Aerial iexchange IP Training Materials

Transcription

1 erial iexchange IP Training Materials. From networkhealth.com, log in to iexchange and select Network Health as the payer.. You will see the main dashboard for iexchange with the following elements. lick Preferences to change your iexchange Password. lick Log Out to gracefully log out of iexchange. This is your provider group ID number and is unique to each office location and set of providers/staff. lick Select a different payer hyperlink and choose Network Health Plan from the list. lick Inpatient if creating an Inpatient request. lick Other if creating an Outpatient request (therapies, DME, home health, dental, outpatient surgeries, etc.) lick Search to search by authorization request ID number, member name or treatment updates. Treatment Updates section contains new information providers need to know for authorization requests. Sponsor ulletin section contains additional information regarding authorizations and Utilization Management. lick Starting Point to start a new request on existing member or a new member

2 Inpatient Request Notification Date Member/Subscriber ID number is required Submitting Provider Facility Treatment Setting Treatment Type dmit Date 8 Emergency 9 Primary Diagnosis 0 Secondary Diagnosis Requested Length of Stay LOS ed Type Principal Service Procedure Scheduled Date Servicing Provider dditional Notes

3 Entering an Inpatient Medical/Surgical Request lick on the green Inpatient button at the top of the screen or under the Inpatient instructions header. Either option will bring you to the New inpatient request entry page General Information Section **Read Payer Notice for valuable information regarding authorization requests** Notification Date Notification Date will be today s date by default Member/Subscriber ID must search for a member first by clicking the Member Search button which will bring you to the Member Search screen on next page. You will now leave this page and go to Member Search

4 Member ID Search by member/subscriber ID Member/Subscriber ID number is required Date of irth is optional First name is optional Search by member last name/date of birth Last name of member is required Date of birth is required First name is optional lick Submit Search button for results Member Search Result. lick View Existing Requests on the Member Search Result screen must do this before you can click the Select button. lick Select button. Please note: The Select button will bring up the Treatment Type screen shot (shown on page ), so you can confirm this is not a duplicate request.

5 Submitting Provider lick the drop down arrow to select from the list of providers in your provider group Facility Will need to indicate the hospital that the member will be admitted to by clicking the Provider Search button Search Type Search by Provider Name or by National Provider ID (NPI #) Provider Type Facility or Practitioner Facility Name or National Provider ID Enter the facility name or the NPI # depending on what you selected in the Search Type lick Submit Search button for results Provider Search Result lick Select button next to the provider you want to use Treatment Setting Select Inpatient Hospital if it s a hospital or LTH Select omprehensive Inpatient Rehabilitation Facility Select Skilled Nursing Facility Treatment Type If you selected Inpatient Hospital in step above, please pick the appropriate Treatment Type from the drop down list If you selected omprehensive Inpatient Rehabilitation Facility in step above, please pick the appropriate Treatment Type from the drop down list If you selected Skilled Nursing Facility in step above, please pick the appropriate Treatment Type from the drop down list

6 dmit Date Enter the dmit date or inpatient DOS using mm/dd/yyyy format 8 Is this an Emergency? Select Yes or No 9 Primary Diagnosis Enter correct ID 0 code or click the Diagnosis Search button Search for diagnosis by description type in description and click Search button Search for diagnosis by code type in code and click dd button lick Save 0 Secondary Diagnosis (optional) You can add up to additional diagnosis codes. NOTE: If you have more than five () diagnosis codes, please type all additional codes in the dditional Notes section at the bottom of this screen Requested Length of Stay You must indicate how many inpatient days you are requesting LOS ed Type Leave blank, as we are not currently using

7 Principal Service (optional) Only needed if this is a surgical admission If you type in a description, you will need to click the Select button next to the procedure(s) that will be performed. You can add up to additional PT/ procedure codes NOTE: If you have more than five () diagnosis codes, please type all additional codes in the dditional Notes section at the bottom of this screen. lick Save button to put this procedure code on the inpatient request dditional Notes (optional) ny other non-clinical information that you want Utilization Management to know regarding this admission, please include it in this iexchange Note. Prior to submitting the inpatient surgical request, an evicore authorization must be obtained and approved, if applicable. lick Next Step button to continue with the inpatient request You will now be taken to the Inpatient Request Preview Page

8 Inpatient Request Preview Watch for any Warning messages that may appear these need to be fixed before it will allow you to submit the request to Utilization Management. Watch for any Payer Notices from Utilization Management (these notices can contain different information depending on the page you are on) Tells you the Projected Status is PEND for the hospital stay Tells you the Projected Status is PEND for the procedure portion Inpatient Request Information section is a summary of all the information that was entered for the inpatient admission. General Information reflects any notes that you included for this admission. lick Edit if you need to make changes to this request 8 lick Submit if everything looks good and all errors have been fixed If you click the Submit button more than once, you will get the following 8 8

9 Inpatient Request onfirmation Page You can print off a Print Friendly Version of this admission Watch for any Payer Notices from Utilization Management (these notices can contain different information depending on the page you are on) You will be given the Pending auth # for this admission for your files You will need to attach all Relevant and Pertinent linicals to Support this dmission Request ttachments a) Title: Enter the word linical b) ttachment: rowse your computer for the Relevant and Pertinent linicals and then click the ttach button (the only allowable file formats are PDF, DO, XLS, JPG, GIF, TIF, DOX, or XLSX). c) When you click the ttach button, you will see the following screen, just click OK. d) Once you click OK, you will get the next informational message on the Inpatient Request onfirmation Page that states the file has been successfully attached and sent to the health plan. 9

10 heck Status of Inpatient Request To check on the status of an authorization via iexchange, you can do this through the Search button and selecting Treatment Update Search Search for click the appropriate radial button to reflect how you would like to search for updates Member/Subscriber ID Number optional uthorized Provider(s) select the name of the submitting provider for this request Date Range specify how far back you want to search for treatment updates Treatment update type Show only unread treatment updates leave box unchecked lick Submit Search button 8 If there are no updates, you will get the following message 0

11 Request Inpatient Extension If you need to extend a patient s stay beyond the last approved date, you must request an extension with clinical to support the extension. lick Search, then Treatment Search and search by uthorization Number which will bring up the Treatment Search Details page lick Request ctions/ttach New File (this process is already in the document) This screen appears when properly attached lick Request ctions/view or dd Note This screen appears lick appropriate hyperlink and dd Note dd your note and click Save This screen appears and lets the user know it s been successfully submitted. User clicks the Extend button and then gets the Inpatient Request Extension Entry page

12 Inpatient Request Extension Entry The Extension Start Date will autofill based on the last approved date of the existing authorization Enter dditional units requested lick Next Step button.

13 Request Inpatient Extension Preview

14 Request Inpatient Extension onfirmation If you are finished with this request click on Starting Point at the top left hand corner to be brought back to the home page