: Ambulatory Care (AC), Inpatient and Surgical Care (ISC), General Recover Guidelines (GRG), Recovery Facility Care (RFC), Home Care (HC) and Chronic Care Guidelines (CCG). They display in the blue shaded area at the top of the page. On the Guideline Overview page the following information is also available: Copyright 2014 Medecision, Inc. 66

69 Guideline Code Code used for the Guideline that links to the General Recovery Guideline page that includes a link to the Case Management General Recovery Guidelines. The information displayed on these pages depends on the Guideline Code and Product listed on the Guideline Overview page. Product Name of the product Title - Diagnosis description entered in iexchange for the patient Goal length of stay (GLOS) Goal length of stay for identified Optimal Recovery Guideline (ORG) Benchmark length of stay (BLOS) The Benchmark length of stay is similar to the GLOS, except that it is age specific. The BLOS is used in the guidelines in the General Recovery Guidelines (GRC) product. 3. Click the appropriate Select link located to the right of the description. The Episode Overview page displays with a series of documentation options listed in the Document column. Guidelines are documented using two types of forms: Outlines forms used to document one time occurrences such as admitting a patient into a hospital Progressions forms used to document the care of the patient and usually span two or more days of care. Guidelines can contain both Outline and Progression forms. CareWebQI automatically displays the correct form types depending on the guideline being documented Copyright 2014 Medecision, Inc. 67

70 Episode Overview 1. Click the link for the outline or progression form you want to fill out. The top of the form contains brief summaries of the patient, episode, and guideline information, followed by Save and Cancel buttons. 2. Select the indications that are appropriate for the patient and episode. 3. Click Save. The Episode Overview page displays with the message "Outline was saved". A checkmark appears by the document link previously selected in the Document column. 4. To close the episode and return the request preview page, click Exit Episode. The user is returned to Aerial iexchange where the request preview page displays. The projected request status is updated as pended or approved depending on the payer automated business rules Copyright 2014 Medecision, Inc. 68

71 The Access CareWebQI link is disabled and marked as being accessed. 5. To review the request information, scroll down the Preview page. 6. Click Submit to save the information and submit the request to the payer. The request confirmation page displays. Access Request Review Questionnaire If the payer has enabled request review questionnaires, the user is prompted to access a questionnaire through a link displayed within the Additional criteria box on the request preview pages. The Additional criteria box and the questionnaire link is displayed and enabled when request preview processing has not resulted in a projected automated approval and when providing additional information may result in an automated approval. 1. To access the questionnaire, click the Questionnaire link in the Additional criteria box. The request questionnaire displays. 2. Click Next step. The request preview page displays Copyright 2014 Medecision, Inc. 69

72 Clinical Review The Clinical Review functionality allows the clinical end user to provide additional clinical information on inpatient, other and referral requests (including behavioral health requests). Note: After the discharge date is entered, the clinical review does not display. 1. To view the requests available, on the Starting point page click View requests awaiting clinical review. The Treatment Search Summary displays. The Treatment search summary page lists the requests that are awaiting additional information for clinical review. If no requests are available for clinical review a message displays stating No requests awaiting clinical review Copyright 2014 Medecision, Inc. 70

73 2. To view all of the requests awaiting additional information for clinical review scroll down the page. 3. To view a request, click View details. The Treatment search details page displays. The Treatment search details introduction section and the Request ID number assigned by the system display. 4. Click the View patient clinical summary or View Health Summary link to review the patient clinical summary or Health Summary report (depending on the payer selected). For additional information on the Patient Clinical Summary, see the Patient Clinical Summary (on page 224) or Health Summary (on page 229) section. 5. Click the View clinical documents link to launch the Member clinical documents page (depending on the payer selected). The Member clinical documents page presents a list of the clinical documents available for the member Copyright 2014 Medecision, Inc. 71

74 The image shown is an example of the information displayed when an inpatient request is selected. The information shown for Other or Referral requests shows the Service number, procedure Code, Start/end date, the number of Units and the status. Summary/Clinical review The Summary/Clinical review section contains: The LOS start/end date The number of Days The Status of the request. The Clinical review link. 1. Click Clinical review. The MCG CareWebQI loading page displays stating Loading CareWebQI, please wait. After loading is complete, the MCG CareWebQI Guideline Overview page displays. If member validation results in an error the system: Disables the Clinical Review link. Presents an error message associated with the member validation on the Treatment search details page. Presents the error message associated with the clinical review, This request is no longer available for clinical review. Your request remains pended. Please contact the health plan for assistance. 2. For CareWebQI, select the indications that are appropriate for the patient and episode. For Request questionnaire complete the questionnaire. 3. Click Save. The Episode Overview page displays with the message Outline was saved. A check mark appears by the document link previously selected in the Document column. For more information on guidelines see the CareWebQI (on page 64) section of this guide on page. For more information on Request questionnaires, see the Request Review Questionnaires section of this guide Copyright 2014 Medecision, Inc. 72

75 The request clinical review preview page displays. The projected request outcome status is updated as approved or pended based on the clinical criteria entered and the payer s automated business rules. The LOS section for inpatient requests or the Service section for other requests of the page is updated based on the episode results returned from the Request questionnaire or CareWebQI. 4. Click Submit. The request clinical review confirmation page displays. Note: The inpatient, other and referral request clinical review preview and the confirmation pages basically contain the same information as the request preview and confirmation pages described earlier in this guide. For additional information see any of the preview and confirmation page sections in this guide. Request Review Questionnaire Request review questionnaires pass information between providers and payers to gain more automated approvals for requests for which the payer needs additional information. When a request is made in Aerial iexchange, the automated business rules identify whether there is a rule defined that should be applied to the request. The identified rule links a questionnaire to the request that is to be completed to determine whether the request should be approved or pended for further review. Provider users can enter answers to questions that were not completed when a request review questionnaire gets submitted so that clinical information can be added. Questions that are already entered cannot be edited after a request review questionnaire is submitted. Once submitted the changes are saved in the request in Aerial Care Management Copyright 2014 Medecision, Inc. 73

76 This functionality is available for all types of requests when enabled. The following are examples of the screens displayed when an inpatient request review questionnaire is launched. 1. To access the questionnaire, click on the questionnaire name link located in the Additional criteria column. The request questionnaire page displays. Note: When a request review questionnaire is saved with a request that has at least one question answered, you can view all questions and answers in the request review questionnaire Copyright 2014 Medecision, Inc. 74

77 Request Questionnaire Copyright 2014 Medecision, Inc. 75

78 None of the question responses are required but leaving questions unanswered may not make it possible for there to be an automated approval. A question mark displays next to each question that has help text. 1. Complete the questionnaire by selecting a response. The response types are: Single Select Only one entry is permitted. Enter the answer to your question. Multi-Select Select from a list of responses. To select multiple responses hold down the CTRL key and click on the response. Free Text Type in your response (printable characters). Currency Enter the US Dollar amount (0 thru 9) in XXXX.XX format. Date Enter the date (0 thru 9) in MM/DD/YYYY format. Decimal Enter a decimal amount (0 thru 9). Whole Number - Enter whole numbers such as 5,10 or 15. If branching questions are available, the question expands and you are prompted to complete the branched questions on the selected response. 2. Click Done to save your responses and return to the preview page. 3. If you have not completed all of the questions, the following message displays "You have not answered all of the questions. If you complete the questionnaire you may receive an approval. Continue?" Copyright 2014 Medecision, Inc. 76

79 4. Click OK to continue and return to the preview page where the questionnaire link is disabled and the page cannot be edited. 5. Click Cancel to return to the questionnaire and complete the questions. Once completed the request preview page displays Copyright 2014 Medecision, Inc. 77

80 6. To view the responses and to print a copy, click the questionnaire name link. 7. The Questionnaire Responses page opens a separate window listing the following information: Payer selected The selected payer. User The user currently logged into the system. Today s date The current date. Member The member s name. Member ID The member s identification number. Questionnaire name The name given to the questionnaire Copyright 2014 Medecision, Inc. 78

81 Questions Lists the questions in the questionnaire. Responses The answers given to the question. 8. Click the Print this page link to print. 9. Click Close to close the window and return to the request preview page. 10. Click Submit on the request preview page to save the information and submit the request to the payer. The request confirmation page displays. Inpatient Request Extensions Some payers may allow you to request extensions on existing inpatient treatments. If enabled, you are able to extend the length of stay as well as add additional procedures, diagnoses and providers to an existing inpatient request. When entering an inpatient extension, all service dates for services entered must be within the length of stay date range. The length of stay date range is determined by the admit date + initial request length of stay + extension request length of stay. For example, if the initial request admit date is 12/01/10 with a length of stay of 3 days, the initial request length of stay date range is 12/01/10-12/04/10. When the initial request is extended by 2 days, the extension request length of stay date range is 12/01/10-12/06/10. Services entered for the extension must have service dates between 12/01/10-12/06/10. If services are entered outside of the length of stay date range, an error message displays. The system does not allow inpatient request extensions on the length of stay if the request status is Closed or Discharged Copyright 2014 Medecision, Inc. 79

82 Entering an Inpatient Request Extension 1. Click Inpatient on the Aerial iexchange navigation menu. The Inpatient instructions page displays. 2. Click on the Extend inpatient request link. The Treatment search page displays. Use the Treatment search page to search for the treatment you wish to extend. When the Treatment search page is initially launched the default Search type Member ID displays. The options available on the Treatment search page depend on which Search type is selected. For additional information on how to perform a treatment search see the Treatment Search (on page 250) section of this guide. Once you have entered your search criteria, click Submit search Copyright 2014 Medecision, Inc. 80

83 The Treatment search summary page displays requests meeting the search criteria. 3. Click the View details link located under the Request ID of the request you want to select. The Treatment Search details page displays. If there is an incomplete clinical review available from the initial inpatient request, an informational message displays, An outstanding clinical review is available for the request. 4. Scroll down the Treatment Search details page to the LOS request information section Copyright 2014 Medecision, Inc. 81

84 5. Click Extend. The Inpatient request extension entry page displays. Inpatient request extension entry 1. To view the details of the request, click View request details in the Request being extended box. The Review type drop down may display depending on the payer selected. 2. Scroll down to Section 1 Extension information the submitting provider from the original request is the default. To select a different provider defined for your provider group, click the Submitting provider drop-down. 3. Click the View provider summary link to view the provider details of the submitting provider. The Primary diagnosis from the original request displays in the Extension primary diagnosis field Copyright 2014 Medecision, Inc. 82

85 4. Enter a different diagnosis or perform a Diagnosis search. For additional information on how to perform a diagnosis search see the Diagnosis Search section of this guide. 5. Enter or select a Secondary diagnosis. (optional) 6. Enter the Additional requested LOS units (number of days). The requested length of stay units must be in the range of 1 to Select a bed type from the LOS bed type drop-down list defined for your provider group. The bed type from the original request if valued previously is the default otherwise this field is optional. Services information 1. Scroll down to Section 2 Services information, enter the principal Procedure and any other additional procedural information. Enter the exact code with or without a modifier (based on payer configuration) or perform a procedure search. All of the fields in this section are optional. For additional information on how to perform a Procedure search, review the Procedure Search section of this guide Copyright 2014 Medecision, Inc. 83

86 2. Scroll down to the Additional notes (optional) section and enter any additional comments. The names of these fields are determined by the payer. 3. Click Next step located at the bottom of the page. Note: When you click Next step, Aerial iexchange evaluates the entered request data before displaying the Inpatient request extension preview page. If a data error is displayed on the entry page, you must correct the error before the preview page can display. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart. Inpatient request extension preview If there is a request review questionnaire available the inpatient request extension preview page displays with a link to the questionnaire. An informational message displays at the top of the page, The status of the LOS is pended. Please complete the attached questionnaire. Based on the score the status may change to Approve. For additional information on questionnaires, see the Request Review Questionnaire section in this guide. The Inpatient request extension preview page is similar to the Inpatient request preview page. For additional information, review the Inpatient Requests (on page 52) section of this guide. 1. Click Edit located at the bottom of the page, to make changes to the information. The Inpatient request extension entry page displays so you can enter your changes. Edit may be disabled after entry of information by way of Request Review Questionnaire or CareWebQI. 2. Scroll down the page and enter the any appropriate changes. 3. Click Next step to save changes. When you click Next step, Aerial iexchange evaluates the entered request data before redisplaying the Inpatient request extension preview page. If a data error is displayed on the entry page, you must correct the error before the preview page can display. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart. 4. Click Submit to save and submit your entries Copyright 2014 Medecision, Inc. 84

87 If Aerial iexchange accepts the request extension, the Inpatient request extension confirmation page displays. Inpatient request extension confirmation The Inpatient request extension confirmation page is similar to the Inpatient request confirmation page. For additional information review the Inpatient Requests (on page 52) section. 1. Click the Print friendly version link located at the top of the page, to generate a printable version of the confirmation page. Once the print-friendly version displays, click the Print this page link to print the page. Click Close to return to the confirmation page. 2. The General information section contains general information about the request such as Reviewer Notes or Screening Notes. 3. Click New payer to select a different payer. 4. Click Return to treatment search results to return to the treatment search summary page. 5. Click Top of page to return to the navigation menu. Other Requests Depending on the payer you selected, you may be able to submit an other request. Other requests enable you to submit requests for outpatient services to the payer. Once submitted, you receive immediate feedback on the outcome status of your request approved or pended). 1. From the Aerial iexchange navigation menu, select Other. The Other instructions page displays. Depending on the payer you have selected, you may be able to select the following options: New other request Use this page to enter a new other request. Extend other request Use this page to access the Treatment search page to search for the existing other or other behavioral health request to be extended Copyright 2014 Medecision, Inc. 85

88 Other clinical review Use this link to access the Treatment search page to search for other requests awaiting clinical review. New other behavioral health request Use this link to access the other behavioral health request page and enter a behavior health request. Prior authorizations Use this page to request prior authorization for a particular service where the date of treatment or the treatment setting may be unknown at the time of submission. Add other services Use this link to access Treatment search page to search for other requests to add services Copyright 2014 Medecision, Inc. 86

89 Entering an Other Request 1. Click Other on the Aerial iexchange navigation menu. The Other instruction page displays. The Other Request Instructions page may contain the following options based on the payer you have selected: New Other request Use this page to enter a new other request Copyright 2014 Medecision, Inc. 87

90 New other behavioral health request Use this link to access the Other behavioral health request page and enter a behavior health request. Extend Other request Use this link to access the Treatment search page and search for the existing other or other behavioral health request to be extended. Add other services Use this link to access the Treatment search page to search for other requests to add services. New prior auth request Use this link to access the Prior auth request entry page. The other behavioral health request links do not display if the behavioral health functionality is not enabled. 2. Click New other request. The Other request entry page displays Copyright 2014 Medecision, Inc. 88

91 Other Request Entry General Information The Notification date defaults to the current date and cannot be edited. Note: Each payer to whom you submit a request can include payer specific fields used to collect additional data. Since these fields can vary in name and function by payer, some are not in this guide. Below is a list of descriptions and steps on how to complete the more commonly prompted fields. Completion of each field is required unless labeled as optional. 1. Enter the Member ID number of the member or subscriber. If the ID is unavailable, search for the member. For additional information on how to perform a member search, see the Member Search (on page 236) section in this guide Copyright 2014 Medecision, Inc. 89

92 Depending on the payer you selected, you may be required to perform a member search to value the Member ID. In this case, you are presented with a message indicating that you must search for the member whom you wish to use, and the Member ID text box is not displayed. 2. Click the Submitting provider drop-down arrow, and select the appropriate submitting provider. 3. Click the Attending physician drop down (if available) and select the attending physician defined for your provider group or perform a Provider search. This field can be required or optional depending on the payer selected. 4. Click the Facility drop-down arrow, and select a facility defined by your provider group. If the facility is not listed, click Provider Search to search for the provider. For additional information on how to perform a provider search, review the Provider Search (on page 269) section of this guide. 5. Click the Servicing provider drop-down, and select the servicing provider defined for your provider group or perform a Provider search. For additional information on how to perform a provider search, review the Provider Search (on page 269) section of this guide. 6. Click the Treatment setting drop-down arrow, and select the treatment setting. 7. Enter the Primary diagnosis code, or select a diagnosis from the diagnosis short list. You can search for a diagnosis. You search for a diagnosis as an ICD9 or ICD10 code. For additional information on how to perform a diagnosis search, see the Diagnosis Search (on page 271) section of this guide. 8. Enter or select any additional diagnoses in the Secondary diagnosis field. Completion of this field is optional Copyright 2014 Medecision, Inc. 90

93 Other Request Entry Services Information 1. In the Service 1 Procedure section, you can do one of the following: Enter a Procedure code. Select a code from the procedure code drop-down list. Select Procedure search to search for a procedure code. Depending on the payer selected you may have the ability to enter or search for a ICD9, ICD10, HCPCS or CPT procedure code. For additional information on how to perform a Procedure search, review the Procedure Search section of this guide. 2. Enter a procedure modifier in the Procedure modifiers field. You can enter up to four procedure modifiers. These fields are optional and display only if procedure modifiers are enabled. 3. Enter the number of occurrences (units or visits) in the Unit fields. The requested units for the service must be in the range 1 to Click the Treatment type drop-down arrow, and select the appropriate treatment type. This field displays only if treatment type is enabled for the selected payer. The field displays for each service. This is a required field. 5. Click the Review type drop-down arrow, and select the appropriate review type. This field displays only if review type is enabled for the selected payer.the field displays for each service and is a required field Copyright 2014 Medecision, Inc. 91

94 6. Click the Place of service arrow, and select the place of service. (Optional) 7. Enter the Start Date, in MM/DD/YYYY format, of the procedure. If you are not sure of the period in which the member's enrollment date allows the member to have the procedure provided, perform a Member Search (on page 236). 8. Enter the End Date, in MM/DD/YYYY format, of the procedure. If you are not sure of the period in which the member's enrollment date allows the member to have the procedure provided, perform a Member Search (on page 236). If the payer has enabled multiple services, a separate Service section displays for each service. Additional Notes 1. Enter any notes in the Additional notes section. Additional note field names vary based on the payer selected and may not always be prompted for. Completion of these fields is optional. 2. Click Next step to continue. Note: When you click Next step, Aerial iexchange evaluates the entered request data before displaying the Other request preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart Copyright 2014 Medecision, Inc. 92

95 Other Request Preview Summary/Additional criteria This section contains the following fields: Service service number Code procedure code Start/end date requested start and end dates for this service Units number of units requested Projected status projected status for this service Copyright 2014 Medecision, Inc. 93

96 Additional criteria The additional criteria link displays for the service if additional criteria, such as information entered by accessing CareWebQI or by completing a Request Review Questionnaire, can affect the review outcome status for each service. If no additional criteria apply, the Summary/Additional criteria label and the text and icons below it do not display. The Additional criteria displays when the payer requires additional information to review the requested service Copyright 2014 Medecision, Inc. 94

97 Other request information Note: Preview the entire request before accessing the additional criteria link. After you access and complete the additional criteria for a service, the edit function is disabled for the request Copyright 2014 Medecision, Inc. 95

98 The Other Request Information section contains the Member, Servicing provider, Service, Attending provider (if available) and Facility entered on the request entry page. Note: The Service information and General other information sections display the procedure and diagnosis ICD9 or ICD10 codes and descriptions depending on the payer selected. CareWebQI only supports the ICD9 coding classification. General information This section lists general information about the request such as Notes. Other options available: 1. Click Edit to return to the Other request entry page to make changes. 2. Click Submit and add services to submit to the payer the services entered so far and add additional services. Depending on the payer selected the Additional other services entry page displays. 3. Click Submit to send the request to the payer for consideration and proceed to the request confirmation page. 4. Click Cancel to cancel the request entry Copyright 2014 Medecision, Inc. 96

99 Additional Other Services Entry Use this page to add additional services to the other request identified in the Summary section. You can add increments of five services to a recommended maximum of fifteen. 1. In the Service (optional) section, you can do one of the following: Enter a Procedure code. An ICD9 or ICD10 code can be entered depending on the payer selected. Select a code from the procedure code drop-down list. Select Procedure search to search for a procedure code. Additional service sections are numbered sequentially, beginning from the last service submitted. In this example three services were submitted previously. For additional information on how to perform a Procedure search, review the Procedure Search section of this guide Copyright 2014 Medecision, Inc. 97

100 2. Enter a procedure modifier in the Procedure modifiers field. You can enter up to four procedure modifiers. These fields are optional and display depending on the payer selected. 3. Enter the number of occurrences (units or visits) in the Unit fields. The requested units for the service must be in the range 1 to Click the Treatment type drop-down arrow, and select the appropriate treatment type. This field displays depending on the payer selected. The field displays for each service. This is a required field. 5. Click the Review type drop-down arrow, and select the appropriate review type. This field displays depending on the payer selected.the field displays for each service and is a required field. 6. Click the Place of service drop-down arrow, and select the place of service. (Optional) 7. Enter the Start Date, in MM/DD/YYYY format, of the procedure. 8. Enter the End date in MM/DD/YYYY format of the procedure. Repeat these steps to add up to five services on this page. 9. Click Next step. Note: When you click Next step, Aerial iexchange evaluates the entered request data before displaying the Additional other request preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart Copyright 2014 Medecision, Inc. 98

101 Additional other request preview Summary This section contains the following fields: Service The service number. The first group of services are those that were previously submitted and the second list are those being added. Code The ICD9 or ICD10 procedure code (depending on the payer selected). Start/end date The start and end date of the service. Units The number of units requested. Status The status of the service previously submitted. Projected status The projected status of the newly added service Copyright 2014 Medecision, Inc. 99

102 Additional criteria The additional criteria link displays only if additional criteria, such as information entered by accessing CareWebQI or by completing a Request Review Questionnaire, can affect the review outcome status for the request. If additional criteria required, the Summary/Additional criteria label displays. The summary section expands to include the Additional criteria column. 1. To make changes to your entries, click Edit located at the bottom of the page. The Additional other request entry page displays. Make the appropriate changes. The services entered previously cannot be edited. When you click Next step, Aerial iexchange evaluates the entered request data before redisplaying the Additional other request preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart. 2. To submit all of the services, click Submit. The Other request confirmation page displays. The Other request information and General other information sections display Copyright 2014 Medecision, Inc. 100

103 Other Request Confirmation 1. Click the print friendly version link. The print friendly version of the request confirmation displays. 2. Click Print this page. The confirmation page prints to the user designated printer. 3. Click Close to leave the page. The Other request confirmation introduction section and the Request ID number assigned by the system display. 4. Click the Attach file link (depending on the payer selected). The system scrolls down to the Request Attachments section. For additional details on how to attach a file to a request see the Request Attachments (on page 218) section of this Guide. Summary The Summary section contains: The Service number The procedure Code The Start/end date of the service The number of Units The Status of each service Copyright 2014 Medecision, Inc. 101

104 Other request information The Other request Information section contains the Member, Servicing provider, Service (including any additional services), Attending provider (if available) and Facility information entered on the Other request entry or the Additional other services entry pages Copyright 2014 Medecision, Inc. 102

105 Note: The Service information and General other information sections display the procedure and diagnosis ICD9 or ICD10 codes and descriptions depending on the payer selected. CareWebQI only supports ICD9 coding classification. The Request Attachments section enables the user to attach a file to the request (depending on the payer selected). For additional details on how to attach a file to a request, see the Request Attachments (on page 218) section of this guide. This section lists general information about the request such as Notes and Treatment setting. Other options available: 1. Click New payer to return to the Starting point page and select another payer. 2. Click Top of page to return to the navigation menu. Other Request Extensions Depending on the payer you selected, you may be able to extend an existing other request Copyright 2014 Medecision, Inc. 103

106 Entering an Other Request Extension 1. Click Other on the Aerial iexchange navigation menu. The Other instructions page displays. 2. Click Extend other request. The Treatment search page displays. 3. Enter the search criteria, click Submit search. For additional information on how to perform a treatment search see the Treatment Search (on page 250) section of this guide. After you submit your search the Treatment search summary page displays listing requests meeting the search criteria. 4. Click the View details link located under the Request ID of the request you want to extend. The Treatment Search details page displays Copyright 2014 Medecision, Inc. 104

107 5. Scroll down the Treatment Search details page to the Service section for the service you want to extend, click Extend. The other request extension entry page displays. Other request extension entry 1. To view the details of the request, click View request details in the Service being extended box. The submitting provider from the original request defaults in the Submitting provider field in the Section 1 Extension information section. 2. To select a different provider, click the Submitting provider drop-down. 3. To view the provider details of the submitting provider, click View provider summary. 4. Enter the Extension primary diagnosis or perform a Diagnosis search. The primary diagnosis from the original request is the default. For information on how to perform a diagnosis search see the Diagnosis Search section of this guide. An ICD9 or ICD10 diagnosis code can be entered depending on the payer selected. 5. Enter or select a Secondary diagnosis (optional). 6. Enter or select a Place of service (optional). 7. Enter the number of Additional requested units. The additional requested units must be in the range of 1 to Enter the Extension start date in MM/DD/YYYY format. 9. Enter the Extension end date in MM/DD/YYYY format Copyright 2014 Medecision, Inc. 105

108 Additional Notes 1. Scroll down to the Additional notes section and enter any additional notes. These fields are optional. 2. Click Next step located at the bottom of the page. The Other request extension preview page displays. When you click Next step, Aerial iexchange evaluates the entered request data before displaying the Other request extension preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart. Other request extension preview If there is a request review questionnaire available the other request extension preview page displays with a link to the questionnaire. An informational message displays at the top of the page: The status of the service is pended. Please complete the attached questionnaire. Based on the score the status may change to Approve. For additional information on questionnaires see the Request Review Questionnaire section in this guide. The Other request extension preview page is similar to the Other request preview page. For additional information review the Other Request (on page 85) section in this guide. 1. Click Edit located at the bottom of the page, to make changes to the information. The Other request extension entry page displays. Enter your changes. Edit may be disabled after entry of information by way of Request Review Questionnaire. 2. Scroll down the page and enter any appropriate changes. 3. Click Next step to save changes. When you click Next step, Aerial iexchange evaluates the entered request data before redisplaying the Other request extension preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart. 4. Click Submit to save and submit your entry Copyright 2014 Medecision, Inc. 106

109 If Aerial iexchange accepts the request extension, the Other request extension confirmation page displays. Other request extension confirmation The Other request extension confirmation page displays confirmation information on the extended service. For additional information review the Other Request (on page 85) section of this guide. It contains the other request extension information including the Request ID, Status, Member information and any extended procedures. 1. Click the Print friendly version link located at the top of the page, to generate a printable version of the confirmation page. Once the print-friendly version displays, click the Print this page link to print the page. Click Close to return to the confirmation page. 2. The General information section contains general information about the request such as Treatment Setting or Primary diagnosis. 3. Click New payer to select a different payer. 4. Click Return to treatment search results to return to the treatment search summary page. 5. Click Top of page to return to the navigation menu. Prior Auth Request Depending on the payer selected, you may have the ability to enter prior auth requests. To access: 1. Click Other on the Starting point page. 2. Click New prior auth request. The Prior auth request entry page displays Copyright 2014 Medecision, Inc. 107

110 Prior Auth Request General Information The Notification date defaults to the current date and cannot be edited. Note: Each payer to whom you submit a request can include payer specific fields used to collect additional data. Since these fields can vary in name and function by payer, some are not in this guide. Below is a list of descriptions and steps on how to complete the more commonly prompted fields. Completion of each field is required unless labeled as optional. 1. Enter the Member ID or click Member search to find the member's identification number. For additional information on how to perform a member search see the Member search (on page 236) section of this guide. Depending on the payer you selected, you may be required to perform a member search to value the Member ID. In this case, you are presented with a message indicating that you must search for the member whom you wish to use, and the Member ID text box is not displayed. 2. Click the Submitting provider drop down arrow and select the appropriate submitting provider. 3. Click the Submitting provider summary link to view identification and demographic information for the selected provider Copyright 2014 Medecision, Inc. 108

111 4. Click the Servicing provider drop-down arrow and select the appropriate servicing provider. If servicing provider is not listed, click Provider search to find the provider. For additional information on how to perform a provider search, review Provider Search (on page 269). 5. Click the Servicing provider summary link to view identification and demographic information for the servicing provider.. 6. Enter a Primary diagnosis or click Diagnosis search to find a primary diagnosis. You search for a diagnosis as an ICD9 or ICD10 code. For additional information on how to perform a diagnosis search see the Diagnosis search (on page 271) section of this guide. 7. Enter or select a Secondary diagnosis. This field is optional. Prior Auth Request Service Information 1. In the Service 1 Procedure section, you can do one of the following: Enter a Procedure code. Select a code from the procedure code drop-down list. Select Procedure search to search for a procedure code Copyright 2014 Medecision, Inc. 109

112 Enter a procedure modifier in the Procedure modifiers field. You can enter up to four procedure modifiers. These fields are optional and display only if procedure modifiers are enabled. Depending on the payer selected you may have the ability to enter or search for a ICD9, ICD10, HCPCS or CPT procedure code. For additional information on how to perform a Procedure search, review the Procedure Search section of this guide. 2. Enter the number of Units of service. 3. Click the Treatment type drop-down arrow, and select the appropriate treatment type. This field displays only if treatment type is enabled for the selected payer. The field displays for each service. This is a required field. 4. Click the Review type drop-down arrow, and select the appropriate review type. This field displays only if review type is enabled for the selected payer.the field displays for each service and is a required field. 5. Enter a Start date. 6. Enter a End date. The current date defaults in both fields. Additional notes 1. Enter any notes in the additional notes section. This field is optional. 2. Click Next step. Note: When you click Next step, Aerial iexchange evaluates the entered request data before displaying the Prior auth request preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart Copyright 2014 Medecision, Inc. 110

113 Prior Auth Preview Summary/Additional criteria The Summary/Additional criteria section contains: The Service number. The procedure Code. The Start/end date. The number of Units. The Projected status for the requested service. The Additional criteria link displays if the additional criteria can affect the review outcome status of the service Copyright 2014 Medecision, Inc. 111

114 Note: It is recommended that you preview the entire request before accessing the additional criteria link. Once you access and complete the additional criteria for a service, the edit function is disabled for the request Copyright 2014 Medecision, Inc. 112

115 Prior auth request information Copyright 2014 Medecision, Inc. 113

116 Copyright 2014 Medecision, Inc. 114

117 The Prior auth request information section contains the Member information, Servicing provider, Submitting provider, Facility and Service information entered on the request entry page. Note: The Service information and General other information sections display the procedure and diagnosis ICD9 or ICD10 codes and descriptions depending on the payer selected. CareWebQI only supports the ICD9 coding classification. General prior auth information This section lists general information about the prior authorization such as Primary diagnosis and Notes. Other options available: 1. Click Edit to return to the request entry page to make changes. 2. Click Submit to send the request to the payer for consideration and display the confirmation page. 3. Click Cancel to cancel the request entry Copyright 2014 Medecision, Inc. 115

118 Prior Auth Confirmation 1. Click the Print friendly version link. The print friendly version of the request confirmation displays. The print friendly page contains all of the information presented on the confirmation page. 2. Click Print this page. The confirmation page prints to the user's designated printer. 3. Click Close to leave the page. The Prior auth request confirmation introduction section and the system assigned Request ID number display. 4. Click the Attach file link (depending on the payer selected). The system scrolls down to the Request Attachments section. For additional details on how to attach a file to a request see the Request Attachments section of this guide. Summary The Summary section contains: The Service number. The procedure Code. The service Start/end date. The number of Units. The Status of each service Copyright 2014 Medecision, Inc. 116

119 Prior authorization request information Copyright 2014 Medecision, Inc. 117

120 Copyright 2014 Medecision, Inc. 118

121 The Prior auth request information section contains (depending on the payer) the Member information, Servicing provider, Attending provider, Service and Service information entered on the request entry page. Request Attachments The Request Attachments section enables the user to attach a file to the request. For additional details on how to attach a file to a request see the Request Attachments (on page 218) section of this guide. General information This section list general information about the prior auth such as the Primary diagnosis and Notes. Other options available: 1. Click New payer to return to the Starting point page and select another payer. 2. Click Top of page to return to the navigation menu. The Service information and General other information sections display the procedure and diagnosis ICD9 or ICD10 codes and descriptions depending on the payer selected. CareWebQI only supports ICD9 coding classification Copyright 2014 Medecision, Inc. 119

122 Referral Requests Referral requests enable you to submit a request for referral treatments to the payer you have selected. Once you submit a referral request, you will receive immediate feedback on the outcome status of your request (approved or pended). 1. From the Aerial iexchange navigation menu, select Referral. The Referral instructions page displays. Depending on the payer you have selected, you may be able to select the following options: New referral request Use this page to enter a new referral request. Extend referral request Use this page to access the Treatment search page to search for the existing referral and behavioral health referral requests to be extended. Referral clinical review Use this link to access the Treatment search page to search for referral requests awaiting clinical review. New referral behavioral health request Use this link to access the referral behavioral health request page and enter a behavior health request. Entering a Referral Request 1. Click Referral on the Aerial iexchange navigation menu. 2. Point to New referral request and do one of the following: Copyright 2014 Medecision, Inc. 120

123 If a menu is not displayed to the right of the request type that are pointing to, request templates for the payer are not available to you. Click on the link that you are pointing to. Note: The name of the New Referral Request links may vary depending on the payer you have selected Copyright 2014 Medecision, Inc. 121

124 If a menu is displayed to the right of the request type that you are pointing to, request templates for the payer are available to you. Click the template that you want to use for the request, or click Standard Template Copyright 2014 Medecision, Inc. 122

125 Referral Request Entry General Information Each payer to whom you submit a request can include extra service fields used to collect additional service data. Since these fields can vary in name and function by payer, they have not been documented in this guide. Listed below are descriptions of the most common fields. The Notification date displays in MM/DD/YYYY format and cannot be edited. 1. Enter the Member ID number of the member or subscriber. If the ID is unavailable, search for the member. For additional information on how to perform a member search, see the Member Search (on page 236) section of this guide. Depending on the payer you have selected, you may be required to perform to a Member Search to value the Member ID. You are presented with a message indicating that you must search for the member you wish to use in place of the Member ID text box. 2. Click the Submitting provider drop-down arrow and select the appropriate submitting provider Copyright 2014 Medecision, Inc. 123

126 3. Click the View provider summary link to view the provider details. 4. Select a Servicing provider from the drop-down list or perform a provider search. For additional information on how to perform a provider search review the Provider Search (on page 269) section of this guide. 5. Click the Treatment setting drop-down arrow and select the treatment setting. 6. Click the Treatment type drop-down arrow and select the treatment type. 7. Enter the Primary diagnosis code, or select a diagnosis from the diagnosis short list. You also have the ability to search for a diagnosis. Depending on the payer selected you may have the ability to enter or search for a ICD9 or ICD10 diagnosis code. For additional information on how to perform a diagnosis search see the Diagnosis Search section of this guide. 8. Enter or select any additional diagnoses in the Secondary diagnosis field. Completion of these fields is optional. Referral Request Entry Services Information 1. Enter a Service 1 (Procedure) code, select a code from the procedure short list, or search for a procedure code. You can manually enter a valid procedure code that is not included in the procedure short list Copyright 2014 Medecision, Inc. 124

127 Depending on the payer selected you may have the ability to enter or search for a ICD9, ICD10, HCPCS or CPT procedure code. For additional information on how to perform a procedure search, review Procedure Search. 2. Enter the number of occurrences (units or visits) in the Unit field. The additional requested units must be in the range 1 to Click the Place of service drop-down, and select the place the service occurred. (Optional) 4. Enter the Start Date, in MM/DD/YYYY format, of the procedure. If you are not sure of the period in which the member's enrollment date allows the member to have the procedure provided, perform a Member Search (on page 236). 5. Enter the End Date, in MM/DD/YYYY format, of the procedure. If you are not sure of the period in which the member's enrollment date allows the member to have the procedure provided, perform a Member Search (on page 236). 6. Scroll down to the Additional notes section, and enter additional information. These fields are optional. 7. Click Next step to continue. (Click Cancel only if you do not want to continue with this referral request). Note: When you click Next step, Aerial iexchange evaluates the entered request data before displaying the Referral request preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart Copyright 2014 Medecision, Inc. 125

128 Referral Request Preview Summary/Additional criteria This section contains: The Service number. The service Code. The Start/End date of the services. The number of Units. The Projected status. The Additional criteria link. The additional criteria displays for a service if additional information can affect the review outcome status. If you complete the additional criteria you may receive an approval for the service. It is recommended that you preview the entire request before accessing the additional criteria link. Once you access and complete the additional criteria for a service, the edit function is disabled for the request. If no Additional criteria applies the Summary/Additional criteria label and the text and icons below it will not display. The Additional criteria column will not display when there is no additional criteria being prompted. Request Review Questionnaires are supported for referral requests but CareWebQI is not supported for referral requests. Referral request information The Referral request information section contains the Member, Service, Servicing provider and Submitting provider information entered on the request entry page Copyright 2014 Medecision, Inc. 126

129 Note: The Service information and General other information sections display the procedure and diagnosis ICD9 or ICD10 codes and descriptions depending on the payer selected Copyright 2014 Medecision, Inc. 127

130 General information This section lists general information about the request such as Treatment setting and Primary diagnosis and Notes. Other options available: 1. Click Edit to return to the request entry page to make changes. 2. Click Submit to send the request to the payer for consideration and proceed to the request confirmation page. 3. Click Cancel to cancel the request entry. Referral Request Confirmation 1. Click the print friendly version link. The print friendly version of the request confirmation displays. 2. Click Print this page. The confirmation page prints to the user designated printer. 3. Click Close to leave the page. The Referral request confirmation introduction section and the Request ID number assigned by the system display Copyright 2014 Medecision, Inc. 128

131 4. Click the Attach file link (depending on the payer selected). The system scrolls down to the Request Attachments section. For additional details on how to attach a file to a request see the Request Attachments (on page 218) section of this Guide. Service summary The Service summary contains: The Service number. The procedure Code. The Start/End date. The number of Units. The Status Copyright 2014 Medecision, Inc. 129

132 Referral request information Note: The Service information and General other information sections display the procedure and diagnosis ICD9 or ICD10 codes and descriptions depending on the payer selected Copyright 2014 Medecision, Inc. 130

133 Request Attachments The section enables the user to attach a file to the request (depending on the payer selected). For additional details on how to attach a file to a request see the Request Attachments (on page 218) section of this Guide. General information This section lists general information about the request such as Treatment setting, Primary diagnosis and Notes. Other options available: 1. Click New payer to return to the Starting point page and select another payer. 2. Click Top of page to return to the navigation menu. Referral Request Extensions Depending on the payer you selected, you may be able to extend a referral request. If enabled, you are able to extend the dates on an existing referral treatment and specify the status that should be assigned to the extended treatment Copyright 2014 Medecision, Inc. 131

134 The steps for extending an existing referral request are similar to the steps for extending an existing inpatient request. For additional information see the Entering an Inpatient Request Extension section of this guide. Entering a Referral Request Extension 1. Click Referral on the Aerial iexchange navigation menu. The Referral instructions page displays. 2. Click on Extend referral request. The Treatment search page displays Copyright 2014 Medecision, Inc. 132

135 Use the Treatment search page to search for the referral treatment you wish to extend. For additional information on how to perform a Treatment search see the Treatment Search (on page 250) section. 3. When you have entered your search criteria, click Submit search. The Treatment search summary page displays listing requests meeting the search criteria entered. 4. Click the View details link located under the Request ID of the request you want to select. The Treatment Search details page displays. 5. Scroll down the Treatment Search details page to the Service 1 section, click Extend. The Referral request extension entry page displays Copyright 2014 Medecision, Inc. 133

136 Referral request extension entry The Referral request extension entry page displays. The Service being extended section of the page displays the Member name, Member ID, Procedure, Start and End dates and the Place of service (if available) of the original service. 1. Click the View request details link to view additional information about the original request. 2. In Section 1 Extension information the submitting provider from the original request is the default. To select a different provider, click the Submitting provider drop-down and select a new submitting provider. 3. Click the Submitting provider summary link to view the provider details of the submitting provider. 4. Click the Place of service drop-down and select a place of service. (optional) 5. Enter the number of Additional requested units. The additional requested unites must be in the range of 1 to Enter the Extension start date in MM/DD/YYYY format Copyright 2014 Medecision, Inc. 134

137 7. Enter the Extension end date in MM/DD/YYYY format. Additional notes (optional) 1. Scroll down to the Additional notes section and enter any additional notes. These fields are optional. 2. Click Next step. The Referral request extension preview page displays. This preview page contains the same information as all of the request preview pages. For additional information review any of the request preview sections in this guide. 3. Click Edit to return to the Referral request extension entry page to make changes. 4. Click Next step to return to the Referral request extension preview page. 5. Click Submit to send the request to the payer for consideration and proceed to the Referral request extension confirmation page. The confirmation page contains the same information as all of the request confirmation pages. For additional information review any of the request confirmation sections in this guide. Behavioral Health Requests Overview Depending on the payer you selected and if enabled, you may be able to enter behavioral health requests. If the Behavioral Health functionality is not enabled, the option does not display in the navigation menu Copyright 2014 Medecision, Inc. 135

138 Entering a New Inpatient Behavioral Health Request for DSM IV 1. Click Inpatient on the Aerial iexchange navigation menu. The Inpatient instructions page displays. 2. Click New inpatient behavioral health request. The Inpatient behavioral health request entry page displays Copyright 2014 Medecision, Inc. 136

139 Inpatient Behavioral Health General Information for DSM IV The Notification date defaults to the current date and cannot be edited. Note: Each payer to whom you submit a request can payer specific fields used to collect additional data. Since these fields can vary in name and function by payer, they have not been documented in this guide. Listed below are descriptions and steps on how to complete the more commonly prompted fields. Completion of each field is required unless labeled as optional Copyright 2014 Medecision, Inc. 137

140 1. Enter the Member ID number of the member or subscriber. If the ID is unavailable, search for the member. For additional information on how to perform a member search, see the Member Search (on page 236) section. Depending on the payer you have selected, you may be required to perform to a member search to value the Member ID. You are presented with a message indicating that you must search for the member you wish to use in place of the Member ID text box. 2. Click the Submitting provider drop-down arrow and select the appropriate submitting provider. 3. Click the Facility drop-down arrow and select a facility defined by your provider group. If the facility is not listed search for the provider. For additional information on how to perform a provider search review the Provider Search (on page 269) section. 4. Click the Treatment setting arrow and select a treatment setting. 5. Click the Treatment type arrow and select a treatment type. 6. Click the Review type arrow and select a review type. Note: The Treatment Setting, Treatment Type and Review Type fields only display depending on the payer selected. 7. Enter the date the member is to be admitted in the Admit Date field in MM/DD/YYYY format. 8. Select Yes or No in the Is this an emergency?...drop-down list. Axis Diagnoses 1. Enter the Axis I, II, or III diagnosis code, or select a diagnosis from the diagnosis short list defined by your provider group. 2. To search for a diagnosis code or description, click Diagnosis search. For additional information on how to perform a diagnosis search see the Diagnosis Search section Copyright 2014 Medecision, Inc. 138

141 Psychiatric Diagnoses are categorized by the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM uses a multiaxial or multidimensional approach. It assesses five dimensions (Axis I, II, III, IV and V) which are described in the following steps. Axis I: Clinical Syndromes Includes typical psychiatric diagnoses such as depression, schizophrenia or social phobia. Axis II: Development Disorders and Personality Disorders Includes Developmental disorders such as autism which are typically first evident in childhood. Also includes Personality disorders such as paranoia which have more long lasting symptoms. Axis III: Physical Conditions Includes physical conditions such as brain injury or HIV/AIDS that can result in symptoms of mental illness. Axis I and Axis II must be a behavioral health diagnosis. The first behavioral health diagnosis entered is the primary default. 3. Click Add. The diagnosis is added to a list. 4. Select one or more psychosocial and environmental problems for the member s diagnosis in the Axis IV section. This section is optional. Axis IV: Severity of Psychosocial Stressors Includes events in a persons life, such as death of a loved one, unemployment or marriage which can impact the disorders listed in Axis I and II Copyright 2014 Medecision, Inc. 139

142 Global Assessment of Functioning Scale Guide 1. Click the View Global Assessment of Functioning Scale Guide link to view the Global Assessment of Functioning Scale for Axis V. The Global Assessment of Functioning Scale Guide window displays Copyright 2014 Medecision, Inc. 140

143 The Global Assessment of Functioning (GAF) is a numeric scale (0 through 100) used by mental health clinicians and physicians to rate the social, occupational, and psychological functioning of patients. Axis V: Highest Level of Functioning Clinician ratings of the person s level of functioning both at the present time and the highest level within the previous year. 2. Review the scale to determine the rating. Click Close. 3. Enter the rating value in the Axis V field. This field is optional. 4. Enter the number of days requested for this member s stay in the Requested length of stay. The requested length of stay must be in the range of 1 to Click the Attending physician drop-down arrow and select the appropriate attending physician defined by your provider group. If the physician is not listed perform a provider search. For additional on how to perform a Provider search review the Provider Search (on page 269) section. Some payers may choose to not prompt for attending physician information on the inpatient request entry page. 6. Click the Attending physician summary link to view the provider details for the attending physician. 7. Click the LOS (length of stay) Bed Type arrow and select the bed type for the inpatient request (optional). Inpatient Behavioral Health Services Information for DSM IV Copyright 2014 Medecision, Inc. 141

144 1. Enter a Principal Service (Procedure) code; select a code from the procedure short list defined for your provider group, or perform a Procedure search. For additional information on how to perform a Procedure search, review the Procedure Search section of this guide. 2. Enter a procedure modifier in the Procedure modifiers field. You can enter up to four procedure modifiers. These fields are optional. 3. Enter the Scheduled date of the procedure. 4. Select a Servicing provider from the drop-down list defined for your provider group or perform a Provider search. For additional information on how to perform a provider search, review the Provider Search (on page 269) section of this guide. 5. Click the Servicing provider summary link to view the provider details for the selected provider. 6. Enter any notes in the Additional notes section. Additional note field names vary based on the payer selected and may not always be prompted for. Completion of these fields is optional. 7. Click Next step to continue. Note: When you click Next step, Aerial iexchange evaluates the entered request data before displaying the Inpatient behavioral health request preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart Copyright 2014 Medecision, Inc. 142

145 Inpatient Behavioral Health Preview for DSM IV Summary/Additional criteria The LOS start/end date section contains: The start and end date. The number of Days requested. The Status for the length of stay requested. The Additional criteria link. The additional criteria link displays for the length of stay if additional criteria such as information entered by accessing CareWebQI or by completing a Request Review Questionnaire, can affect the review outcome status for the length of stay. If no Additional criteria apply the Summary/Additional criteria label and the text and icons below, it does not display. The Additional criteria column does not display Copyright 2014 Medecision, Inc. 143

146 It is recommended that you preview the entire request before accessing the additional criteria link. Once you access and complete the additional criteria for a length of stay, the edit function is disabled for the request. The Service section contains: The Service number. The procedure Code. The procedure's Scheduled date Copyright 2014 Medecision, Inc. 144

147 Inpatient behavioral health request information The Inpatient behavioral health request information section contains the Member, Submitting provider, Facility, Attending physician, LOS request and Services information entered on the request entry page Copyright 2014 Medecision, Inc. 145

148 General information This section lists general information about the request such as Reviewer Notes and Treatment type. Other options available: 1. Click Edit to return to the request entry page to make changes. 2. Click Submit to send the request to the payer for consideration. 3. Click Cancel to cancel the request entry. Inpatient Behavioral Health Confirmation for DSM IV 1. Click the print friendly version link. The print friendly version of the request confirmation displays. 2. Click Print this page. The confirmation page prints to the user designated printer. 3. Click Close to leave the page. The Inpatient request confirmation introduction section and the Request ID number assigned by the system display. 4. Click the Attach file link (depending on the payer selected). The system scrolls down to the Request Attachments section. For additional details on how to attach a file to a request see the Request Attachments (on page 218) section of this guide Copyright 2014 Medecision, Inc. 146

149 Summary The Summary section contains: The LOS start/end date The number of Days The Status of the request The Service section contains: The Service number The procedure Code The procedure Scheduled date Copyright 2014 Medecision, Inc. 147

150 Inpatient behavioral health request information The Inpatient behavioral health request information section contains the Member, Submitting provider, Facility, Attending physician, LOS request and Services information entered on the request entry page Copyright 2014 Medecision, Inc. 148

151 Request Attachments The Request Attachments section enables the user to attach a file to the request (depending on the payer selected). For additional details on how to attach a file to a request see the Request Attachments (on page 218) section of this guide. General information This section lists general information about the request such as Notes and Treatment type. Other options available: 1. Click New payer to return to the Starting point page and select another payer. 2. Click Top of page to return to the navigation menu. Entering an Inpatient Behavioral Health Request Extensions Depending on the payer you selected, you may be able to extend an existing inpatient behavioral health request Copyright 2014 Medecision, Inc. 149

152 When entering an inpatient behavioral health extension, all service dates for services entered must be within the length of stay date range. The length of stay date range is determined by the admit date + initial behavioral health request length of stay + extension request length of stay. For example, if the initial behavioral health request admit date is 12/01/10 with a length of stay of 3 days, the initial behavioral health request length of stay date range is 12/01/10-12/04/10. When the initial behavioral health request is extended by 2 days, the extension request length of stay date range is 12/01/10-12/06/10. Services entered for the extension must have service dates between 12/01/10-12/06/10. If services are entered outside of the length of stay date range, an error message displays. 1. Click Extend inpatient request. The Treatment search page displays. 2. Enter the search criteria, click Submit search. The Treatment search summary page displays listing requests meeting the search criteria Copyright 2014 Medecision, Inc. 150

153 For additional information on how to perform a treatment search, see the Treatment Search (on page 250) section of this guide. 3. Click the View details link located under the Request ID of the request you want to view. The Treatment Search details page displays. 4. Scroll down the page to the LOS request information section Copyright 2014 Medecision, Inc. 151

154 Copyright 2014 Medecision, Inc. 152

155 5. Click Extend. The Inpatient behavioral health request extension entry page displays. Inpatient Behavioral Health Request Extension Entry 1. To view additional information about the original request, click View request details in the Request being extended section. The submitting provider from the original request defaults into the Submitting provider field. 2. Click on the drop-down arrow to select a new submitting provider Copyright 2014 Medecision, Inc. 153

156 3. To view the provider details of the submitting provider, click Submitting provider summary. 4. Enter the Axis I, II, or III diagnosis code, or select a diagnosis from the diagnosis short list defined by your provider group. The diagnoses from the previous request are displayed. An additional diagnosis is not required to extend the request. 5. To search for a diagnosis code or description, click Diagnosis search. For additional information on how to perform a diagnosis search see the Diagnosis Search section of this guide. 6. Click Add. The diagnosis is added to a list. Repeat steps 8-10 until all diagnoses are entered. Global Assessment of Functioning Scale Guide 1. Click the View Global Assessment of Functioning Scale Guide link to view the Global Assessment of Functioning Scale for Axis V. The Global Assessment of Functioning Scale Guide window displays. 2. Review the scale then click Close. 3. Select one or more psychosocial and environmental problems for the member s diagnosis in the Axis IV section. This section is optional. 4. Enter the Additional requested units. The additional requested units must be in the range of 1 to Enter the LOS bed type. This field is optional Copyright 2014 Medecision, Inc. 154

157 Services information 1. Enter a Procedure code for Extension service 1. This field is optional. 2. Enter the Procedure modifiers. These fields only display if the configuration is enabled. 3. Enter the Scheduled date. 4. To select a Servicing provider click on the drop down arrow or click Provider search to select a provider from your group. Additional notes (optional) 1. Enter any notes in the Additional notes section. Additional note field names vary based on the payer selected and may not always be prompted for. Completion of these fields is optional. 2. Click Next step to continue Copyright 2014 Medecision, Inc. 155

158 Note: When you click Next step, Aerial iexchange evaluates the entered request data before displaying the Inpatient behavioral health request extension preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart. Inpatient Behavioral Health Preview If additional clinical criteria can be entered by way of CareWebQI for the extension request the preview page displays a link to CareWebQI. For additional information on CareWebQI, see the MCG Guidelines CareWebQI section. If there is a request review questionnaire available, the inpatient behavioral health request extension preview page displays with a link to the questionnaire. An informational message displays. For additional information on questionnaires see the Request Review Questionnaire section Copyright 2014 Medecision, Inc. 156

159 Note: It is recommended that you review the preview page before accessing CareWebQI or the Request Review Questionnaire. The Edit functionality may be disabled after entry of information. The Inpatient behavioral health request extension preview page is similar to the inpatient request preview page. For additional information, review the Inpatient Requests (on page 52) section. 1. Click Edit located at the bottom of the page to make changes to the information. The Inpatient behavioral health request extension entry page displays. 2. Make the appropriate changes, click Next step on the request entry page Copyright 2014 Medecision, Inc. 157

160 When you click Next step, Aerial iexchange evaluates the entered request data before redisplaying the Inpatient behavioral health request extension preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart. 3. Click Submit. The Inpatient behavioral health request extension confirmation page displays. Inpatient Behavioral Health Extension Confirmation for DSM IV The confirmation page contains the inpatient behavioral health extension information including the request ID, status, the member's name and ID, Facility, Submitting provider and any extended procedures Copyright 2014 Medecision, Inc. 158

161 1. Click the Print friendly version link located at the top of the page, to generate a printable version of the confirmation page. Once the print-friendly version displays, click the Print this page link to print the page. Click Close to return to the confirmation page. 2. The General information section contains general information about the request such as Reviewer Notes or Screening Notes. The other options available. 3. Click New payer to return to the Starting point page and select another payer. 4. Click Return to treatment search results to return to the treatment search summary page. 5. Click Top of page to return to the navigation menu Copyright 2014 Medecision, Inc. 159

162 Entering a New Other Behavioral Health Request for DSM IV 1. Click Other on the navigation menu and then select New other behavioral health request. The Other behavioral health request entry page displays Copyright 2014 Medecision, Inc. 160

163 General Information 1. The Notification date defaults to the current date and cannot be edited. Each payer to whom you submit a request can include treatment request and treatment review custom fields used to collect additional data. Since these fields can vary in name and function by payer, they have not been documented in this guide. Listed below are descriptions and steps on how to complete the more commonly prompted fields. Completion of each field is required unless labeled as optional Copyright 2014 Medecision, Inc. 161

164 2. Enter the Member ID number of the member or subscriber. If the ID is unavailable, search for the member. For additional information on how to perform a member search, see the Member Search (on page 236) section. Depending on the payer you have selected, you may be required to perform a member search to value the Member ID. You are presented with a message indicating that you must search for the member you wish to use in place of the Member ID text box. 3. Click the Submitting provider drop-down arrow and select the appropriate submitting provider. 4. Click the Facility drop-down arrow and select a facility defined by your provider group. If the facility is not listed search for the provider. For additional information on how to perform a provider search review the Provider Search (on page 269) section. 5. Click the Servicing provider drop down arrow and select the servicing provider or perform a Provider search. 6. Click the Attending physician drop down (if available) and select the attending physician defined for your provider group or perform a Provider search. This field can be required or optional depending on the payer selected. 7. Click the Treatment setting drop-down arrow and select the treatment setting. Axis Diagnosis 1. Enter the Axis I, II, or III diagnosis code, or select a diagnosis from the diagnosis short list defined by your provider group. Psychiatric Diagnoses are categorized by the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM uses a multiaxial or multidimensional approach. It assesses five dimensions (Axis I, II, III, IV and V) which are described in the following steps. Axis I: Clinical Syndromes Includes typical psychiatric diagnoses such as depression, schizophrenia or social phobia. Axis II: Development Disorders and Personality Disorders Includes Developmental disorders such as autism which are typically first evident in childhood. Also includes Personality disorders such as paranoia which have more long lasting symptoms Copyright 2014 Medecision, Inc. 162

165 Axis III: Physical Conditions Includes physical conditions such as brain injury or HIV/AIDS that can result in symptoms of mental illness. 2. After selecting a diagnosis from the short list, click Add. 3. To search for an Axis I, II, or III diagnosis code or description, click Diagnosis search. For additional information on how to perform a diagnosis search see the Diagnosis Search section. 4. Select one or more psychosocial and environmental problems for the member s diagnosis in the Axis IV section. This section is optional. Axis IV: Severity of Psychosocial Stressors Includes events in a persons life, such as death of a loved one, unemployment or marriage which can impact the disorders listed in Axis I and II. Global Assessment of Functioning Scale Guide 1. Click the View Global Assessment of Functioning Scale Guide link to view the Global Assessment of Functioning Scale for Axis V. The Global Assessment of Functioning Scale Guide window displays. The Global Assessment of Functioning (GAF) is a numeric scale (0 through 100) used by mental health clinicians and physicians to rate the social, occupational, and psychological functioning of patients. Axis V: Highest Level of Functioning Clinician ratings of the person s level of functioning both at the present time and the highest level within the previous year. 2. Review the scale then click Close. 3. Enter a value in the Axis V field. This field is optional. For additional information on this field review the Entering a New Inpatient Behavioral Health Request section of this guide Copyright 2014 Medecision, Inc. 163

166 Services Information 1. Enter a Service 1 Procedure code or select a code from the procedure short list defined for your provider group, or search for a procedure. For additional information on how to perform a Procedure search, review the Procedure Search section. 2. Enter a procedure modifier in the Procedure modifiers field. You can enter up to four procedure modifiers. These fields are optional and display depending on the payer selected. 3. Enter the number of occurrences (units or visits) in the Unit fields. The requested number of units must be in the range of 1 to Select a Treatment type from the drop down list. This field displays depending on the payer selected. 5. Select a Review type from the drop down arrow. This field displays depending on the payer selected. 6. Click the Place of service drop-down and select the place of service. This field is optional Copyright 2014 Medecision, Inc. 164

167 7. Enter the Start Date in MM/DD/YYYY format, of the procedure. 8. Enter the End Date in MM/DD/YYYY format, of the procedure. Additional Notes 1. Enter any notes in the Additional notes section. Additional note field names vary based on the payer selected and may not always be prompted for. Completion of these fields is optional. 2. Click Next step to continue. When you click Next step, Aerial iexchange evaluates the entered request data before displaying the Other behavioral health request preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart Copyright 2014 Medecision, Inc. 165

168 Additional Other Behavioral Health Services Entry for DSM IV Use this page to add additional services to the other behavioral health request identified in the Summary section. You can add up to five additional services on this page. 1. In the Service 4 (optional) section, you can do one of the following: Enter a Procedure code. Select a code from the procedure code drop-down list. Select Procedure search to search for a procedure code. Additional service sections are numbered sequentially, beginning from the last service submitted. In this example three services were submitted previously. For additional information on how to perform a Procedure search, review Procedure Search Copyright 2014 Medecision, Inc. 166

169 2. Enter a procedure modifier in the Procedure modifiers field. You can enter up to four procedure modifiers. These fields are optional and display depending on the payer selected. 3. Enter the number of occurrences (units or visits) in the Unit fields. The requested units for the service must be in the range 1 to Click the Treatment type drop-down arrow, and select the appropriate treatment type. This field displays only if treatment type is enabled. The field displays for each service. This is a required field. 5. Click the Review type drop-down arrow, and select the appropriate review type. This field displays only if review type is enabled. The field displays for each service and is a required field. 6. Click the Place of service arrow, and select the place of service. (Optional) 7. Enter the Start Date, in MM/DD/YYYY format, of the procedure. 8. Enter the End date in MM/DD/YYYY format of the procedure. Repeat these steps to add up to five services on this page (if needed). 9. Click Next step. When you click Next step, Aerial iexchange evaluates the entered request data before displaying the Additional other behavioral health services preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart Copyright 2014 Medecision, Inc. 167

170 Additional other behavioral health services preview 1. To make changes to you entries, click Edit located at the bottom of the page. The Other request entry page displays. Make the appropriate changes. Only the additional services entered previously can be edited. 2. Click Next step. When you click Next step, Aerial iexchange Web evaluates the entered request data before redisplaying the Additional other behavioral request preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart. 3. Click Submit. The Other behavioral health request confirmation page displays Copyright 2014 Medecision, Inc. 168

171 Other Behavioral Health Preview for DSM IV Summary/Additional criteria The Service section contains. The Service number The procedure Code The Start/end date The Units of service The Projected status Additional criteria link. The additional link displays for the service if additional criteria such as information is required and to be entered in CareWebQI or by completing a Request Review Questionnaire which can affect the review outcome status for the request Copyright 2014 Medecision, Inc. 169

172 If no additional criteria apply, the Summary/Additional criteria label and the text and icons below do not display. The Additional criteria column does not display. Note: It is recommended that you preview the entire request before accessing the additional criteria link. Once you access and complete the additional criteria, the edit function is disabled for the request Copyright 2014 Medecision, Inc. 170

173 Other behavioral health request information The Other behavioral health request information section contains the Member name, Submitting provider, Facility, the Servicing provider and the Service information entered on the entry page Copyright 2014 Medecision, Inc. 171

174 General other information This section lists general information about the request such as Review Notes and Treatment Type. Other options available: 1. To re-display the request entry page and make changes, click Edit. 2. To return to the request preview page, click Next step on the request entry page. Note When you click Next step, Aerial iexchange evaluates the entered request data before redisplaying the Other behavioral health request preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a printfriendly copy of the request to keep on the patient's chart. 3. To add additional services, click Submit and add services. The Additional other behavioral health services entry page displays. 4. To save the information and submit the request to the payer, click Submit. The Other behavioral health request confirmation page displays Copyright 2014 Medecision, Inc. 172

175 Other Behavioral Health Confirmation for DSM IV 1. Click Print friendly version. The print friendly version of the request confirmation displays. 2. Click Print this page. The confirmation page prints to the user designated printer. 3. Click Close to leave the page. The Other behavioral health request confirmation introduction section and the Request ID number display. The summary and the details provide information on all services reviewed for this request. 4. Click the Attach file link (depending on the payer selected). The system scrolls down to the Request Attachments section. For additional details on how to attach a file to a request see the Request Attachments (on page 218) section of this guide. Summary The Summary section contains: The Service number. The procedure Code. The Start/end date for the service. The number of Units. The Status of the request Copyright 2014 Medecision, Inc. 173

176 Other behavioral health request information Copyright 2014 Medecision, Inc. 174

177 The Other behavioral health request information section contains the Member information, Servicing provider, Submitting provider and Service information entered on the request entry page. Request Attachments The Request Attachments section enables the user to attach a file to the request (depending on the payer selected). For additional details on how to attach a file to a request see the Request Attachments (on page 218) section of this guide. General other information This section lists general information about the request such as Treatment setting and Primary diagnosis. Other options available: 1. Click New payer to return to the Starting point page and select another payer. 2. Click Top of page to return to the navigation menu Copyright 2014 Medecision, Inc. 175

178 Extending an Other Behavioral Health Request for DSM IV Depending on the payer you selected, you may be able to extend an existing other behavioral health request. 1. Click Extend other request. The Treatment search page displays. 2. Enter the search criteria, click Submit search. The treatment search summary page displays listing requests meeting the search criteria. For additional information on how to perform a treatment search see the Treatment Search (on page 250) section of this guide Copyright 2014 Medecision, Inc. 176

179 3. Click the View details link located under the Request ID of the request you want to view. The Treatment Search details page displays. 4. Scroll down the Treatment Search details page to the Service section, click Extend. 5. The Other behavioral health request extension entry page displays Copyright 2014 Medecision, Inc. 177

180 Extension Information Section 1. To view the details of the request, click the View request details link in the Service being extended box. The submitting provider from the original request defaults in the Submitting provider field in the Extension information section. 2. To select a different submitting provider, click the Submitting provider drop-down Copyright 2014 Medecision, Inc. 178

181 3. To view the provider details of the submitting provider, click View provider summary. Axis Diagnoses 1. Enter the Axis I, II, or III diagnosis code, or select a diagnosis from the diagnosis short list defined by your provider group. The diagnoses from the previous request are displayed. An additional diagnosis is not required to extend the request. 2. To search for a diagnosis code or description, click Diagnosis search. For additional information on how to perform a diagnosis search see the Diagnosis Search section of this guide. 3. Click Add. The diagnosis is added to a list. Repeat steps 8-10 until all diagnoses are entered. 4. Select one or more psychosocial and environmental problems for the member s diagnosis in the Axis IV section. This section is optional. Global Assessment of Functioning Scale Guide 1. Click the View Global Assessment of Functioning Scale Guide link to view the Global Assessment of Functioning Scale for Axis V. The Global Assessment of Functioning Scale Guide window displays. 2. Review the scale then click Close. 3. Enter a value in the Axis V field. This field is optional. 4. Enter the Additional requested units. The additional requested units must be in the range of 1 to Enter the Extension start date. 6. Enter the Extension end date. Additional Notes 1. Enter any notes in the Additional notes section. Additional note field names vary based on the payer selected and may not always be prompted for. Completion of these fields is optional. 2. Click Next step to continue Copyright 2014 Medecision, Inc. 179

182 Note: When you click Next step, Aerial iexchange evaluates the entered request data before displaying the Other behavioral health request extension preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart. Other Behavioral Health Extension Preview for DSM IV Copyright 2014 Medecision, Inc. 180

183 Other behavioral health request information 1. To review the request information, scroll down the Preview page. 2. To re-display the request entry page and make changes, click Edit Copyright 2014 Medecision, Inc. 181

184 3. To return to the request preview page, click Next step. When you click Next step, Aerial iexchange evaluates the entered request data before redisplaying the Other behavioral health request extension preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart. 4. To save the information and submit the request to the payer, click Submit. The Other behavioral health request extension confirmation page displays Copyright 2014 Medecision, Inc. 182

185 Entering a New Referral Behavioral Health Request for DSM IV 1. Click Referral on the Aerial iexchange navigation menu. The Referral instructions page displays Copyright 2014 Medecision, Inc. 183

186 2. Click New referral behavioral health request. The Referral behavioral health request entry page displays. Behavioral Health Referral request entry General information 1. The Notification date defaults to the current date and cannot be edited. Each payer to whom you submit a request can include treatment request and treatment review custom fields used to collect additional data. Since these fields can vary in name and function by payer, they have not been documented in this guide. Listed below are descriptions and steps on how to complete the more commonly prompted fields. Completion of each field is required unless labeled as optional Copyright 2014 Medecision, Inc. 184

187 2. Enter the Member ID number of the member or subscriber. If the ID is unavailable, search for the member. For additional information on how to perform a member search, see the Member Search (on page 236) section of this guide. Depending on the payer you have selected, you may be required to perform a member search to value the Member ID. You are presented with a message indicating that you must search for the member you wish to use in place of the Member ID text box. 3. Click the Submitting provider drop-down arrow and select the appropriate submitting provider. 4. Click the Servicing provider drop-down arrow and select the appropriate servicing provider. 5. Click the View provider summary link to view the provider summary. 6. Click the Treatment setting drop-down arrow and select the treatment setting. 7. Click the Treatment type drop-down arrow and select the treatment type. Axis Diagnoses 1. Enter the Axis I, II, or III diagnosis code, or select a diagnosis from the diagnosis short list defined by your provider group. Psychiatric Diagnoses are categorized by the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM uses a multiaxial or multidimensional approach. It assesses five dimensions (Axis I, II, III, IV and V) which are described in the following steps. Axis I: Clinical Syndromes Includes typical psychiatric diagnoses such as depression, schizophrenia or social phobia. Axis II: Development Disorders and Personality Disorders Includes Developmental disorders such as autism which are typically first evident in childhood. Also includes Personality disorders such as paranoia which have more long lasting symptoms. Axis III: Physical Conditions Includes physical conditions such as brain injury or HIV/AIDS that can result in symptoms of mental illness. 2. After selecting a diagnosis from the short list, click Add Copyright 2014 Medecision, Inc. 185

188 3. To search for an Axis I, II, or III diagnosis code or description, click Diagnosis search. For additional information on how to perform a diagnosis search see the Diagnosis Search section of this guide. 4. Select one or more psychosocial and environmental problems for the member s diagnosis in the Axis IV section. This section is optional. Axis IV: Severity of Psychosocial Stressors Includes events in a persons life, such as death of a loved one, unemployment or marriage which can impact the disorders listed in Axis I and II. 5. Click the View Global Assessment of Functioning Scale Guide link to view the Global Assessment of Functioning Scale for Axis V. The Global Assessment of Functioning Scale Guide window displays. The Global Assessment of Functioning (GAF) is a numeric scale (0 through 100) used by mental health clinicians and physicians to rate the social, occupational, and psychological functioning of patients. Axis V: Highest Level of Functioning Clinician ratings of the person s level of functioning both at the present time and the highest level within the previous year. 6. Review the scale then click Close. 7. Enter a value in the Axis V field. This field is optional Copyright 2014 Medecision, Inc. 186

189 Behavioral Health request entry Services information 1. Enter a Principal Service (Procedure) code; select a code from the procedure short list defined for your provider group, or search for a procedure. For additional information on how to perform a Procedure search, review the Procedure Search section of this guide on page. 2. Enter the number of occurrences (units or visits) in the Unit fields. The additional requested units must be in the range of 1 to Click the Place of service drop-down and select the place of service. This field is optional. 4. Enter the Start Date in MM/DD/YYYY format, of the procedure. 5. Enter the End Date in MM/DD/YYYY format, of the procedure. Additional notes 1. Enter any notes in the Additional notes section. Additional note field names vary based on the payer selected and may not always be prompted for. Completion of these fields is optional. 2. Click Next step to continue. The Referral behavioral health preview page displays Copyright 2014 Medecision, Inc. 187

190 When you click Next step, Aerial iexchange evaluates the entered request data before displaying the Referral behavioral health request preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart. Referral Behavioral Health Preview for DSM IV Summary The Summary section includes the following information: The Service number. The service procedure Code. The Start/end date of the service. The number of Units. The Projected status of the request Copyright 2014 Medecision, Inc. 188

191 Referral behavioral health request information The Referral behavioral health request information section contains the Member, Submitting provider, Servicing provider, and Service information entered on the request entry page Copyright 2014 Medecision, Inc. 189

192 General information This section lists general information about the request such as Treatment setting and Primary diagnosis. Other options available: 1. To re-display the request entry page and make changes, click Edit. 2. To return to the request preview page, click Next step on the request entry page. When you click Next step, Aerial iexchange evaluates the entered request data before redisplaying the Referral behavioral health request preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a printfriendly copy of the request to keep on the patient's chart. 3. To save the information and submit the request to the payer, click Submit. The Other behavioral health request confirmation page displays Copyright 2014 Medecision, Inc. 190

193 Referral Behavioral Health Confirmation for DSM IV 1. Click the print friendly version link. The print friendly version of the request confirmation displays. 2. Click Print this page. The confirmation page prints to the user designated printer. 3. Click Close to leave the page. The Referral behavioral health request confirmation introduction section and the Request ID number assigned by the system display. 4. Click the Attach file link (depending on the payer selected). The system scrolls down to the Request Attachments section. For additional details on how to attach a file to a request see the Request Attachments (on page 218) section of this guide. Summary The Summary section contains: The Service number The service procedure Code The Start/end date of the service Copyright 2014 Medecision, Inc. 191

194 The number of Units The Status of the request. Referral behavioral health request information The Referral behavioral request information section contains the Member, Servicing Provider, Service and Facility information entered on the request entry page Copyright 2014 Medecision, Inc. 192

195 Request Attachments The section enables the user to attach a file to the request (depending on the payer selected). For additional details on how to attach a file to a request see the Request Attachments (on page 218) section of this guide. General information This section lists general information about the request such as Treatment setting and Primary diagnosis. Other options available: 1. Click New payer to select another payer. 2. Click Top of page to return to the navigation menu Copyright 2014 Medecision, Inc. 193

196 Extending a Referral Behavioral Health Request for DSM IV Depending on the payer you selected, you may be able to extend an existing referral behavioral health request. 1. Click Referral on the navigation menu and then select Extend referral request. The Treatment search page displays Copyright 2014 Medecision, Inc. 194

197 2. Enter the search criteria, and click Submit search. The treatment search summary page displays listing requests meeting the search criteria. For additional information on how to perform a treatment search see the Treatment Search (on page 250) section of this guide Copyright 2014 Medecision, Inc. 195

198 3. Click the View details link located under the Request ID of the request you want to view. The Treatment Search details page displays Copyright 2014 Medecision, Inc. 196

199 4. Scroll down the Treatment Search details page to the Principal Service section, click Extend. The Referral behavioral health request extension entry page displays. 5. To view the details of the request, click the View request details link in the Service being extended box. The submitting provider from the original request defaults in the Submitting provider field in the Extension information section. 6. To select a different submitting provider, click the Submitting provider drop-down. 7. To view the provider details of the submitting provider, click View provider summary. 8. Enter the Additional requested units. The additional requested units must be in the range of 1 to Copyright 2014 Medecision, Inc. 197

200 9. Enter the Extension start date in MM/DD/YYYY format. 10. Enter the Extension end date in MM/DD/YYYY format. Additional Notes 1. Enter any notes in the Additional notes section. Additional note field names vary based on the payer selected and may not always be prompted for. Completion of these fields is optional. 2. Click Next step to continue. When you click Next step, Aerial iexchange evaluates the entered request data before displaying the referral behavioral health request extension preview page. If a data error is displayed on the entry page, you must correct the error before the preview page displays. If you cannot correct the error immediately, you can print a print-friendly copy of the request to keep on the patient's chart. 3. Click Submit. The Referral behavioral health request extension confirmation page is displayed Copyright 2014 Medecision, Inc. 198

201 Referral Behavioral Health Extension Confirmation for DSM IV 1. Click the Print friendly version link. The print friendly version of the request confirmation displays. 2. Click Print this page. The confirmation page prints to the user designated printer. 3. Click Close to leave the page. The Referral behavioral health request extension confirmation introduction section and the Request ID number assigned by the system displays. Summary The Summary section contains: The Service number The procedure Code for the service. The Start/end date of the service Copyright 2014 Medecision, Inc. 199

202 The number of service Units. The Status of the service Copyright 2014 Medecision, Inc. 200

203 Referral behavioral health request extension information Copyright 2014 Medecision, Inc. 201

204 The Referral behavioral health request extension information section contains the Member, Servicing provider Submitting provider and service information for the service extended. General other information The General other information section contains general information about the request such as Treatment setting, Primary diagnosis and Notes. The other options available include: 1. Click New payer located at the bottom of the page to return to the Starting point page and select another payer. 2. Click Return to treatment search results located at the bottom of the page to return to the Treatment search summary page. 3. Click Top of page located at the bottom of the page to return to the navigation menu Copyright 2014 Medecision, Inc. 202

205 Chapter 4 Managing Treatment Updates In This Chapter Overview Categories of Treatment Updates Treatment Updates Notification Treatment Update Summary Treatment Update Search Overview When a payer is selected and the system determines that treatment update functionality is enabled for the payer, the system then searches each treatment update category to determine if at least one treatment update exists for any authorized provider in your group. If so, the system presents the treatment update links under the Treatment updates header. Treatment update functionality notifies the user when the payer or a provider has created or modified a request that either directly or indirectly impacts their group. The user is prompted to: View new updates submitting providers when the treatment update search has determined that at least one treatment update exists in the payer treatment update category for a submitting provider in the group. View new updates for facilities and servicing providers when the treatment update search has determined that at least one treatment update exists in the facility or servicing provider treatment update categories for any provider in the group. View new updates for primary care physician when the system has determined that at least one treatment update exists for a primary care physician in the group. If no treatment updates exists, the system presents the message: No treatment updates are available Copyright 2014 Medecision, Inc. 203

206 Managing Treatment Updates Categories of Treatment Updates You can receive any of the following categories of Treatment Updates. Updates for Submitting Providers Updates for submitting providers inform you of changes made by the payer to requests submitted by an authorized provider in your group. You can receive updates for submitting providers when: The payer has modified the status of a request treatment submitted by a provider in your group. When the payer modifies the status of a treatment from pend to approved, pend to denied, approved to pend, approved to denied or void, you receive a submitting provider treatment update. The payer has added notes to a request submitted by a provider in your group. Updates for Facilities and Servicing Providers Updates for facilities/servicing providers inform you of initial or extended treatments for inpatient, other or referral medical and behavioral requests added by a specialist or the payer with which your facility is authorized, or an authorized provider is directly involved. For example, when a treatment with which your facility or a provider in your group is extended by the payer or a specialist, you receive a treatment extension update. Notification is received for the following: New service treatment updates for facilities Service extension treatment updates for facilities New service treatment updates for servicing providers Service extension treatment updates for servicing providers Service status changed to approved, pend, denied or void Copyright 2014 Medecision, Inc. 204

207 Managing Treatment Updates Updates for the Primary Care Physician Updates for primary care physicians (PCP) inform you of changes made to a request by the payer or by an authorized provider. This may include updates from submitting providers, servicing providers, or facility providers. You can receive updates for primary care physicians following: New service treatment update Service extension treatment update Primary care physician treatment updates are only received for requests the PCP has no other provider role with. For example if an authorized provider is both submitting provider and the PCP on a request that has been extended by the payer, that provider receives a treatment update by way of the submitting provider treatment updates but not by way of the PCP treatment updates. Treatment Updates Notification After you have selected a payer, the Treatment updates notification displays in the Treatment updates section of the Starting point page. Within the Treatment Updates notification, one or more Treatment Update links can display (depending on payer selected): View new updates for submitting providers View new updates for facilities and servicing providers View new updates for primary care physician If there are no Treatment Updates, the message No treatment updates are available displays Copyright 2014 Medecision, Inc. 205

208 Managing Treatment Updates Note: The payer determines the number of days the system looks for treatment updates when determining whether the updates exist for presentation of the treatment update links. Treatment Update Summary The Treatment Update Summary page provides a summary of the treatment updates generated for the authorized submitting providers, facilities and servicing providers and for primary care physicians in your group. Note: The Submitting provider, Facility and Servicing provider or Primary Care Physician displayed on the Treatment Update Summary pages reflects the provider in that role on the treatment request at the time of the treatment update. The additional treatment request information displayed on the Treatment Update Summary pages reflects the current information for the treatment request and may not reflect the information at the time of the treatment update Copyright 2014 Medecision, Inc. 206

209 Managing Treatment Updates Viewing New Updates for Submitting Providers 1. To view updates for a submitting provider, click View new updates for submitting providers in the Treatment updates notice box. The Treatment update summary page displays. The Treatment Updates are grouped by member name (alphabetically in ascending order). For each member, the treatment updates associated with the member are sorted as follows: Status changed to Approved Copyright 2014 Medecision, Inc. 207

210 Managing Treatment Updates Status changed to Denied Status changed to Pend Status changed to Void Notes added Treatment extended The following information displays: Updates for member: A header that contains the Member Name and Member ID. Treatment Updates associated with the member are listed below the Member identifier row. View indicator column: This column contains a checkbox for each Treatment Update listed. This check box is used to specify which Treatment Updates you want to mark as viewed. Update summary column: This column indicates the reason the Treatment Update was generated. Additionally the date the treatment update was generated displays. If Notes were added they display in a separate row which lists the submitting provider who first added the note, the request ID and the comments that were added. Submitting provider: This column presents the name of the submitting provider associated with the request. Request ID: This column contains the request ID of the request from which the treatment update was generated. Request type: This column contains the service type such as inpatient, other referral or prior auth. Primary diagnosis: This column contains the primary diagnosis code and description associated with the request that has been updated. Both ICD9 and ICD10 codes display depending on the payer selected. Treatment: This column lists the type of service and the description. The procedure coding classification values (ICD9, ICD10, HCPCS,or CPT) displayed depends on the payer selected. Treatment dates: The information displayed in this column will vary. This column displays either the treatment start and end date for an updated service or scheduled treatment date associated with an updated length of stay Copyright 2014 Medecision, Inc. 208

211 Managing Treatment Updates Last outcome: The column lists the treatment start and end date or the scheduled treatment date associated with an updated length of stay or service. Also displayed is the status (approved, pend or denied) as well as the reason the status was assigned. For example: "Approved Clinical Criteria Met". 2. Click View details to view detailed information about the updated treatment. For additional information see the Treatment Update Details (on page 213) section of this guide. 3. Click Next or Previous links to view the prior or next set or Treatment Updates for your group. 4. Click Cancel to return to the Starting point page Copyright 2014 Medecision, Inc. 209

212 Managing Treatment Updates Viewing Updates for Facilities and Servicing Providers 1. To view updates for a facility or servicing provider, click View new updates for facilities and servicing providers in the Treatment updates notice box. The Treatment update summary page displays Copyright 2014 Medecision, Inc. 210

213 Managing Treatment Updates The Treatment Update Summary provides a summary of the treatment updates generated for the facilities and servicing providers in your group. The information and options displayed on the Treatment update summary page for the facilities and servicing providers is similar to the information displayed for the submitting providers, except for following: Updates for Facility/Servicing Provider: (Provider/Facility Name: This row contains the Name of the facility or servicing provider. Member: The row contains the Member name and Member ID Servicing Provider: Contains the name of the facility or servicing provider. Note: The updates for facilities and servicing providers presents new treatment and extended treatment updates and status such as approved, denied, pend or void Copyright 2014 Medecision, Inc. 211

214 Managing Treatment Updates Viewing Updates for Primary Care Physician 1. To view updates for a primary care physician, click View new updates for primary care physician in the Treatment updates notice box. The Treatment update summary page displays. The Treatment Update Summary provides a summary of the treatment updates generated for the primary care physician in your group. The information and options displayed on the Treatment update summary page for the primary care physician is similar to the information displayed for the submitting providers, except for following: Updates for Primary Care Physician: This row contains the name of the primary care physician. Member: The row contains the Member name and member ID. Primary care physician: Contains the name of the primary care physician Note: Displays the new treatment and extended treatment updates for the primary care physician Copyright 2014 Medecision, Inc. 212

215 Managing Treatment Updates Mark as Read or Unread Note: This option is available whether View new updates for submitting providers, View new updates for facilities and servicing providers or View new updates for primary care physician is selected. To mark one or more treatment updates as read or unread: 1. Click inside the check box located in the Update summary column next to the treatment update you want to select. 2. To mark the selected treatment updates as read, click the Mark as read button located at the top of the page above the Member identifier header. 3. To mark the selected treatment updates as unread, click the Mark as unread button. 4. To select all of the treatment updates listed and mark as read or unread, click inside the check box located next to Update summary then click Mark as read or Mark as unread. When a treatment update is marked as read, the display of the treatment update is grayed out to designate the treatment update as read. The View details link is enabled. Treatment updates that have been marked as "read" continues to display in a grayed out state until you exit the treatment update functionality. Once you have marked a treatment update as "read" and exited out of treatment update functionality, the treatment update is only viewable if you search for it using the treatment update search functionality. When a treatment update is marked as unread, the display of the treatment update displays to a non-grayed out state to designate the treatment update as unread. The Treatment Update Details lists the treatment updates associated with the selected request. The information available on the Treatment Update Details page is similar to the information provided on the Treatment Search Details page. Note: The treatment request information displayed on the Treatment Update Details pages reflects the current information for the treatment request and may not reflect the information at the time of the treatment update Copyright 2014 Medecision, Inc. 213

216 Managing Treatment Updates Accessing the Treatment Update Details Page 1. To view a treatment update, click View details on the Treatment update summary page. The Treatment update details page displays. The information displayed on this page varies by payer and by request type. The LOS start/end date and Service sections are not displayed for other, prior auth and referral requests. Instead of a Summary section, a section displays the Service, Code/Modifiers, Start/End date, Units and Status columns. The Treatment updates section lists the treatment update links that are available for the selected request depending on the type and number of treatment updates that meet the search criteria. 2. To view an update, click the link. The display scrolls to the section on the page associated with the update. Some examples of the update links that may display are: LOS status changed to <status description>. Service <service code>has been added. Service <service code> status has been changed to approved. <Note title> has been updated. 3. To mark an updated as read or unread, click the check box located next to the individual update. 4. To mark all the updates as read or unread, click the All updates check box. 5. Click Mark as read or Mark as unread. When a treatment update is marked as read, the display of the treatment update is grayed out to designates the treatment update as read. Treatment updates that are marked as read continue to be displayed in a grayed out state until you exit the treatment update functionality. After you mark a treatment update as read and exit out of treatment update functionality, the treatment update is viewable only if you search for it using the treatment update search functionality. When a treatment update is marked as unread, the display of the treatment update returns to a non-grayed out state to designate the treatment update as unread. 6. Click the View patient clinical summary or Health Summary link to view the report (depending on the payer selected) Copyright 2014 Medecision, Inc. 214

217 Managing Treatment Updates 7. Click the View Clinical Documents link to view clinical documents (depending on the payer selected). 8. Click the Enter discharge date and disposition to enter a discharge date and disposition (depending on the payer selected). Summary The Summary section contains the following: The Service number. The service Code The Start/end date for the service. The number of Units. The Status of service. The Summary section for inpatient requests contains the following (not shown): LOS Start/End Date Days Status Service Code Scheduled Date Units Status Add Services to Other Request 1. To add additional services to the request, click Add services. The Additional other services entry page displays. 2. Enter the additional services in the Services information section. 3. Click Next Step. The Additional other services preview page displays Copyright 2014 Medecision, Inc. 215

218 Managing Treatment Updates 4. Click Submit. The Additional other services confirmation page displays. For additional information on how to add additional services review the Additional other services entry section. Inpatient request information The Inpatient request information section contains the Member, Submitting provider, Facility, Attending physician, LOS request information and Service information. You can add additional days and services by clicking Extend in the LOS request information section. For additional information on how to extend services or days on a request, review Inpatient Request Extensions (on page 79) Copyright 2014 Medecision, Inc. 216

219 Managing Treatment Updates Request Attachments This section enables you to attach a file to the request (depending on the payer selected). For additional details on how to attach a file to a request see Request Attachments (on page 218). General information In this section you can add or review notes. For additional information on how to add notes to a request, see Notes (on page 266). You can also 1. Click Back to return to the Treatment search summary page. 2. Click New search to return to the Treatment search page. View Patient Clinical Summary or Health Summary 1. To view the patient clinical summary or health summary, click View patient clinical summary or Health Summary (depending on the payer selected and your MCO's configuration) Copyright 2014 Medecision, Inc. 217

220 Managing Treatment Updates Viewing Clinical Documents 1. Click the View clinical documents link to launch the Member clinical documents page (depending on the payer selected). The Member clinical documents page presents a list of the clinical documents available for the member. 2. Click the View link to open the document. Extending a Request 1. To extend an inpatient, other or referral request scroll down to the LOS request information or the Service section of the page and click Extend (depending on the selected payer). The request (inpatient, other or referral) extension entry page displays. 2. Enter the extension data. Click Next step. 3. To submit the data, click Submit. The request extension confirmation page displays. For information on how to complete the extension entry page see the Inpatient Request Extensions (on page 79), the Other Request Extensions or the Referral Request Extensions (on page 131) section of this guide. 4. To return to the Treatment update details page, click Return to treatment search results. 5. Click Back to return to the Treatment update summary page. Request Attachments 1. To attach a file to the request (depending on the payer selected), scroll down to the Request Attachments section of the page and click Browse. The Choose file dialog box displays. 2. Select the file you wish to attach. (Supports PDF, XLS, DOC, JPG and GIF format). 3. Click Open. The file pathway displays in the Attachment field. 4. Enter the name of the document in the Title field. 5. Click Attach. An informational message displays at the top of the page: The file selected has been successfully attached and will be sent to the health plan Copyright 2014 Medecision, Inc. 218

221 Managing Treatment Updates Attached documents which have been confirmed as received by the health plan displays the document name, title and date in the Attached Files field. For more information on how to attach a file to a request, see the Treatment Search Details (on page 257) section of this guide. Treatment Update Search Use the Treatment update search page to search for and display treatment updates for authorized providers in your group. The Treatment Update search returns all treatment updates matching the search criteria you specify including those that have been marked as read if desired. 1. To access the Treatment update search page, click Search on the navigation menu. The Search instructions page displays. 2. Click the Treatment update search link. The Treatment update search entry page displays. Use the Treatment update search page to specify your treatment update search criteria Copyright 2014 Medecision, Inc. 219

222 Managing Treatment Updates 3. In Search for select Updates for submitting providers, Updates for facilities and servicing providers or Updates for Primary Care Physician. Updates for Submitting Providers 1. Enter a Member ID or click Member search to search for a member. (Optional). 2. Select one, multiple providers or all providers from the Authorized provider(s) drop down list to view all of the providers approved by the payer. The selected providers display in the table located under the drop down list Copyright 2014 Medecision, Inc. 220

223 Managing Treatment Updates The providers in the list are providers in your group who have been approved by the payer you have selected for use in treatment search and treatment update search. 3. To remove a provider from the table click on the x link in the Remove column. 4. Scroll down and select the Date range for the treatment updates you want included in your search. 5. Click on the Treatment update type arrow and select the type of treatment updates to include in your search. There are seven treatment update types: Notes added Status changed to approved Status changed to denied Status changed to pend Status changed to void Treatment extended All updates types from selected payer 6. Click inside the Show only unread treatment updates check box to view only treatment updates that have not been read. 7. Click Submit search to initiate the search. The Treatment update summary page displays listing the treatment updates that have met your search criteria. Updates for Facilities and Servicing Providers 1. Enter a Member ID or click Member search to search for a member. (Optional). 2. Select one, multiple providers or all providers from the Authorized provider(s) drop down list to view all of the providers approved by the payer. The selected providers display in the table located under the drop down list. The providers in the list are providers in your group who have been approved by the payer you have selected for use in treatment search and treatment update search. 3. To remove a provider from the table click on the x link in the Remove column. 4. Scroll down and select the Date range for the treatment updates you want included in your search Copyright 2014 Medecision, Inc. 221

224 Managing Treatment Updates 5. Click on the Treatment update type arrow and select the type of treatment updates to include in your search. There are seven treatment update types: Status changed to approved Status changed to denied Status changed to pend Status changed to void New Treatment Treatment extended All updates types from selected payer 6. Click inside the Show only unread treatment updates check box to view only treatment updates that have not been read. 7. Click Submit search to initiate the search. The Treatment update summary page displays listing the treatment updates that have met your search criteria. Updates for Primary Care Physician 1. Enter a Member ID or click Member search to search for a member. (Optional). 2. Select one, multiple providers or all providers from the Authorized provider(s) drop down list to view all of the providers approved by the payer. The selected providers display in the table located under the drop down list. The providers in the list are providers in your group who have been approved by the payer you have selected for use in treatment search and treatment update search. 3. To remove a provider from the table click on the x link in the Remove column. 4. Scroll down and select the Date range for the treatment updates you want included in your search. 5. Click on the Treatment update type arrow and select the type of treatment updates to include in your search. There are seven treatment update types: New Treatment Treatment extended All update types from selected payer Copyright 2014 Medecision, Inc. 222

225 Managing Treatment Updates 6. Click inside the Show only unread treatment updates check box to view only treatment updates that have not been read. 7. Click Submit search to initiate the search. The Treatment update summary page displays listing the treatment updates that have met your search criteria Copyright 2014 Medecision, Inc. 223

226 Chapter 5 Patient Clinical Summary In This Chapter Overview Accessing the Patient Clinical Summary Patient Clinical Summary Report Details Overview The Patient Clinical Summary (PCS) provides you with the ability to view additional information about a patient. Contained within the PCS is a summary of a patient s claims and care management data from the selected payer. Through the Patient Clinical Summary, you are presented with a more complete view of the conditions for which the patient has been treated, monitored services for the patient, the patients' laboratory results, medications that have been filled for the patient and treatment opportunities the provider may want to consider. To view the PCS as a PDF file, you must install the free Adobe Reader application on the computer used to access Aerial iexchange. Accessing the Patient Clinical Summary Depending on the payer you have selected, either the Patient Clinical Summary, the Health Summary, or neither feature will be configured to be available for a member. (For more information about the Health Summary, see Health Summary (on page 229).) In addition, even if you have access to the PCS, the MCO might restrict your access to certain patient information based upon your provider group. If the PCS is enabled and the link for a particular member is available but disabled, you can hover your mouse over the link to view one of the following messages that display: Patient Clinical Summary for member is not available member is not eligible Copyright 2014 Medecision, Inc. 224

227 Patient Clinical Summary Patient Clinical Summary for member is not available access to member restricted by health plan. Patient Clinical Summary for member is not available no recent member activity. Patient Clinical Summary for member is not available at least one of the data sources cannot be accessed at this time. The View patient clinical summary link displays on the following pages: Member Search Result Member Search Details Treatment Search Details Treatment Update Search Details 1. Click the View patient clinical summary link. The Conditions of use displays in a separate window. 2. Read through the usage policy agreement. You must agree to the conditions of use before you can access the PCS Copyright 2014 Medecision, Inc. 225

228 Patient Clinical Summary Each user is only prompted with the Conditions of use page once per browser session per payer. 3. Click I agree to view the report. The Patient Clinical Summary report displays in PDF format in a separate browser window. 4. Click I don t agree to return to the previous page. 5. To print the report click the print icon located on the Adobe Reader Toolbar. 6. To save the report click to a local file directory the save icon located on the toolbar. 7. To close the report click the X located in the top right corner of the page. Patient Clinical Summary Report Details The report is broken down into various sections detailing clinical information regarding the patient. Note: The payer can choose to enable or disable some of the data elements listed below based on configuration settings. Patient Summary Standard elements include: Member Name (Last Name, First Name MI), Member ID, Member Eligibility, Member Gender Code and Member Date of birth. Program and Severity The PCS presents the Program and Severity for each care management program found for the member. The Start date of the program or the Update date, if the associated severity is changed within the program is also presented. Medical Conditions - The Medical Conditions information allows providers to view a history of the member s medical conditions based on claims data. In general, the Medical Conditions section lists member conditions for the past year. However, some conditions may have a start date older than one year when the condition is considered chronic. Conditions are presented as subcategories under the headings "High Severity", "Medium Severity" and "Low Severity" Copyright 2014 Medecision, Inc. 226

229 Patient Clinical Summary Inpatient Facility Admissions The Inpatient Facility Admissions information allows providers to view a history of the member s inpatient admissions based on claims data. The Inpatient Facility Admissions section lists the patient s inpatient admissions for the past year. For each Inpatient Facility Admission presented on the report, the system displays the following data elements: Facility Description Admission Date Discharge Date LOS Days Principal Diagnosis Code and Description Emergency Room Visits The Emergency Room Visits information allows providers to view the total number of ER visits the patient has had in the past year. The number of emergency room visits are displayed in the following format: "Patient has had <N> emergency room visits in the past 12 months". Monitored Services/Diagnostic Services The Monitored Services information allows providers to view a summarized history of the member s services activity based on claims data. For each service on the report the system displays the following: Service, Number of Services, Last service date, Most Recent Servicing Provider and the servicing provider phone number. Laboratory Results This section displays the results of lab tests for the patient. Results are grouped by lab class and by specific test. The test results, test date, and data source are displayed. Where applicable, the test's quantitative results are shown alongside a reference range of results. Medications This section displays the medication class, number of fills, and the Last Fill Date. The display of medication information is configurable at the payer level. Providers Seen The Providers Seen information allows providers to view a summarized history of the member s providers based on claims data. For each provider on the report the system displays the following: the Provider Name, Specialty, Provider Phone Number and the Last Service Date. Clinical Flags The Clinical Flags section is comprised of the following three subsections. Case Findings Description of each returned patient finding Copyright 2014 Medecision, Inc. 227

230 Patient Clinical Summary Treatment Opportunities Description of each returned treatment opportunity. Preventative Health and Wellness Description of each returned preventative health and wellness intervention. The Clinical Flags allows providers to view suggested interventions to benefit the member based on evidence based medicine and best practices. Health Status Measure The Health Status Measure gives providers a quick way to identify whether a member should be considered a complex/high-risk patient (high resource burden) within a 12 month period. The Health Status Measure for a member will range from one to ten, with higher numbers indicating higher complexity and risk. The value is displayed in the following format: "The Health Status Measure is N for this patient. This measure indicated risk in the next 12 months, where 1 is low 10 is high". Active Care Management Summary For each active care management the following group of information is presented (grouped by problem code): Problem, Open Date, Product Description, Program Description and Goal descriptions. Closed Care Management Summary For each closed care management the following group of information is presented (grouped by problem code): Problem, Open Date, Closed Date, Production Description and Program Description, Goal Descriptions and Goal outcome Descriptions Copyright 2014 Medecision, Inc. 228

231 Chapter 6 Health Summary In This Chapter Overview Accessing the Health Summary Health Summary Report Details Navigating the Report Overview The Health Summary provides you with the ability to view additional personal and clinical information about a patient. Contained within the Health Summary is a record of a patient s claims and care management data from the selected payer. Through the Health Summary, you are presented with a more complete view of the conditions for which the patient has been treated, monitored services for the patient, the patient's laboratory results, medications that have been filled for the patient, and other information providers may find useful. Accessing the Health Summary Depending on the payer you have selected, either the Health Summary, the Patient Clinical Summary, or neither feature will be configured to be available for a member. (For more information about the Patient Clinical Summary, see the Patient Clinical Summary (on page 224).) Note: Health Summary is only compatible with Internet Explorer 8.0 and Copyright 2014 Medecision, Inc. 229

232 Health Summary When the Health Summary is enabled for a payer, access restrictions for the report also depend on your provider group. MCOs can restrict a provider group's access to information in the Health Summary designated as sensitive, as well as information that is related to behavioral health. Note: The Health Summary is composed of data from the claims filter, which sends it to Analytics and then to the Aerial Care Management Hub. When enabled, the View health summary link displays on the following pages: Member Search Result Member Search Details Treatment Search Details Treatment Update Search Details To view the Health Summary for a patient, click the View health summary link. The Health Summary opens in a new web browser window. Health Summary Report Details The report is broken down into various sections detailing clinical information regarding the patient. When you access the Health Summary, the following available data displays: Copyright 2014 Medecision, Inc. 230

233 Health Summary Health Summary Header Contains the patient's name, ID, date of birth (and age), gender, client code, plan, group ID, line of business, and eligibility dates. You can click on the patient's name to view additional personal information about the patient, including subscriber ID, ethnicity, home address, address, and home, work, and mobile phone numbers. Attributed Provider Contains the provider responsible for the patient's cost and quality of care, determined by analysis of the patient's claim data. Information displayed here includes the provider's name, specialty, provider group name, street address, phone number, provider ID, alternative ID, provider NPI, and group ID. Medical Conditions Contains chronic and acute medical conditions, start and end dates of episodes, and severity levels. Because chronic conditions are continuous, they do not display an end date. Additionally, all chronic conditions are displayed regardless of the reporting range selected. All conditions are sorted alphabetically by condition name. Repeat occurrences of the same condition are listed in reverse chronological order. Medications Summary This section displays medication information for the patient, including medication name, route, fill date and number, amount dispensed, duration of prescription, cost, member payment, and prescriber. Information is grouped by medication name and sorted by fill date. You can view detailed information about a prescriber by clicking the prescriber name. The information in this section can be viewed in either a graph or table view. Clinical Indicators This section includes patient findings, and gaps in care either related to a condition or not. Care Management Summary This section includes plan of care data grouped by program start date and includes program goals, goal start dates and descriptions, as well as interventions and descriptions. Your organization determines the types of programs (case management or wellness and disease management or both) from which to retrieve the plan of care data and the date range to be included in the report. All open programs are displayed by earliest start date. If a program has goals and interventions, the goals are sorted by date and the interventions by description. Inpatient Admissions This section displays inpatient admissions for the patient, listed in reverse chronological order. It includes the facility, principal diagnosis code, admission date, discharge date, and LOS days for all inpatient stays for the patient within the specified reporting period. You can view additional details about a facility by clicking the facility name Copyright 2014 Medecision, Inc. 231

234 Health Summary Emergency Department This section displays the emergency room visits for the patient during the specified reporting period, listed in reverse chronological order. It includes the facility name, diagnosis/complaint, and date of service. You can view additional details about a facility by clicking the facility name. Services This section contains all services as well as service codes and descriptions for procedures, tests, and visits. It also includes the number of services, last date of service, and the service provider. Services are grouped by service type, with each group able to be expanded or collapsed. You can view additional details about a provider by clicking the provider name. Laboratory Results This section displays the results of lab tests for the patient. It includes results selected by your organization and may not reflect all available laboratory data. Results are grouped by lab class and by specific test. The test results, abnormal flags, units, reference high, reference low, test date, and data source, and ordering provider are displayed. You can view additional details about a provider by clicking the provider name. Provider Visits This section includes information about all providers the patient has seen during the specified reporting period. Information displayed includes the provider name, specialty, phone number and most recent service date. Information in this section can be viewed in either a graph or table view. You can view additional details about a provider by clicking the provider name. Each section header except the Care Management Summary displays the process date. The process date indicates the process end date for the latest payer claims in the source information for the section Copyright 2014 Medecision, Inc. 232

235 Health Summary Navigating the Report After the Health Summary is generated and displayed, you can click the arrow to the left of a section to expand the section and view the information it contains. Click the arrow again to collapse the section. By default, the Health Summary reporting range is 12 months from the current date. You can change the reporting range to view information up to 27 months in the past, in 12-month time increments. To change the date range on the patient's Health Summary report, click the drop-down list on either the months or years to set a new date range. When you change the date range from the drop-down list, the reporting range start and end dates automatically recalculate and the report is regenerated based on the new reporting range Copyright 2014 Medecision, Inc. 233

236 Health Summary Printing a PDF Report Click the PDF icon below the Health Summary header to print a PDF copy of the report. When the Health Summary is printed as a PDF file, each section is expanded, and all available information is displayed on the report Copyright 2014 Medecision, Inc. 234

237 Chapter 7 Performing Searches In This Chapter Overview Member Search View Existing Requests Treatment Search Notes Provider Search Accessing Provider Search from the Navigation Menu Diagnosis Search Performing a Diagnosis Search Procedure Search Performing a Procedure Search Overview Aerial iexchange enables you to perform several types of searches that help to expedite routine processes. After you perform any search, you are returned to the page and field where you initiated the search. Through Aerial iexchange, you can perform the following types of searches: Member Search: You can use Member search to search by member Id or, depending on the payer you selected, by last name/date of birth to view detailed member information. The Patient Clinical Summary and Clinical Documents can be accessed from the Member search result page. For more information on how to perform a member search, see the Member Search (on page 236) section of this guide Copyright 2014 Medecision, Inc. 235

238 Performing Searches Treatment Search: Treatment search is used to search by Treatment Range, Member Id, Request Id or Clinical Review for treatment information. After performing a Treatment search you may choose based on the payer to extend a service. The Patient Clinical Summary and Clinical Documents can be accessed from the Treatment search details page. For more information on how to perform a treatment search, see the Treatment Search (on page 250) section of this guide. Provider Search: You can use Provider search to search by provider Id or provider name. For more information on how to perform a provider search, see the Provider Search (on page 269) section of this guide. Diagnosis Search: Diagnosis search is used to search for a diagnosis that is not in your diagnosis short list, that you do not have the ICD9 or ICD10 code for, or you know the code but are not sure of the description. You can perform a diagnosis search from any of the request entry pages. ICD9 or ICD10 codes availability depend on the payer selected. Procedure Search: Procedure search allows you to search for a procedure that is not in your procedure short list, that you do not have the ICD9, ICD10, CPT or HCPCS code for, or you know the code but are not sure of the description. You can perform a procedure search from any of the request entry pages. The procedure classification codes available depend on the payer selected. Treatment Update Search: You can use Treatment update search to search for updates for your provider group made to existing treatments. Treatment updates inform you when the payer has changed the status of or has added notes to an inpatient, other, or referral request submitted by a submitting provider updates for a primary care physician, facility or servicing provider in your provider group. The Patient Clinical Summary and Clinical Documents can be accessed from the Treatment update details page. For more information on how to perform a treatment update search see the Treatment Update Search section of this guide. Member Search Member search allows you to search for (and in some cases select) a particular member and verify the member s eligibility Copyright 2014 Medecision, Inc. 236

239 Performing Searches Member Search from Request Entry Page If you are not sure of the member's ID you can perform a member search on any of the pages listed below by clicking the Member search button. Once the Member search page displays you can search by either Member ID or Last name/date of birth. Depending on the payer selected you can also create a new member. You can perform a member search directly from the following Aerial iexchange entry pages: New Inpatient request New inpatient behavioral health Extend inpatient request Inpatient clinical review New other request New other behavioral health request Extend other request Add other services Other clinical review New prior auth request New referral request New referral behavioral health request Extend referral request Referral clinical review Treatment search Treatment Update search Copyright 2014 Medecision, Inc. 237

240 Performing Searches The Inpatient entry request page is shown as an example Copyright 2014 Medecision, Inc. 238

241 Performing Searches 1. Click Member search. The Member search page displays. 2. Enter the search criteria required in either the Search by member ID or Search by last name and date of birth section. 3. Click Submit search Copyright 2014 Medecision, Inc. 239

242 Performing Searches The same steps apply when performing a Member search from any request entry page or a Treatment search page. The ability to perform a member search using a member ID on the request entry page depends on whether the functionality is made available by the payer. If the functionality is not available the message "You must search for a member " displays and the Member ID text field is unavailable. If the Member search results are an exact match, you are presented with the Member search summary page. If the search does not produce results, you are presented with the Member Search page along with an Informational message stating the member was not found Copyright 2014 Medecision, Inc. 240

243 Performing Searches Access Member Search from Navigation Menu 1. Click Search on the Aerial iexchange Navigation menu. The Search instructions page displays. 2. Click Member search. The Member search page displays. Search by Member ID or Member last name/date of birth. It is recommended that you have this information before performing the search Copyright 2014 Medecision, Inc. 241

244 Performing Searches Access Member Search from Request Entry or Treatment Search pages You can initiate a member search from any of the Medical or Behavioral Health request entry pages. Search by Member ID or, depending on the payer you have selected, by Last name/date of birth. You can also create a temporary member from any entry page using the member search functionality. For additional information on how to create a new member see the Create New Member section of this guide. 1. For example, on the Navigation menu on the Starting point page, click Inpatient. 2. Click the New inpatient request link. The Inpatient request entry page displays. 3. Click Member search. The Member search page displays Copyright 2014 Medecision, Inc. 242

245 Performing Searches Search by Member ID 1. In Section A enter a Member ID. 2. Enter the member s Date of birth in MM/DD/YYYY format. (optional) 3. Enter the member s First Name. (optional) Completion of the Member ID field is mandatory. The Date of birth and First name fields are optional. However, you may be instructed to value the Date of birth and First name field if the member search you perform returns more than one member record matching the search criteria you entered. 4. Click Submit search to initiate the search. If a Member is found matching the search criteria the Member search result page displays. For additional information on the Member search result page see the Member Search Result section in this guide. Search by Member Last Name and Birth Date Copyright 2014 Medecision, Inc. 243

246 Performing Searches 1. In Section B enter the member Last name. 2. Enter the member Date of birth. 3. Enter the member First name. (optional) 4. Click Submit search to initiate the search. 5. If a Member is found matching the search criteria the Member search result page displays. Member Search Result Aerial iexchange displays the results of your search on the Member search result page. If you perform a search for a Member based on a Member ID other than the primary Aerial iexchange Member ID, the primary Aerial iexchange Member ID displays on the Member Details page. When the search is returned, the Aerial iexchange primary Member ID displays in the Member ID field, and the alternate ID displays in the Member Search Results page for reference Copyright 2014 Medecision, Inc. 244

247 Performing Searches Note: To search on a Member using an alternate Member ID, Aerial Care Management and Aerial iexchange must be configured to allow searching on other member IDs. The Member search result page displays a summary of the member information for each member record returned. 1. Click Select (if available and enabled) to select the appropriate member. If the Select button is disabled you will need to view the existing requests for the member prior to being able to select the member. (Review the note shown below). 2. Click the View Details link to display the Member search result details page containing additional information about the member. For additional information on View Details see the View Member Details section of this guide. 3. Click the View patient clinical summary or the View Health Summary link to view additional information about the patient and also care management information (depending on the payer selected). 4. Click the View clinical documents link to view the clinical documents available for the member (depending on the payer selected) Copyright 2014 Medecision, Inc. 245

248 Performing Searches 5. Click View existing requests (if available) to review the member s existing requests containing recent activity. For additional information on View existing requests see the View Existing Requests section of this guide. Note: Depending on the payer settings, you may be required to View existing requests prior to being permitted to select the member for use in a New Request. This is to prevent duplicate requests from being sent to a payer. The message "You must view existing requests for a member prior to selecting a member" will display. If this message displays complete the following steps to select the member: 6. Click the View existing requests link. The Treatment search summary page displays. Verify that a request for the new service has not already been entered for the member. 7. Click Return to member search. 8. Click New search to search for another member. View Member Details When you select the View Details link associated with a member record on the Member search result page, the Member search result details page displays. If you perform a search for a Member based on a Member ID other than the primary Aerial iexchange Member ID, the primary Aerial iexchange Member ID displays on the Member Details page. When the search is returned, the Aerial iexchange primary Member ID displays in the Member ID field, and the alternate ID displays in the Member Search Results page for reference. Note: To search on a Member using an alternate Member ID, Aerial Care Management and Aerial iexchange must be configured to allow searching on other member IDs Copyright 2014 Medecision, Inc. 246

249 Performing Searches This page provides detailed information about the member such as demographic and enrollment information. The following functions are available to you on the Member search result details page: Click the View patient clinical summary or the View Health Summary link to view additional information about the patient and also care management information (depending on the payer selected) Copyright 2014 Medecision, Inc. 247

250 Performing Searches Click the View clinical documents link to access the Member clinical documents page (depending on the payer selected). The Member clinical documents page presents a list of the clinical documents available for the member. Click the View link to open the document. Click View existing requests to view the member s existing requests. Click Back to return to the Member search result page. Click New Search to return to the Member search page to search for a different member. View Existing Requests When you choose View existing requests for a member, a list of requests containing recent activity displays. The payer you have selected defines the date range that is used in retrieving the requests. Therefore, there may be requests that exist for the member that are not returned (requests that do not have recent activity). For additional information on how to view requests that do not have recent activity, see the Treatment Search section of this guide. Depending on the payer you have selected, viewing of existing requests may be mandatory or optional. Viewing of existing requests is always optional when you have reached the Member search result page or the Member search details page through a Stand-alone Member search. The View existing requests link does not display when Member search is done from within Treatment Search but does display when Member Search is done from within Treatment Update Search Copyright 2014 Medecision, Inc. 248

251 Performing Searches 1. Click View existing requests. The Treatment search summary page displays. 2. Click View all to view all requests associated with this member. 3. Click View open (default) to view only open requests. 4. Click next to view additional pages. 5. Click Return to member search to return to the Member search page. Treatment Search Summary Page The Treatment search summary includes the following: Header: Displays the Member name and Member ID Copyright 2014 Medecision, Inc. 249

252 Performing Searches Request ID: This column displays the identification number of the request and the View details link which gives access to the Treatment search details page. For more information on the Treatment search details page see the Treatment Search Details (on page 257) section of this guide. Request type: This column displays the type of request. Primary diagnosis: This column displays the primary diagnosis code and description. Both ICD9 and ICD10 codes display depending on the payer selected. Treatment: This column lists the type of service requested. Treatment dates: This information in this column vary by payer. This column displays either the Treatment start date and Treatment end date for the service or Scheduled treatment date associated with a Length of Stay (Start date only). Last outcome: This column displays the status (Approved, Pend, Void, or Denied) as well as the reason why the status was assigned. For example: "PA Review Required/PEND". Confirmed treatment end date: This column display the confirmed end date of treatment. Treatment Search Treatment search allows you to search for existing referral requests and inpatient and other requests for a member associated with an authorized provider in your group. This includes referring providers, servicing providers, member's primary care physician providers (depending on payer selected) and submitting providers. You can search using the Member ID, Treatment range, Request ID or depending on the selected payer, by Clinical review. Access Treatment Search from Navigation Menu 1. Click Search on the Aerial iexchange Navigation menu. The Search instructions page displays. Treatment search functionality may or may not be available to you depending on the payer you have selected Copyright 2014 Medecision, Inc. 250

253 Performing Searches 2. Click Treatment search. The Treatment search entry page displays. Searching for a Treatment from the Treatment Search Page In Section 1 Select a search type, choose one of the available search categories and enter the required information for that search type in Section 2 Enter search criteria. There are 4 types available: Member ID Request ID Treatment Range Clinical Review Copyright 2014 Medecision, Inc. 251

254 Performing Searches Member ID Search 1. Enter the Member ID. If you are not sure of the member ID perform a member search. For more information on how to perform a member search see the Member Search (on page 236) section of this guide. 2. Enter the Start and End date to search for treatments performed in a specific date range. The start and end date default is based on the payer selected. 3. Click the Request type drop down arrow and select a request type. There are four types: Show Inpatient, Other, Prior Auth and Referral treatments Show Inpatient treatments only Show Other and Prior Auth treatments only Show Referral treatments only 4. Click on the radio button to filter the search to return All requests or Open requests. The default is All requests. 5. From the Authorized provider section drop down, select one or more providers. The selected providers are added to the provider table. All providers is the default selection. 6. To remove a provider from the table, click the x in the Remove column. 7. Click Submit search to initiate the search. The Treatment search summary page displays. Treatment Range 1. Enter the Start and End Date to search for treatments performed in a specific date range. The start and end date default is based on the payer selected. 2. Click the Request type drop down arrow and select a request type. There are full types: Show Inpatient, Other, Prior Auth and Referral treatments Show Inpatient treatments only Show Other and Prior Auth treatments only Show Referral treatments only Copyright 2014 Medecision, Inc. 252

255 Performing Searches 3. Click on the radio button to filter the search to return All requests or Open requests. 4. From the Authorized provider drop down, select one or more providers. The selected providers are added to the provider table. 5. To remove a provider from the table, click the x in the Remove column. 6. Click Submit search to initiate the search. The Treatment search summary page displays. Request ID 1. Enter the Request ID. 2. From the Authorized provider section drop down, select the provider associated with the request. The selected provider is added to the provider table. 3. To remove a provider from the table, click the x in the Remove column. 4. Click Submit search to initiate the search. The Treatment search details page displays. Clinical Review 1. Select Clinical Review from the Search type drop down. 2. Enter the Member ID. If you are not sure of the member Id perform a member search. For more information on how to perform a member search see the Member Search (on page 236) section of this guide. 3. Select a Date range from the drop down for the treatment search. 4. Click the Request type drop down arrow and select a request type. There are four types: Show Inpatient, Other, Prior Auth and Referral treatments Show Inpatient treatments only Show Other and Prior Auth treatments only Show Referral treatments only Copyright 2014 Medecision, Inc. 253

256 Performing Searches 5. From the Authorized provider section drop down, select one or more providers. The selected providers are added to the provider table. All providers is the default selection. 6. To remove a provider from the table, click the x in the Remove column. 7. Click Submit search to initiate the search. The Treatment search summary page displays Copyright 2014 Medecision, Inc. 254

257 Performing Searches Treatment Search Summary The Treatment search results list displays the following standard information: Header: Displays the Member Name and Member ID. Request ID: This column displays the identification number of the request and the View details link which gives access to the Treatment search details page. For more information on the Treatment search details page see the Treatment Search Details (on page 257) section of this guide Copyright 2014 Medecision, Inc. 255

258 Performing Searches Request type: This column displays the type of request. Primary diagnosis: This column displays the primary diagnosis code and description. Both ICD9 and ICD10 codes display depending on the payer selected. Treatment: This column lists the type of service and the description. The procedure coding classification values (ICD9, ICD10, HCPCS, or CPT) displayed depends on the payer selected. Treatment dates: This information in this column varies by payer. This column displays either the Treatment start date and Treatment end date for the service or Scheduled treatment date associated with a Length of Stay (Start date only). Dates for voided services are not shown. Last outcome: This column displays the status (Approved, Pend, Void, or Denied) as well as the reason why the status was assigned. For example: "PA Review Required/PEND". Confirmed treatment end date: This column display the confirmed end date of treatment. Other options available on the page include: 1. Click View all to view all requests for members associated with this provider. 2. Click View open (default) to view only open requests. 3. If there are additional pages, click next to view those pages. 4. Click the Print friendly version link (located at the top of the page) to generate a printable version of the summary page. Once the print friendly version displays, click Print this page to print the page. Click Close to return to the Treatment search summary page. 5. Click New search to perform a new treatment search. Multiple Services Other requests entered with multiple treatments are displayed on the Treatment search summary page listing each service associated with the request with the least recent service date first. Inpatient requests with multiple scheduled treatments associated with a length of stay are displayed on the Treatment search summary page listing each scheduled treatment with the least recent scheduled date first. Referral requests can not have more than one service Copyright 2014 Medecision, Inc. 256

259 Performing Searches Treatment Search Details To select a request, click View details in the Request ID column of the Treatment search summary page. The Treatment search details page displays. Note: The information displayed on this page varies by payer and by request type. The LOS start/end date and Service sections are not displayed for other and referral requests. Instead, a different Service section displays the Service, Code, Start/End date, Units and Status columns. The Add services button also may display for other requests only depending on the payer selected. For additional information on adding services see the Additional other services entry section. Summary/Clinical review For inpatient requests this section includes the following fields: LOS start/end date Dates for voided services are not shown. Days the number of days requested Status the status of the length of stay requested Clinical review The clinical review link displays if the length of stay requires the completion of a review. For other and referral requests this section does not display. If no clinical review information is required, the heading is just Summary and the Clinical review column is not displayed. For other and referral requests the Summary/Clinical review section displays the following fields: Service the service number Code the procedure code Start/end date the procedure's scheduled date Units displays depending on the payer selected Status displays depending on the payer selected Copyright 2014 Medecision, Inc. 257

260 Performing Searches Clinical review the clinical review link displays if the service requires the completion of a review Copyright 2014 Medecision, Inc. 258

261 Performing Searches Inpatient request information Copyright 2014 Medecision, Inc. 259

262 Performing Searches Copyright 2014 Medecision, Inc. 260

263 Performing Searches The Inpatient request information section contains the Member, Submitting provider, Facility, Attending physician, the LOS request information and the Service information. You can add additional days and services by clicking Extend. For additional information on how to extend services or days on a request, see the Inpatient Request Extensions (on page 79) section of this guide. Request Attachments This section enables the user to attach a file to the request depending on the payer selected. For additional details on how to attach a file to a request, see the Request Attachments (on page 218) section of this guide. General information In this section you can add or review notes. For additional information on how to add notes to a request, see Notes (on page 266). You can also: Click Back to return to the Treatment search summary page. Click New search to return to the Treatment search page Copyright 2014 Medecision, Inc. 261

264 Performing Searches View Patient Clinical Summary or Health Summary 1. To view the patient clinical summary or health summary, click View patient clinical summary or Health Summary (depending on the payer selected and your MCO's configuration). View Clinical documents 1. Click the View clinical documents link to launch the Member clinical documents page (depending on the payer selected). The Member clinical documents page presents a list of the clinical documents available for the member. 2. Click the View link to open the document. Prior Auth 1. To view the details of a prior auth request, click the View details link under the request ID on the Treatment search summary page Copyright 2014 Medecision, Inc. 262

265 Performing Searches The Treatment search details page displays. You can attach documents and add notes on this page. The prior auth request cannot be extended Copyright 2014 Medecision, Inc. 263

266 Performing Searches Extend a Request 1. To access the request extension entry page, click Extend located in the LOS request information, Principal service or Service section of the Treatment search details page. For additional information on request extensions see the Inpatient Request Extensions (on page 79), Other Request Extensions or the Referral Request Extensions (on page 131) sections of this guide. Request Attachments 1. To attach a file to the request (depending on the payer selected), scroll down to the Request Attachments section of the page and click Browse. The Choose file dialog box displays. 2. Select the file you wish to attach. (Supports PDF, XLS, DOC, JPG and GIF format). 3. Click Open. The file pathway displays in the Attachment field. 4. Enter the name of the document in the Title field. 5. Click Attach. An informational message displays at the top of the page: The file selected has been successfully attached and will be sent to the health plan. Attached documents which have been confirmed as received by the health plan displays the document name, title and date in the Attached Files field. For more information on how to attach a file to a request, see the Treatment Search Details (on page 257) section of this guide. Add to Notes 1. Click the Add to notes link located in the General information section of the page. For additional information on how to add notes see the Notes (on page 266) section of this guide. 2. Click View all notes (if available) to view all of the notes associated with the selected request. The Request Notes window displays. 3. Click next or previous to page through additional notes. 4. Click Close to close the Request Notes window and return to the Treatment search details page Copyright 2014 Medecision, Inc. 264

267 Performing Searches Add services 1. Click Add services located in the Summary/Clinical review section of the Treatment search details page, to enter additional services to the request. The Additional other services entry page displays. For information on how to add services see the Additional other services entry section of this guide. Enter Discharge Date and Disposition 1. From the Treatment Search Details page, select Enter discharge date and disposition from the Request actions drop-down list to enter the discharge date and disposition of the member (depending on the payer selected). The Enter discharge date and disposition page displays. Discharge date and disposition can be entered for inpatient, other, referral, and prior authorization medical and behavioral health requests. The Discharge date default is the latest outcome end date. 2. Enter the discharge date Copyright 2014 Medecision, Inc. 265

268 Performing Searches 3. Click the Discharge disposition drop-down arrow and select the destination for the member after discharge. The selections on the list are dispositions from Aerial Care Management. 4. Click Save. The Treat Search Details page reloads with the following message: Informational - Discharge date and disposition have been successfully saved. After the discharge date and disposition have been saved, the Enter discharge date and disposition link is disabled and the request cannot be extended. You cannot complete a clinical review after the discharge date is entered on a request. Reopen a Request Keep the following in mind while reopening a request: Reopening a request is available for inpatient, other, referral, and prior authorization medical and behavioral health requests. If your MCO has configured it, you are able to reopen a closed request. If your MCO has configured a time period that has lapsed for a request, then you are not able to reopen the request. You cannot reopen a request from the Treatment Update Search Details page, only from the Treatment Search Details page. 1. To reopen a request, click View details in the Request ID column of the Treatment search summary page. The Treatment search details page displays. 2. Select Reopen request from the Request actions drop-down list on the Treatment search details page. The page reloads with following message displayed at the top of the page: Informational - The request has been reopened. Notes If the system is configured to allow the Add Notes functionality for the selected payer additional notes can be added to an existing request Copyright 2014 Medecision, Inc. 266

269 Performing Searches Adding Notes If the system is configured to allow the Add Notes functionality for the selected payer additional notes can be added to an existing request. To add notes: 1. On the Treatment search details page of the selected request, scroll down to the General information section. 2. Click the Add to notes link to add notes to the Reviewer Notes or Physician Advisor Notes fields. The Add to Notes page displays. The note fields available depend on the payer selected. The names of the fields are configurable by the payer. 3. In the Add request notes, enter any additional notes in the Reviewer Notes section. 4. Click Save to save the updates. The Treatment search details page displays with an informational message stating "Request # has been updated." Copyright 2014 Medecision, Inc. 267

270 Performing Searches General Information 1. To view the notes, scroll down to the General information section of the page. The note added displays in the Reviewer Notes field. 2. To enter additional notes repeat steps 2 through Click the View all notes link located in the General Information section to review all of the comments added to the request. The Request Notes window displays. The Request Notes window displays. Request Notes 1. Click next or previous to page through all of the notes associated with the request. 2. Click Close to return to the Treatment search details page. 3. To return to the Treatment search summary page, click Back Copyright 2014 Medecision, Inc. 268

271 Performing Searches 4. To return to the Treatment search page, click New search. Provider Search Provider search allows you to search for a particular provider based on search type and provider type. You can perform a provider search from any of the request entry pages. Accessing Provider Search from the Navigation Menu 1. Click Search on the Aerial iexchange Navigation menu. The Search instructions page displays. 2. Click Provider search. The Provider search page displays. 3. Click the Search type drop down arrow. The Search type allows you to search for a provider using three different types of search criteria. The three search types for name search: Provider Name Provider MCO ID Copyright 2014 Medecision, Inc. 269

272 Performing Searches National Provider ID 4. Click the Provider type drop-down arrow and select a provider type. The Provider type allows you to search for a provider using three different types of search criteria. The provider types and their specific criteria are: Practitioner Enter the Practitioner last name. (Practitioner first name is optional) Facility Enter the Facility name. Group Practice Enter the Group practice name. A fourth provider type of All is available when the Search type selected is Provider MCO ID or National Provider ID. 5. Click Clear form to reset the form and re-enter search criteria. 6. Click Submit search. The Provider search result page displays. The Provider search result page lists the providers meeting your search criteria Copyright 2014 Medecision, Inc. 270

273 Performing Searches 7. If the search results lists multiple providers, click the next link which is located at the top of the page (not shown) to view the next set of providers. Click previous to view the prior set of providers. 8. Click New search to search for a different provider. Depending on the payer selected, only providers with an NPI is returned. Diagnosis Search Diagnosis search allows you to search for a diagnosis that is not in your diagnosis short list defined for your provider group that you do not have the diagnosis code for, or you know the code but are not sure of the description. Depending on the payer selected you may have the ability to select either a ICD9 or ICD10 diagnosis code on the initial inpatient, other, referral and prior authorization request entry pages Copyright 2014 Medecision, Inc. 271

274 Performing Searches Performing a Diagnosis Search 1. Click Diagnosis search on any of the request entry pages. The Diagnosis Search page displays. You can perform one of the following steps. 2. Depending on the payer selected, you can select the code version (ICD9 or ICD10). 3. In Section A enter a diagnosis description. 4. In Section B enter a diagnosis code. You can enter a ICD9 or a ICD10 diagnosis code Copyright 2014 Medecision, Inc. 272

275 Performing Searches 5. Once the search criteria is entered, click Search. If the diagnosis you entered has more than one possible definition, the Search result page displays with all possible definitions of the diagnosis displayed. 6. Click Select next to the appropriate diagnosis definition. Click New Search to start a new search. Click Cancel to end your search Copyright 2014 Medecision, Inc. 273

276 Performing Searches 7. If you click Select one of the offered definitions, the Diagnosis Search page redisplays. If more than one diagnosis is selected, the system automatically lists the first diagnosis as the primary diagnosis. Click inside the radio button to set the diagnosis as the primary diagnosis. 8. Click Delete to remove the diagnosis and perform another search. 9. Click Cancel. The message "You are about to cancel your current transaction and lose any entered data. Continue?" Click OK to continue to cancel the transaction and return to the request entry page. Click Cancel to return to the Diagnosis Search page. 10. Click Save to add the diagnosis to the request. The request entry page displays with the diagnosis code and description entered. Procedure Search Procedure search allows you to search for a procedure that is not in your procedure short list defined for your provider group, that you do not have the ICD9, ICD10, CPT or HCPCS code (depending on which procedure coding is supported by the selected payer) for, or you know the code but are not sure of the description. You can perform a Procedure search from any of the request entry pages Copyright 2014 Medecision, Inc. 274

277 Performing Searches Performing a Procedure Search 1. Click Procedure search on any of the request entry pages. The Procedure Search page displays. You can perform one of the following steps. 2. Depending on the payer selected, you can select the code version (ICD9, ICD10, CPT or HCPCS). 3. In Section A enter a procedure description. 4. In Section B enter a procedure code. 5. Once the search criteria is entered, click Search. If the procedure you entered has more than one possible definition, the Search result page displays with all possible definitions of the procedure displayed Copyright 2014 Medecision, Inc. 275

278 Performing Searches 6. Click Select next to the appropriate procedure definition. Click New Search to start a new search. Click Cancel to end your search Copyright 2014 Medecision, Inc. 276

279 Performing Searches If you select one of the offered definitions, the Procedure Search displays listing the procedures selected. 7. Click Delete to remove the procedure and perform another search.. 8. Click Cancel. The message "You are about to cancel your current transaction and lose any entered data. Continue?" Click OK to continue to cancel the transaction and return to the request entry page. Click Cancel to return to the Procedure Search page. 9. Click Save to add the procedure to the request. The request entry page displays with the procedure code and description entered Copyright 2014 Medecision, Inc. 277