North Carolina Medicaid ProviderConnect User Guide Community Support

Transcription

1 North Carolina Medicaid ProviderConnect User Guide Community Support

2 About This Guide This ProviderConnect User s Guide is specific to North Carolina Medicaid (NC Medicaid). There are several links and functions contained on the ProviderConnect homepage and throughout the software that are not relevant to NC Medicaid. This User s Guide addresses only the links and functions relevant or applicable to NC Medicaid. Links and/or functions viewable on various ProviderConnect screens that are not included in this User s Guide indicate that such links and/or functions are not relevant to NC Medicaid and should not be used. 2

3 Table of Contents 1 INTRODUCTION... 4 PROVIDERCONNECT OVERVIEW... 4 COURSE OBJECTIVES... 4 CONTACT INFORMATION PROVIDERCONNECT LOG ON... 5 ACCESS PROVIDERCONNECT... 5 NEW USER REGISTRATION 6 LOG ON... 8 ACCESS INFORMATION WITHOUT LOGGING ON PROVIDERCONNECT NAVIGATION MAIN MENU NAVIGATION BAR YOUR MESSAGE CENTER USE NEXT AND BACK BUTTONS MEMBER INFORMATION SEARCH MEMBER DEMOGRAPHICS TAB VIEW MEMBER AUTHORIZATIONS View Authorization Letter View Authorization Details Auth Summary Tab...16 Auth Details Tab...17 ENTER AUTH REQUEST AUTHORIZATION LISTING ENTER AN AUTHORIZATION (RFS) SEARCH A MEMBER REVIEW DEMOGRAPHICS CAPTURE PROVIDER ENTER REQUESTED SERVICES LEVEL OF SERVICE INPATIENT/HLOC/SPECIALTY MY ONLINE PROFILE NETWORK SPECIFIC INFORMATION

4 1 Introduction ProviderConnect Overview ProviderConnect is an online system that gives providers an easy-to-use application for completing everyday service requests. This system will allow users to access information 24 hours per day/seven days per week. Providers will be able to use ProviderConnect to: Submit Community Support authorization requests View authorizations and print authorization letters Attach documents NC Medicaid providers can NOT use ProviderConnect to: Verify eligibility and/or benefits of consumers Submit a claim or check claim status Change provider specific information currently in the Valueoptions system, such as provider address Each user must have a valid ValueOptions Provider ID. Course Objectives After successfully completing the ProviderConnect course, the General User should be able to: Understand the basic navigational system flow Access and register a provider Search member information Enter an authorization request Contact Information For assistance with any technical problems (such as connecting to or accessing the site) please call our e-support Help Line at during business hours Monday through Friday 8AM - 6PM ET or you can an Applications Support Specialist at e- SupportServices@valueoptions.com 4

5 2 ProviderConnect Log On ProviderConnect is a web-based application that can be accessed from the ValueOptions web site. Access ProviderConnect To access ProviderConnect: 1. Enter the URL in the web browser. 2. Click on the Providers button. Figure 1: ProviderConnect home page The ProviderConnect home page will display. 5

6 New User Registration New users must register to access ProviderConnect. 1. Click on Register. Figure 2: New User The Provider Online Services Registration screen will display. 2. Fill out the fields. Note: The fields with a red asterisk are required. 3. Enter the provider/agency name in the Last Name field exactly as it is registered with North Carolina Medicaid. 4. Enter the name of the person to contact at the office in the Contact Name field. 5. Enter the provider number in the Provider ID field. Your provider number for NC Medicaid will be your Medicaid billing number plus alpha suffix. If you have multiple sites and services contact the Helpdesk ( ) to set up a Group Practice account versus having to register each site and service. Enter the nine-digit Federal ID number or Social Security number in the Tax ID field. 6. Enter the provider s primary address in the Primary Address field. Note: The address must be in an abc@xyz.com format. 7. Enter the same address in the Verify Primary Address field. 8. Enter a ten-digit phone number without dashes in the Phone Number field. 9. Enter a ten-digit number without dashes in the Fax Number field. 6

7 Figure 3: New User Registration Screen A password must be created on the same Provider Online Services Registration screen. To create a password: 1. Enter a password in the Select a Password field. Passwords: Must be between 8-10 characters in length May contain numbers and uppercase letters Cannot contain lowercase letters Cannot contain spaces Are case sensitive 2. Enter the same password in the Confirm New Password field. 3. Create a question in the Password Reminder field. 4. Enter the answer to the question in the Password Reminder Answer field. 5. Click Submit. 7

8 Figure 4: Create Password Log On To log on to ProviderConnect: 1. Click Log In. Figure 5: Click Log In 2. Enter the user ID and password. 3. Click Log In. 8

9 Figure 6: Please Log In Screen 4. Click Yes on the User Agreement Page. Figure 7: User Agreement Page Access Information Without Logging On Providers can access information without logging on to ProviderConnect. Nine links are located on the left side of the ProviderConnect home page, two of which are relevant to NC Medicaid. Enables the user to return to the ProviderConnect home page. Provides users with administrative and clinical forms specific to NC Medicaid, training documents for ProviderConnect, and other various resources and links to relevant websites. 9

10 3 ProviderConnect Navigation Users have two options to navigate ProviderConnect. The first option is to use the hyperlinks on the Main Menu screen. The second option is to use the hyperlinks on the Navigation Bar. Directions on how to use the options on the Navigation Bar will be given in this user s guide in chronological order. Figure 8: Navigate ProviderConnect Main Menu The Main Menu screen contains five options, three of which are relevant to NC Medicaid: Specific Member Search (authorizations) Review an Authorization Enter an Authorization Request Navigation Bar The Navigation bar contains 15 options, six of which are relevant to NC Medicaid: Home Specific Member Search Authorization Listing 10

11 Enter an Authorization Request (for Community Support) My Online Profile Network Specific Information A user can access a specific section by clicking on the hyperlink on the navigation bar. Your Message Center This functionality is not currently available to NC Medicaid providers. Please do not attempt to contact Valueoptions using this method. Figure 9: Message Center 11

12 Use Next and Back Buttons In ProviderConnect, several processes require filling information out on more than one screen. Use the Next and Back buttons located on the bottom of the screens to navigate to the next screen or to return to a previous screen. If these buttons are not used, the information that was entered will be deleted. Figure 10: Use Back/Next Buttons Note: Do NOT use the Next and Back arrows on the internet browser s toolbar. 12

13 4 Member Information A user can search for and access information for a specific member through the Specific Member Search section of ProviderConnect. ProviderConnect can not be used to verify consumer benefits, eligibility, or to submit a claim for NC Medicaid. Providers should contact EDS and/or DMA for such issues or if there are questions about these issues. Search Member To search for a member: Click on either the Specific Member Search link on the navigation bar or on the Specific Member Search (authorizations) button on the Main Menu page. Figure 11: Specific Member Search The Eligibility & Benefits Search screen will display. To retrieve member information: 1. Enter a member ID number in the Member ID field. This is the consumer s NC Medicaid ID number. 2. Enter a date in the Date of Birth field. Note: Enter information in MMDDYYYY format only. 3. Enter the member s first and last names to further refine the search (this step is optional). 4. Click Search. Once the search has been completed, the member s information is displayed in a section that contains four tabs, one of which is relevant to NC Medicaid: Demographics Displays all of the member s information 13

14 Figure 12: Demographics Tab Demographics Tab The Demographics screen displays member-specific information such as ID, name, date of birth, etc. Please disregard the information in the eligibility section as a consumer s eligibility can not be verified through ProviderConnect. Seven buttons are located at the bottom of the screen, two of which are relevant to NC Medicaid: View Member Auths Displays all of the authorizations for the selected member Enter Auth Request Authorizations (Requests for Services) can be submitted electronically View Member Authorizations Click on the View Member Auths button on the Demographics tab. Figure 13: View Member Auths Button The Authorization Search Results screen displays. This screen contains information on member-specific authorizations. Clicking on the hyperlinks in this screen enables users to view authorization letters and authorization detail information. 14

15 Figure 14: Authorization Search Results Screen View Authorization Letter To view an authorization letter: 1. Click on a View Letter icon on the Authorization Search Results screen. Figure 15: View Letter Icon 2. Click the View hyperlink to display the authorization letter. The letter will display. Figure 16: View Letter Hyperlink View Authorization Details To view authorization details: 1. Click on the View Member Auth button on the Demographics screen. The Authorization Search Results screen will display. 15

16 2. Click the desired Auth # hyperlink on the Authorization Search Results screen. Figure 17: Auth # Hyperlink The information for that authorization will display on three screen tabs: Auth Summary, Auth Details, and Associated Claims. Auth Summary Tab Click on the Auth Summary tab to view the following information: Member ID Authorization Number Authorization Status Client Auth Number (EDS PA Number) From Provider Admit Date Discharge Date Figure 18: Auth Summary Tab 16

17 Auth Details Tab Click on the Auth Details tab to view the following information: Service Code Service Class Description Dates of Service Visits Requested/Approved Visits Actually Used (N/A to NC Medicaid) Status Figure 19: Auth Details Tab NOTE: If the Visits Requested/Approved column indicates 0/0, seven days after submitting the request, contact Valueoptions ( ) to determine status of the request. Enter Auth Request Refer to Chapter 6: Enter an Authorization (Request for Services) of this user s guide for detailed instructions on how to enter an authorization request (Request for Services). Figure 20: Enter Auth Request 17

18 5 Authorization Listing In this section of ProviderConnect, a user can search for information on provider-specific authorizations. Note: To research a specific member s authorizations, select Specific Member Search on the navigation bar instead of Authorization Listing. To access the Authorization Listing section: 1. Click either on Authorization Listing on the navigation bar or on Review an Authorization on the Main Menu screen. Figure 21: Access Authorization Listing Section 18

19 The Search Authorizations screen will display. Or 2. Click View All to see all authorizations for the provider. The Search Results screen will display all of the authorizations. Note: Results can be sorted by Member ID, Member Name, or Authorization Number. 3. Enter a number in the Authorization # field. 4. Enter a date range in the Effective Date and Expiration Date fields. 5. Click Search. The Search Results Screen will display the specified authorization. Figure 22: Search Authorizations For detailed information on the Search Results section (including the Auth Summary, Auth Details, and Associated Claims tabs), refer to the View Authorization Details section of this user s guide. 19

20 6 Enter a Community Support Request The Enter an Authorization Request function enables users to electronically submit requests for Community Support online. To access the Enter an Authorization Request section: 1. Click on either Enter an Authorization Request on the navigation bar or on Enter an Authorization Request on the Main Menu screen. Figure 23: Access Enter an Authorization Request The Disclaimer screen will display. 2. Read the disclaimer. 3. Click Next. Figure 24: Disclaimer Screen 20

21 Search a Member The Search a Member screen will display. 1. Enter the member s ID in the Member ID field. This is the consumer s NC Medicaid ID number. 2. Enter the member s date of birth in the Date of Birth field. Figure 25: Search Member 3. Click Search. Figure 26: Click Search 21

22 Review Demographics The Demographics screen will display. 1. Review the member s information. 2. Click Next. Figure 27: Review Demographics Capture Provider The Provider screen will display. 1. Click the Capture button to capture the provider s information. If this is a Group Practice Account, make sure to capture the provider ID number that matches the requested level of care. 2. Click Next. 22

23 Figure 28: Capture Provider Information Enter Requested Services The Requested Services Header screen displays next. The level of service that is selected on this screen determines which additional fields will display on this screen and which screens need to be completed. There are three options for the level of service, one of which is relevant to Community Support requests: Select Inpatient/HLOC/Specialty for Community Support DO NOT submit Outpatient requests to Valueoptions via ProviderConnect at this time. The steps for entering an Inpatient/HLOC/Specialty request will be covered in the next section. Note: Directions are given for all of the fields on a screen; however, only the fields with an asterisk are required. Level of Service Inpatient/HLOC/Specialty For an Inpatient/HLOC/Specialty level of service: 1. Enter a date in the Requested Start Date field. 2. Select Inpatient/HLOC/Specialty from the Level of Service drop-down list. Figure 29: Inpatient/HLOC/Specialty Level of Care 3. Select an option from the Type of Service drop-down list. 4. Select Community Support from the Level of Care drop-down list. 23

24 5. Enter a date in the Admit Date field. The admit date is the date of first contact with this consumer by your agency for this episode of care. This date remains the same on all concurrent/subsequent requests. Figure 30: Requested Services Header Screen 6. Attach a current PCP and/or PCP Revision. This must be attached with each submission. 7. Click Next. Figure 31: Attach Documents and Click Next NOTE: If entering a concurrent/subsequent request, the Admit Date must match the Admit Date of the previous request. If entered correctly, ProviderConnect will prompt the following screen for processing a concurrent request or discharge. Click the appropriate button based on your request. 24

25 Figure 32: Concurrent Request/Discharge Screen A screen with ten tabs will display. Note: Each field on every screen will be covered; however, only the fields with asterisks are required. Figure 33: Ten screens for Inpatient/HLOC/Specialty The Level of Care screen is completed first. Figure 34: Level of Care Tab 1. Enter the treatment in the Treatment Unit/Program field. Please type Community Support Individual, Community Support Group or Community Support Individual & Group in this field. 2. Enter a name in the Member s Guardian field. 3. Select an option from the Member s Current Location drop-down list. 4. Select an option from the Primary Referral Source drop-down list. Figure 35: Level of Care Screen 25

26 5. Enter the Utilization Reviewer contact name and phone number. This is the person ValueOptions will contact should there be any clinical questions. 6. Click Next. Figure 36: Level of Care Screen Continued The Currents Risks screen will display next. Figure 37: Current Risks Tab To complete this screen: 1. Select an option from the Precipitant (Why Now?) drop-down list and provide the following information in the text box: current behaviors the consumer exhibited causing you to request this service; include root cause or particular history; include progress or lack of progress during the reporting period. There is currently a limit of 250 characters in this field; it will be expanded in the coming months. 26

27 Figure 38: Precipitant (Why Now?) 2. Fill out the Member s Risk to Self section. This entails an assessment of any current suicidal ideation (SI), plans and intent. 3. Fill out the Member s Risk to Others section. This entails an assessment of any current homicidal ideation (HI), plans and intent. Figure 39: Member s Risk to Self and Others 27

28 4. Click Next. Figure 40: Click Next The Current Impairments screen displays next. Figure 41: Current Impairments Tab 28

29 1. Rate the severity of each impairment. 2. Click Next. Figure 42: Current Impairments The Diagnosis screen displays next. Figure 43: Diagnosis Screen 1. Select Diagnosis codes for the Axis I and Axis II sections. Figure 44: Axis I and Axis II 29

30 2. Select Diagnosis Codes for the Axis III, Axis IV, and Axis V sections. 3. Click Next. Figure 45: Axis III, Axis IV, and Axis V The Treatment History screen will display next. Figure 46: Treatment History Tab 1. Fill out the Psychiatric Treatment in the Past 12 Months section. 2. Fill out the Substance Abuse Treatment in the Past 12 Months section. 3. Click Additional History heading to expand and enter relevant information, if applicable. 4. Click Next. Figure 47: Treatment History Fields 30

31 Click heading to expand additional fields Figure 48: Additional History heading expanded to display additional fields. The Psychotropic Medications screen displays next. Figure 49: Psychotropic Medications Tab 1. Enter the medication s name in the Medication field or click the hyperlink to select a medication. 2. Enter the amount in the Dosage field. 3. Select an option from the Frequency drop-down list. 4. Select Yes or No for the Side Effects field. 5. Select Yes or No for the Usually adherent field. 6. Select an option from the Prescriber drop-down list. 7. Repeat steps one through six for each medication. Figure 50: Psychotropic Medications 8. Click Next. 31

32 Figure 51: Click Next The Substance Abuse screen displays next. Figure 52: Substance Abuse Tab 1. Check all Substance Abuse types that apply. Figure 53: Substance Abuse Types For each selected substance: 2. Select an option from the Total Years of Use drop-down list. 3. Select an option from the Length of Current Use drop-down list. 4. Enter an amount in the Amount of Use field. 5. Select an option from the Frequency of Use drop-down list. 6. Enter a date in the Date Last Used field. 32

33 Figure 54: Substance Abuse Details 7. Select all Withdrawal Symptoms that the member is experiencing. Note: This field is required if the Type of Service is Detoxification. 8. Fill out the member s vitals in the Blood Pressure, Temperature, Pulse, Respiration, and Blood Alcohol fields. Figure 55: Withdrawal Symptoms and Vitals The ASAM/Other Patient Placement Criteria section must be filled out next. 1. Select Low, Medium, or High for the Dimension 1, Dimension 2, and Dimension 3 fields if the Type of Service is Detoxification. 2. Select Low, Medium, or High for the Dimension 1 through Dimension 6 fields if the Type of Service is Substance Abuse. 3. Click Next. Figure 56: ASAM/Other Placement Criteria The Treatment Plan screen will display next. 33

34 Figure 57: Treatment Plan Tab 1. Click Next as the Treatment Plan tab will not be used at this time since the PCP is attached already. The Treatment Request screen will display next. Figure 58: Treatment Request tab 1. Select Yes or No for the Certificate of Need Required field. 2. Select Yes or No for the Is Family/Couples Therapy Indicated field. 3. Enter a date in the Date of First Scheduled Appointment field. Figure 59: Treatment Request 1. Check all that apply for the Treatment Request Information fields. 2. Enter the length in the Specify Length field if the Fixed Length Program option is checked. 3. Enter a number if the Frequency of Program option is checked. Please indicate the number of units being requested for a specific time period (e.g. 520 units per 90 days). If submitting a request for both Community Support Individual and Community Support Group on the same submission, please follow the example below when specifying units for each: Ex: 280 HA per 90days; 280 HQ per 90d 4. Select an option from the Primary Reason for Continued Stay drop-down list. 5. Select an option from the Primary Barrier to Discharge drop-down list. 34

35 Figure 60: Check all that Apply 6. Check all applicable Baseline Functioning behaviors. Describe the behavior in the text box if Other is checked. 7. Enter a date in the Expected Discharge Date field. 8. Enter a date in the Estimated Return to Work Date field. Check N/A if the information is not available or not applicable. Figure 61: Check all that Apply 9. Select an option from the Planned Discharge Level of Care drop-down list. 10. Select an option from the Planned Discharge Residence drop-down list. 11. Click Submit. Figure 62: Planned Discharge Fields and Submit The Results screen will display next. 35

36 Figure 63: Determination Status 36

37 7 My Online Profile In this section of ProviderConnect, users can access and modify their own information. To access this section, click on the My Online Profile link in the navigation bar. Figure 64: Select My Online Profile A screen containing two sections will display: The Modify Profile section contains information that cannot be changed (e.g., Provider ID, Provider Name, and Tax ID). In the Editable Profile Details section, however, the user can edit information (e.g., Address, Phone Number, and Password). 37

38 To edit provider information: 1. Enter the new information in the Editable Profile Details section. 2. Click Update Profile. Figure 65: Modify Profile 38

39 8 Network Specific Information Users can access network-specific information in this section of ProviderConnect. To access the Network-Specific Information screen, click Network Specific Information on the navigation bar. Figure 66: Click Network Specific Information The Network-Specific screen will display. The network specific information for NC Medicaid can be found by clicking on this hyperlink. North Carolina Medicaid 39

40 Figure 67: Network-Specific Screen Examples of network information that can be accessed from this screen are: Clinical and administrative forms as well as instructions for completion Training materials for ProviderConnect Resources explaining the authorization process and typical authorization periods per level of care Links to relevant websites (e.g. DMA, DMH/SA/DD) 40