AcuExchange Provider Manual

Transcription

1 AcuExchange Provider Manual Last update April 28, 2014 Update 4/28/14: Browser compatibility and remove enrollment form instructions

2 Contents Chapter One Accessing AcuExchange 3 Chapter Two AcuExchange Login Process and Troubleshooting 5 Chapter Three Basic Navigation and Search Tools of AcuExchange 13 Chapter Four - Submitting an Inpatient Request 27 Chapter Five Submitting an Outpatient Request 39 Chapter Six Viewing Correspondence and Working with Existing Requests 53 Chapter Seven Automatic Approvals and Assessments 65 Chapter Eight Reports 70 AcuExchange Appendix A General Terminology and Icons 75 AcuExchange Appendix B Provider Roles 77 AcuExchange Appendix C AcuExchange Frequently Asked Questions 80 BCBSVT AcuExchange Provider Manual Page 2 of 85

3 Chapter One Accessing AcuExchange AcuExchange AcuExchange is a secure provider portal that allows providers and facilities to communicate with Blue Cross and Blue Shield of Vermont (BCBSVT) via the internet. This tool allows providers to submit requests for inpatient and outpatient services, check status, attach electronic documents, send and receive messages, view notes and view letters. In some instances you may be able to receive an automated approval for some services. Registration You must have access to the Provider Resource Center (PRC) to access AcuExchange. Once you register for the PRC your AcuExchange login is generated. Within 72 hours someone from BCBSVT will contact you to provide you with an assigned user ID. Follow the steps in chapter two to complete the registration process. Browsers AcuExchange is a web-based program that functions best when accessed via Internet Explorer (IE), version nine (9) or FireFox version 20. In addition, more recent versions of either browser are acceptable. Allow pop-ups messages and verify the Override Automatic Cookie Handling box is unchecked. Follow these instructions to verify this setting: 1. Open your internet browser 2. Go to the tools menu 3. Click on Internet Options 4. Click on the Privacy tab 5. See images to change setting based on browser type BCBSVT AcuExchange Provider Manual Page 3 of 85

4 Logging out AcuExchange will log you out after 20 minutes of inactivity. The following warning message will appear before the system logs you out. The Provider Resource Center times out as well. The AcuExchange portal timing is nonrelated to the PRC. To log back in, close your browser and log back into the Provider Resource Center and access AcuExchange. BCBSVT AcuExchange Provider Manual Page 4 of 85

5 Chapter Two AcuExchange Login Process and Troubleshooting Once you are assigned and notified of your user ID for the AcuExchange Portal, click the link inside the Provider Resource Center. You should access AcuExchange only through the Provider Resource Center. Please refrain from accessing the URL outside of the Provider Resource Center. Synchronized Sign-on and Request Account Form Synchronize your Provider Resource Center login. Follow these steps to complete your AcuExchange portal registration. See image below. 1. Enter your user ID in the UserId field the same as the user ID used for the Provider Resource Center. 2. Click the login button. This will prompt the AcuExchange Account Request form to pop-up. See image below. 1. Enter your user ID in the User ID field the same as the user ID as used for the Provider Resource Center. 2. Enter the address provided during the Provider Resource Center registration. This is not the user s address. 3. Enter the Tax ID in the Tax ID field provided during the Provider Resource Center registration. 4. Enter a password. The AcuExchange password is maintained separately from the Provider Resource Center password. See rules below. 5. Re-enter desired password. 6. Include a password hint, as it cannot be the same as the password. 7. Click the Request Account button. BCBSVT AcuExchange Provider Manual Page 5 of 85

6 When this process is complete you will return to the AcuExchange portal login page. Enter your user ID and new password to start using the AcuExchange portal. If there are any errors, ensure the address and tax ID is correct. Password Rules BCBSVT AcuExchange Provider Manual Page 6 of 85

7 Forgot Password AcuExchange has specific password rules explained herein. This information is available on the forgot your password or AcuExchange Reset Password form by clicking on the link. See image below. 1. Enter your user ID in the User ID field the same as the user ID used for the Provider Resource Center. 2. Enter the address provided during the Provider Resource Center registration. This is not the user s address. 3. Enter the Tax ID in the Tax ID field provided during the Provider Resource Center registration. 4. Enter a password. The AcuExchange password is maintained separately from the Provider Resource Center password. See rules below. 5. Re-enter desired password. 6. Include a password hint, as it cannot be the same as the password. 7. Click the Request Account button. BCBSVT AcuExchange Provider Manual Page 7 of 85

8 When this process is complete you will return to the AcuExchange portal login page. Enter your user ID and new password, and then start using the AcuExchange portal. If there are any errors re-check the address and tax ID and ensure they are correct. See the troubleshooting section below for resolving other errors. Troubleshooting Listed herein are common errors users may receive and can easily correct on your own. Request Account button Most of the error messages display a Request Account button. Clicking this button brings you back to the password reset page where you restart the process. Password Hint Include a password hint, as it cannot be the same as the password or you will get the error displayed bellow. Click the Request Account button to restart the process. BCBSVT AcuExchange Provider Manual Page 8 of 85

9 Password Mismatched If you get the mismatch password error while trying to complete registration or reset your password, click the Request Account button. Re-enter your desired password in both the desired password and re-enter password fields ensuring the entries match, then press reset password again. Click the Request Account button to restart the process. Password Too Short You must enter a password that is at least eight characters in length or you will get the error message shown below. Click the Request Account button to restart the process. BCBSVT AcuExchange Provider Manual Page 9 of 85

10 Password Character Types You must use three of the four (Numeric, Upper Case, Lower Case, and Special Characters) character types in your password. Click the Request Account button to restart the process. 24 Month Rule You cannot use a password that has been used in the past 24 months. This includes partial passwords. Username and Password Exist If you get the error shown below, close your browser, go back in, and try again to log in. BCBSVT AcuExchange Provider Manual Page 10 of 85

11 Provider Does Not Exist One of three issues exists: BCBSVT has not received your registration form, BCBSVT has not completed the processing of your registration form yet, or the information on record at BCBSVT is incorrect or incomplete; it somehow is not matching what you are entering. Please verify the information you entered is accurate and if you find errors, correct any deficiencies and reenter the information. BCBSVT AcuExchange Provider Manual Page 11 of 85

12 Too Many Failed Logins If you attempt to log in three times without success, you can click on the password reset in this error message. If you know your password but entered it incorrectly, or if you have reset your password by clicking on the link in the error message, close your browser, go back in, and try to login again. Account is Disabled Your account has been disabled. This is done when your provider record indicates you no longer contract with us. Additional Miscellaneous Information and Technical Support The application will timeout after four hours and you will be required to close your browser and log back in to continue using it. If you fail to successfully log in three times you need to close the browser and try again. If you do not close the browser first it will not work. If you cannot remember your password, reset it by following the steps listed above. If you are experiencing difficulties other than the contents of this troubleshooting guide, please contact us at or through at BCBSVT AcuExchange Provider Manual Page 12 of 85

13 Chapter Three Basic Navigation and Search Tools of AcuExchange There are certain features in AcuExchange you will use when submitting, reviewing, and/or responding to a request. This chapter of the Blue Cross and Blue Shield of Vermont (BCBSVT) AcuExchange Provider Manual explains the purpose of the main tool bar icons. The manual also defines how the different navigation buttons are and how to manage searches and filters. Be aware not all icons within AcuExchange are used as this is not a completely customized software tool. Main Toolbar Icons At the top of the screen you will see the five icons shown below: Workflow Help Shows helpful text pertaining to the screen you are currently viewing. The text can be turned on and off. Open Reports Folder Access the reports module to run reports that have been set up by BCBSVT. More detailed information on reports will follow. Security Settings Allows users to change AcuExchange password and address. Exit Application Exit the AcuExchange portal. Navigation Buttons AcuExchange has four buttons at the top you will use to navigate through and submit requests. BCBSVT only uses the current requests, new inpatient requests, and new outpatient requests buttons. You will not be able to submit a request from the referral request tab. All requests submitted, including those you believe are referrals, will be submitted as either an inpatient or an outpatient request based on the rendered place of service. This section defines the difference between an inpatient and outpatient request. Entering data into these buttons to submit a request, as well as how you use the current requests tab to view your current requests will be explained in subsequent chapters of this manual. BCBSVT AcuExchange Provider Manual Page 13 of 85

14 Current Requests Tab This button is used to view, sort, and filter the requests you have submitted to us. BCBSVT limits the volume in which requests you see when using filters. Instruction on searching and using filters is discussed later in this chapter. Inpatient Request Tab This button is used when submitting a request for an inpatient admission. This is not used for observation level of care when rendered at a facility. Inpatient admissions include inpatient admissions for elective, emergent, or urgent care, inpatient rehabilitation of any type, inpatient admissions at a skilled nursing facility, and inpatient hospice services including respite care. Additional information related to the data entry portion of submitting an inpatient admission request will be discussed in later chapters. Outpatient Request Tab This button is used when submitting a request for an outpatient service. This request type is used for office based care such as chiropractic, ancillary services (lab, radiology, etc), home health care, sleep studies and durable medical equipment. Additional information related to the data entry portion of submitting an outpatient request will be discussed in later chapters. Look Up Windows While you enter data into the request tabs, you will see several icons resembling binoculars. These icons are called look up windows. Users can access our database of valid entries to select data for that field. When you click the binoculars you will see the AcuExchange Lookup window for that field. The green search field pictured below is where you will enter search criteria if applicable. There are instances where filters and searching is not needed. Click in the green search field under the respective field header to enter data in the AcuExchange Lookup window. In the example below, to search by the provider s NPI click the green cell (blue boxed area shown below) directly below the NPI field header. The search wizard window will appear. Enter the provider s NPI and press enter or click BCBSVT AcuExchange Provider Manual Page 14 of 85

15 ok. Matching queried records will appear on the LookUp window. Double-click the correct provider listed. Filters and the Search Wizard Filters are created by using the search wizard which is discussed in the next section of this chapter. Using saved filters saves you from having to re-think and re-enter the search parameters each time. Filters can be set for any column in a browse or search window, and there are no limitations on the number of filters that can be used, keep in mind that the more complex the filter, you may encounter errors and yield no results. Saved filters are specific to a user's login ID. Now that you understand saved filters, we will incorporate the instructions on using the search wizard to query complex searches and saving those filters. Using the Search Wizard AcuExchange offers a search wizard to help you find what you need quickly and easily. In this section you will learn how to search for a particular record using the search wizard. This functionality is a versatile tool that provides you with the ability to search through, find and access records quickly and easily. When creating a search, you will enter in the detail box a column, operator and value. You may also chose to check or leave blank the not and null boxes. The search feature returns exactly what you requested so you must ensure you fully understand and ask for what you need. BCBSVT AcuExchange Provider Manual Page 15 of 85

16 Search Components This section explains the components the search wizard uses to conduct searches. You must fully understand these components to get the expected results. If any piece of the components is incorrect, you will not get the expected result. In any case if you are having a difficult time finding what you want, try using less exact search criteria, e.g. Ba instead of Baily. You will get more items in your search, but it opens up your possibilities in case your spelling is incorrect. For example, using Ba will also find Bailey, Bailie and Bayley. Column The column represents the data element on which you wish to search. For example, if you want to see all authorization requests that are suspended (received and in process) you would sort by the status column. Click in the green box below the header if your search wizard is not open yet and it will default to this column. Otherwise, select the column you wish to search from the drop down box. Operator The operator is the quality of the value. This defaults to Contains for all data values that are not date values, and Equal to for date values. These operators function very specifically so you must understand each of these in order to yield the expected results. Try each of these so you can be familiar with the way this search functionality works. Contains gives you the largest selection since it will find your search criteria wherever it appears in the column. An example of this use is when you know a patient s first name is Amy but are unsure if it is spelled Aimee, Amy, or if I her name is actually Amelia. By using contains and putting Am as a value in the first name column, the system will return all records where the patient s first name contains the letters a and m. This means Amy, Samuel, Tammy, and so on, will all be returned. Starts With returns all records where the data in the column you selected to search starts with the value you entered in the value box. Using the previous Am example, your results would be limited to names like Amy, Amelia, Amanda, and so on. Ends With returns all records where the data in the column you selected to search ends with the value you entered in the value box. Using the previous Am example, your results would be limited to names like Sam, Pam, Liam, and so on. Equal returns dates or other values with the smallest selection since the data needs to match what you entered exactly. You will not find certain things if the entry is misspelled or has an extra space, hyphen, character etc. Only use this when you know exactly what you are matching. BCBSVT AcuExchange Provider Manual Page 16 of 85

17 A good example of when you have a letter from BCBSVT with a request number on it and you want to check the status of that request. You would select request ID as the column (click in the green box below it if your search wizard is not open yet and it will default to this column), ensure your operator is equal to, enter the request ID number in the field, and click okay. This search will return only this record and if you reverse digits or otherwise do not match exactly the record on file, nothing will be returned. Between can be used for dates or non-date values. This operator will find you the records between two values. For example, if you wanted to review all requests submitted between two dates, you would use the request date as the column, between as the operator, and the dates as the values. Clicking okay with this search criteria will return requests entered between the start and end dates you entered. In List requires you list the entire character string with a comma in between them. For example, if you are looking for John Doe and Jane Thompson you would enter the following in the value field of the search wizard: John Doe, Jane Thompson, and then click ok. If you misspell anything you will not get the results you are looking for. Greater Than can be used only on date fields. When you use this operator you will get back only items where the date you are on for the column is greater than the date you enter in the value field. Greater Than or Equal To can be used only on date fields. When you use this operator you will get back items where the date you are on for the column is greater than or the same as the date you enter in the value field. Less Than can be used only on date fields. When you use this operator you will get back only items where the date you are on for the column is less than the date you enter in the value field. Less Than or Equal To can be used only on date fields. When you use this operator you will get back only items where the date you are on for the column is less than or the same as the date you enter in the value field. Value The value is the third piece that drives what records are returned. The value can be a date, number, or series of letters. This field changes based on the operator to allow more than one data point for betweens and only one data point for the other operators, to allow you to select null on the equal to (non-date fields only) operator, and to account for date formats or not. In this section you can see examples of how this BCBSVT AcuExchange Provider Manual Page 17 of 85

18 change looks. There are two types of values, non-date values which are not dates, and date values which are dates. Non-Date Values The non-date values have specific operators you can use they are: contains, starts with, ends with, equal to, between, and in list. Contains, starts with, ends with, equal to all give you one value line where you enter what you are looking for within the column and based on the operator you selected. The example below is expecting you to enter part of a provider name in the value field. Between gives you two places to enter values. Enter the start value in the value field on the left and the ending value in the value field on the right. Your results will include the start and end values. In the example below if you enter Allen Jones and Peter Comstock in the fields below you would get all providers (in that group if you are logged in as an individual you would only see you) who alphabetically landed between the two. Date Values The date values have specific operators you can use, they are greater than, greater than or equal to, less than, less than or equal to, and between. Greater than, greater than or equal to, less than and less than or equal to all give you one space to enter a value. BCBSVT AcuExchange Provider Manual Page 18 of 85

19 The between operator gives you two places to enter values. Enter the start value in the value field on the left and the ending value in the value field on the right. Your results will include the start and end values. This is the search commonly used to see folks who are having services rendered between a start and end date. There is an example of the Between Date value search wizard below. See the next page for an example of this screen. BCBSVT AcuExchange Provider Manual Page 19 of 85

20 Not Box When you check the Not Box on the search wizard, the search will return all records that do not meet your criteria. In the example shown below you will get all requests that were not submitted today. Conducting a Simple Search 1. The search wizard (shown below) will be displayed showing the Column you selected. 2. Choose the desired Operator from the drop-down. Examples of operators are: Starts With, Contains, Ends With, Equals, In List, or between. a. You can check the checkbox, if you are looking for something that does not start With, Contain, End With, or Equal (or whichever other operator you select) the value Entered. b. Enter the desired Value to search on - For example: "Fletcher". BCBSVT AcuExchange Provider Manual Page 20 of 85

21 3. Click OK to conduct this simple search. PRESSING ENTER ON YOUR KEYBOARD DOES NOT EXECUTE THE SEARCH. a. If you do not find the value you are looking for in the results window, increase your retrieval limit on your search screen. The maximum retrieval limit is 999. If your retrieval limit reaches 999 and you still do not find the record you are looking for, further refine your search to reduce the number of results by adding criteria as shown on the next page. Creating Complex Searches A complex search is used when you need information that matches more than one criterion. For example, let s say you routinely need to see all approvals for a requests submitted during a particular date range. You can find this list by doing two separate searches or by doing one search. Column Filter List When creating a complex filter search the AND/OR logic has everything to do with what you receive in your search. For example, if you are looking for all patients with dates of birth in July and August you would want to use the OR feature because no one will have a date of birth in July AND August. To create a complex search, follow the steps in creating a simple search, then continue with step one below: 1. To refine your search by adding search criteria, click on the Advanced Search button to the Right of the Column dropdown. This will open the advanced search tool shown on the next page which enables you to do complex searches and save filters for future use. As a reminder, saved BCBSVT AcuExchange Provider Manual Page 21 of 85

22 filters are helpful, and save you time when you have searches you use on a routine basis. You do not have to re-think and re-enter the search parameters each time. Filters can be set for any column in a browse view, and there are no limitations on the number of filters that can be used. Saved filters are specific to a user's login id. Make sure your naming convention (what you name your filters) makes sense to you today and will still make sense tomorrow. Once a filter is saved, to change the name simply open the filter, type over the name, and click the save button again. Search 1: Find all approvals 1. On the Current Requests screen, click on the green bar below the Status Column. 2. The Wizard will appear with Status and Starts With already selected. 3. Enter Value as Approved. 4. Click OK and you will get a list of all approved requests. BCBSVT AcuExchange Provider Manual Page 22 of 85

23 Search 2: Find only the approvals where the request date is in 01/01/10 to 01/07/ Click on the green bar below the Request Date Column. 2. The Wizard will appear with Request Date and Equal To already chosen. 3. Change the Operator from Equal To to Between since the requests entered between January 1, 2010 and January 7, 2010 Click the Radio Button next to the Date (00/00/0000) Value and enter 01/01/2010 in the first column and 01/07/2010 in the column to the right. a. Notice that the choices for the Value are different for date/times than they are for alpha searches (Null, Today Plus, Current Month, Current Year, Date) 4. Click OK and you will get a list authorizations with a request date in that range. To combine those searches, follow these instructions 1. On the Current Requests screen, click on the green bar below the Status Column. 2. The Wizard will appear with Status and Starts With already selected. 3. Enter Value as Approved. 4. Do not click OK. 5. Click Add to add the Request Date search criteria to the Column Filter List. 5. Immediately go back up to Column and select Request Date from the dropdown arrow. 6. The Wizard will appear with Request Date and Equal To already chosen. 7. Change the Operator from Equal To to Between since we requests entered between January 1, 2010 and January 7, 2010 Click the Radio Button next to the Date (00/00/0000) Value and enter 01/01/2010 in the first column and 01/07/2010 in the column to the right. a. Notice that the choices for the Value are different for date/times than they are for alpha searches (Null, Today Plus, Current Month, Current Year, Date) Saving Search Filters Saved filters are really helpful. Filters can save you a lot of time when you have searches you use on a routine basis. Now that you know how to do searches using multiple search criteria, let s save some time and conduct the search in one search function instead of two, and let s save this search, so we can use it in the future without having to set up all the parameters each time. BCBSVT AcuExchange Provider Manual Page 23 of 85

24 1. Click on the green bar below the Requesting Provider Column. 2. The Wizard will appear with Requesting Provider and Contains already chosen. 3. Enter Value as [the name of your requesting provider]. In this example, we have chosen Dr. Smith. 4. Do not click OK. 5. Click Add to add the Other Provider search criteria to the Column Filter List. 6. Immediately go back up to Column and select Other Provider from the dropdown arrow. 7. Select Contains for the Operator. 8. Click Add to add the Other Provider search criteria to the Column Filter List. 9. Click Save. A prompt will come up asking you to enter a name for your saved filter. 10. Enter a name for this search in the Saved Filters field, i.e. Dr. Smith - [your other provider]. This will allow you to conduct this search again without having to enter all the parameters each time. Note: The Filter Name can be a maximum of 40 characters long including spaces. 11. Click OK to the prompt window and your filter has been saved. BCBSVT AcuExchange Provider Manual Page 24 of 85

25 12. Now click OK to get the results of both searches. Reset Search Wizard If you make a mistake while searching and want to clear /reset the search criteria click the Clear All Filters Button on the Browse Window. Sorting Capabilities You can use the sorting capabilities to search or sort the information returned by a search. Sorting can be done on the various column headers. To sort them in ascending BCBSVT AcuExchange Provider Manual Page 25 of 85

26 or descending order just click on the column header name. If you click it again it will sort the records the opposite way. Filter Capabilities At the bottom of the screen to the left there are filter options. Use the radio and/or drop downs to filter data. Individual provider logins will have one filter; you can look at items that require action or all items. Group level login s can see action/all AND can filter on all or the requesting provider. Requires Action shows requests that require an action on the provider s behalf. This is a quick way to filter out new versus old requests and it allows you to quickly focus on those requests that need immediate attention. Clear all Filters To clear any search you simply click the Clear All Filters button and your screen will go back to showing all current requests. BCBSVT AcuExchange Provider Manual Page 26 of 85

27 Chapter Four - Submitting an Inpatient Request AcuExchange can receive requests for inpatient services that are pre or post service. There are required fields, and in some cases, there are not fields available for information you may want to include so you will need to enter a message to provide this information. This section of the Blue Cross and Blue Shield of Vermont (BCBSVT) AcuExchange provider manual will explain to you what fields are required when submitting a request, how to attach supporting documentation related to that request and how to view and enter notes related to a request. Basic Icons Both the inpatient and outpatient request submission tabs share the basic icons shown and described below. Calendar Lookup Brings up a calendar for you to select the date to assign a field. AcuExchange Lookup Brings up a look up search window where you can select from a list of available options for a particular field. Drop Down Data Window Displays a drop down window that provides detailed information related to that field. Attachment Signifies an attachment can be added to the field. Inpatient Requests This screen is used to create a request for a new inpatient admission. There is a section that will allow you to attach documents to this Request. After a request has been created it can be viewed by the providers on the request (on the Current Requests tab) and the reviewer at BCBSVT. Creating a New Inpatient Request You can submit a pre or post service request for review of an inpatient stay via AcuExchange by following the steps below. Screen shots of the request screen are shown at the end of this section. 1. Log into AcuExchange 2. Click on the New Inpatient Request Tab at the top of the screen. BCBSVT AcuExchange Provider Manual Page 27 of 85

28 NOTE: All fields shown in red are mandatory fields that must be filled in before you ll be able to submit your request. 3. Complete all fields as indicated below: a. Reference # read only field that displays the number for this Authorization Request. b. Entered By (First Name) Identifies the person who entered the information, so they can be contacted if there are any questions. This is a mandatory field for submitting a request. Enter your first Name. If there is more than one person in the office with that name, be sure to enter a last initial or some other unique characteristic, i.e. Susan1 or Susan2 so the reviewer can contact you if there is a question. This name will automatically be entered on all subsequent requests you submit for as long as you are logged in to that session. This will save you the time of having to fill in the field again if you re entering numerous requests. BCBSVT AcuExchange Provider Manual Page 28 of 85

29 c. Request Date This field defaults to the current date and time. There should be no need to change this date field. d. Phone Enter your phone number in case the reviewer needs to contact you. e. Member ID For security reasons, you must manually enter the member s ID; there is no look up feature where you can select the member from a list of members on the policy. Once you enter the Member ID and press the TAB button. (Pressing the enter button will not be successful) The system will auto-populate the field with the member s name, both first and last and date of birth. You will need to include the members prefix for Federal Employee Members (prefix R) You will need to include the members prefix New England Health Care members (prefix CTN, CTP, EHF, EHG, EHH, EHJ, NHN, NHP, MEN, MEP, MTN, MTP, YGL, YGE, YGI). For all other Blue Cross and Blue Shield of Vermont members, do not include the prefix, the member ID needs to be only the numeric values of an ID number. You must include the last two digits known as the dependent code (00, 01, 02, etc) at the end of the member s ID number. f. First Name, Last Name, and Birth Date Auto-populate based on the member ID that was entered above. If what you see is not what you expected to see, verify the member ID numbers are all correct. g. Retro Request Identifies if the patient has already been admitted and discharged. This field defaults to No since requests are normally submitted prior to admission. Click Yes if already admitted and discharged Click No if the patient has not been admitted or is still admitted h. Admit Date Specify the date of admission. It will default to today s date. Change date by clicking on the Icon. i. Admit Type Defaults to Elective since this is the most common type of Admission. Use Elective for all scheduled admissions Use Emergency for all emergency room admissions BCBSVT AcuExchange Provider Manual Page 29 of 85

30 Use Urgent for all urgent admissions This can be changed to another admit type simply by clicking on the Icon. (See below) j. Setting Click the Icon to select the Setting. Once selected this field will become read only. k. Source Click the Icon to select the Source. Once selected this field will become read only. l. Surgery Date This field is only used to capture delivery dates for newborn infants on maternity admissions. Please do not enter any other dates in this field. To enter the delivery date of a newborn, click the the appropriate date. Icon to select m. Estimated Delivery Date Click the Icon to specify the estimated birth date. n. Provider (1 st Line) The attending Provider- provider that is attending the service. Use the icon to select the provider attending the service. (2nd Line) Facility. Click the Icon to select the appropriate facility for our facility list. If the facility you are referring the member to is a non-contracting facility, enter provider in the External Provider ID field. You MUST enter the following information when entering a non contracting facility into the Clinical Rationale Section or the request will not process correctly. BCBSVT AcuExchange Provider Manual Page 30 of 85

31 Facility name Provider s full legal name Address Mailing address if different Phone number including area code UR department fax number UR department contact person UR department phone number including area code and any applicable extensions Patient s medical record number for that facility if known. (3rd Line) - If you need to enter additional providers (such as a primary care physician), click the Icon to select another provider. If the additional provider is a non-contracting provider (most providers not close to our borders do not contract with BCBSVT) enter provider in the External Provider ID field. You MUST enter the following information when entering a non contracting provider into the Clinical Rationale Section or the request will not process correctly. Facility name Provider s full legal name Address Mailing address if different Phone number including area code UR department fax number UR department contact person UR department phone number including area code and any applicable extensions Patient s medical record number for that facility if known. o. Role (1 st Line) Describes the role of the Provider. Defaults to Attending Provider and should not be changed or removed. (2 nd Line) Facility is the defaulted role of the second provider and should not be changed or removed. (3rd Line) Defaults to Requesting Provider and should not be changed or removed. p. Diagnosis Enter the diagnosis or click the Icon to select the Patient s diagnosis. Once selected an Icon will appear to the right of it. BCBSVT AcuExchange Provider Manual Page 31 of 85

32 Click the Icon if you decide you need to remove the diagnosis. After you add a Diagnosis, another empty diagnosis field will appear on the next line allowing you to add an additional diagnosis; if you have no additional codes to enter, do nothing with the subsequent line. If you frequently use the same codes you can manually type in your diagnosis codes without having to use the lookup button. If it is a valid code it will populate the code name in the description field to the right. Rank The first diagnosis s rank field is Read only and will default to the value of Admitting Diagnosis. You can select the rank for subsequent diagnosis codes by clicking the Icon. q. Procedure Enter the procedure code or click the Icon to select the Patient's Procedure. Once selected the Icon will appear to the right of it. Click the Icon if you decide you need to remove the Procedure. Each time you add a Procedure, another empty Procedure field will appear on the next line allowing you to add an additional Procedure; if you do not have another procedure, do nothing with this subsequent line. If you frequently use the same codes you can manually type in your procedure codes without having to use the lookup button. If it is a valid code it will populate the code name in the description field to the right. Although it is not required to submit your request, unless pre-certifying an emergent admission where the procedure is unknown, you are strongly encouraged to enter a CPT or HCPCS code. Requests may be delayed, particularly for elective admissions, without a code in this field, as we may request the information from you prior to making a decision. Rank Use the Icon to select the Rank for the Procedure. Once selected the field will become read only. r. Request Date The request date is required. It defaults to the data and time of entry and should not be changed. s. Days The number of days you are requesting is required; if unknown (such as in the event of an emergency admission) enter one (1). In all cases regardless of the entry here we will continue to conduct concurrent reviews in accordance with our policies. t. Service Type Click the Icon to select the Service Type for the level or type of service being requested. Once selected this field will become read only. You have the option to add an attachment to this field. This could be anything that you would want to have linked to this particular BCBSVT AcuExchange Provider Manual Page 32 of 85

33 Request, including but not limited to pictures. We will explain how to attach items later in this section. u. Clinical Rational for Admission You MUST enter the following information in the clinical rationale section when submitting a request for non contracting provider or facility not found in your search or the request will not process correctly. Facility name Provider s full legal name Address Mailing address if different Phone number including area code UR department fax number UR department contact person UR department phone number including area code and any applicable extensions Patient s medical record number for that facility if known. You may enter pertinent clinical data that explains why the patient is being admitted if you elect not to attach the clinical documentation you already have. If you elect to type the information here please ensure that it is complete. If we do not have enough information to make a determination your request will take longer to process as we will request the needed information from you. History, S+S, Treatment Plan, Pervious Admissions, etc Abnormal Clinical Findings, Labs, Tests, X-rays, etc Adding an Attachment AcuExchange allows you to add a document to a request. It can be used to attach such things as diagnostic reports, lab results, progress notes, even color photos. There is no limit on the number of attachments you can add to a request. You can add an attachment to the separate service lines. The attachments will also be viewable by the Reviewer. a. Click the icon to bring up the attachments window. BCBSVT AcuExchange Provider Manual Page 33 of 85

34 b. Click the Browse Button to find the file or document you wish to attach to this Request. (A window will appear giving you access to your computer files). c. Select the document you want and either double click the file or highlight and click Open to attach it to the Request. d. The filename will appear in the field next to Browse. e. You can now choose to click Browse to add more attachments, Delete to delete the attachment, or Close to go back to the request window. The attachments will be saved with the record. Submitting a Request Once you ve finished filling in all mandatory fields and any other pertinent fields click the Submit Request Button at the top right of the screen. This saves the request and transfers it to the Reviewer s Task List. It also makes it available for viewing and follow-up on your Current Requests tab. Canceling a Request If you decide you do not want to submit a request, you do have the option to cancel it as long as the request has not been submitted already. 1. Click the Cancel button on the upper right hand portion of the screen. BCBSVT AcuExchange Provider Manual Page 34 of 85

35 2. It will give you a warning message: 3. Click OK to close out your screen and cancel your request. BCBSVT AcuExchange Provider Manual Page 35 of 85

36 New Inpatient Request Submission Tab Quick Reference 1. Click on the New Inpatient Request Tab. 2. Entered By: Enter the name of the person entering the information. 3. Phone: Enter your telephone in case the Reviewer needs to contact you. 4. Member ID: Enter the member ID and dependent code without the prefix. (If an FEP member enter the R prefix; if an NEHP member enter the three letter prefix.) For Blue Cross Shield of Vermont member s you must use the dependant codes. 5. Retro Request: Check Yes if patient has already been admitted; check No if patient has not been. 6. Admit Date: Specify the date of admission. 7. Admit Type: Defaults to elective; change by clicking on the icon. 8. Setting: Click the icon to select. 9. Source: Click the icon to select. 10. Surgery Date: This field is only used to capture delivery dates for newborn infants on maternity admissions. PLEASE do not enter any other dates in this field. To enter the delivery date of a newborn, click the icon to select the appropriate date. BCBSVT AcuExchange Provider Manual Page 36 of 85

37 11. Estimated Delivery Date: Click the icon to specify the estimated birth date. 12. Provider (1 st Line) The attending Provider- provider that is attending the service. Use the icon to select the provider attending the service(s). 13. Provider (2nd Line) Facility. Click the Icon to select the appropriate facility for our facility list. If the facility you are referring the member to is a noncontracting facility, enter provider in the External Provider ID field. You MUST enter the following information when entering a non contracting facility into the Clinical Rationale Section or the request will not process correctly. Facility name Provider s full legal name Address Mailing address if different Phone number including area code UR department fax number UR department contact person UR department phone number including area code and any applicable extensions Patient s medical record number for that facility if known. 14. Provider (3rd Line) - If you need to enter additional providers (such as a primary care physician), click the Icon to select another provider. If the additional provider is a non-contracting provider (most providers not close to our borders do not contract with BCBSVT) enter provider in the External Provider ID field. You MUST enter the following information when entering a non contracting provider into the Clinical Rationale Section or the request will not process correctly. Facility name Provider s full legal name Address Mailing address if different Phone number including area code UR department fax number UR department contact person UR department phone number including area code and any applicable extensions Patient s medical record number for that facility if known BCBSVT AcuExchange Provider Manual Page 37 of 85

38 15. Diagnosis: Enter the diagnosis or click the icon to select. You may add additional diagnoses. 16. Procedure: Enter the procedure or click the icon to select. You may add additional procedures. Although the procedure code is not required we recommend that one is entered to prevent the reviewer from possibly requiring additional information and delaying the decision. 17. Rank: Use the icon to select the Rank for the Procedure. 18. Request Date: The request date is required. It defaults to the data and time of entry and should not be changed. 19. Days: The number of days is required; if unknown (such as in the event of an emergency admission) enter one (1). 20. Service Type: Click the icon to select the level or type of service being selected. 21. Clinical Rationale for Admission: If you choose not to attach notes to the authorization you may manually enter pertinent clinical data in the first field available. When you are referring to a provider who you could not find a record for you must enter the provider information (to include their name, mailing address and fax or phone information) in the second field available. 22. Attachments can be added by clicking on the icon. 23. Submit or Cancel Request: Press to submit or cancel the request being entered. BCBSVT AcuExchange Provider Manual Page 38 of 85

39 Chapter Five Submitting an Outpatient Request AcuExchange can receive requests for outpatient services that are pre or post service. There are fields you are required to complete, and in some cases, there are not fields available for necessary information so you will need to enter a message to provide this information. This section will explain to you what fields are required when submitting a request, how to attach the supporting documentation related to that request, and how to view and enter notes related to that request. Basic Icons Both the inpatient and outpatient request submission tabs share the basic icons shown and described below. Calendar Lookup Brings up a calendar for you to select the date to assign to a field. AcuExchange Lookup Brings up a look up search window where you can select from a list of available options for a particular field. Drop Down Data Window Displays a drop down window that provides detailed information related to that field. Attachment Signifies an attachment can be added to the field. Outpatient Requests This screen is used to create a request for outpatient services that are home, facility or office based. There is a section that will allow you to attach documents to this request. After a request is created it can be viewed by both the provider (on the Current Requests tab), and by the reviewer at BCBSVT. Creating a New Outpatient Request 1. Log in to AcuExchange 2. Click on the New Outpatient Request tab. BCBSVT AcuExchange Provider Manual Page 39 of 85

40 NOTE: All fields shown in red are mandatory fields that must be filled in before you ll be able to submit your request. 3. Complete all fields as indicated below: a. Reference # A read only field that displays the number for this Authorization Request. b. Entered By (First Name) Identifies the person who entered the information, so they can be contacted if there are any questions. This is a mandatory field for submitting a request. c. Request Date This field defaults to the current date and time and should not require change. d. Phone Enter your phone number in case the Reviewer needs to contact you. e. Member ID For security reasons, you must manually enter the member s ID; there is no look up feature where you can select the member from a list of those on the policy. Once you enter the Member ID and press the TAB button. (Pressing the enter button will not be successful) It will auto-populate the field with the member s name, both first and last and date of birth. BCBSVT AcuExchange Provider Manual Page 40 of 85

41 You will need to include the members prefix for Federal Employee Members (prefix R) You will need to include the members prefix New England Health Care members (prefix CTN, CTP, EHF, EHG, EHH, EHJ, NHN, NHP, MEN, MEP, MTN, MTP, YGL, YGE, YGI). For all other Blue Cross and Blue Shield of Vermont members, do not include the prefix, the member ID needs to be only the numeric values of an ID number. You must include the last two digits known as the dependent code (00, 01, 02, etc) at the end of the member s ID number. f. First Name, Last Name, and Birth Date these are systematically populated with the patient s birth date based on the member ID that was entered above. g. Retro Request - Identifies if the patient has had the Service/Procedure and defaults to No since requests are normally submitted prior to the procedure. We expect home health agencies to make the initial visit to do an evaluation and determine a treatment plan prior to contacting us for approval so in this instance you will not check yes even though your first visit was conducted prior to the request submission. All other services would be considered retrospective if services started or were rendered prior to the request being submitted. Click Yes, if the service/procedure has already been done. Click No if the patient has not had the service/procedure yet. h. Setting Click the icon to select the setting. Once selected this field will become read only. i. Provider (1 st Line) The attending Provider- provider that is attending the service. Use the icon to select the provider attending the member. (2nd Line) Facility. Click the Icon to select the appropriate facility for our facility list. If the facility is a non-contracting facility, enter provider in the External Provider ID field. You MUST enter the following information when entering a non contracting facility into the Clinical Rationale Section or the request will not process correctly. Facility name Provider s full legal name Address Mailing address if different BCBSVT AcuExchange Provider Manual Page 41 of 85

42 Phone number including area code UR department fax number UR department contact person UR department phone number including area code and any applicable extensions Patient s medical record number for that facility if known j. Role (3rd Line) - If you need to enter additional providers (such as a primary care physician), click the Icon to select another provider. If the additional provider is a non-contracting provider (most providers not close to our borders do not contract with BCBSVT) enter provider in the External Provider ID field. You MUST enter the following information when entering a non contracting provider into the Clinical Rationale Section or the request will not process correctly. Facility name Provider s full legal name Address Mailing address if different Phone number including area code UR department fax number UR department contact person UR department phone number including area code and any applicable extensions Patient s medical record number for that facility if known (1 st Line) Describes the role of the Provider. Defaults to Attending Provider and should not be changed or removed. (2 nd Line) Facility is the defaulted role of the second provider and should not be changed or removed. (3rd Line) Defaults to Requesting Provider and should not be changed or removed. k. Diagnosis Enter the diagnosis or click the Icon to select the Patient s diagnosis. Once selected an Icon will appear to the right of it. Click the Icon if you need to remove the diagnosis. After you add a Diagnosis, another empty diagnosis field will appear on the next line allowing you to add an additional diagnosis; if you have no additional codes to enter, do nothing with the subsequent line. If you frequently use the same codes you can manually BCBSVT AcuExchange Provider Manual Page 42 of 85

43 type in your diagnosis codes without having to use the lookup button. If it is a valid code it will populate the code description in the field to the right. Rank The first diagnosis s rank field is read only and will default to the value of Admitting Diagnosis. You can select the rank for subsequent diagnosis codes by clicking the Icon. l. Number of Services Enter in the number of services you are requesting. m. Service Type Click the icon to select the Service Type. Once selected this field will become read only. Click the Add Another Service Button to add another service line to this Request. You have the option to add an attachment to this field. This could be anything that you would want to have linked to this particular request including color photos. n. Request Date Defaults to today s date and time and should not be changed. o. Start Date Will default to today s date but can be changed by using the Icon and clicking on the chosen date. p. End Date Default date will be automatically entered. You can choose a different date by using the Icon and clicking on the chosen. q. Procedure Enter the procedure code or click the Icon to select a procedure related to the request. If you frequently use the same codes you can manually type in your procedure codes without having to use the lookup button. If it is a valid code it will populate the code name in the description field to the right. Although this field is not required to submit your request, you are strongly encouraged to enter a CPT or HCPCS code. Requests may be delayed without a code in this field as we may request the information from you prior to making a decision. Rank - Use the Icon to select the rank for the procedure. Once selected the field will become read only. *** Chiropractic codes: Only enter the primary (one) code for services requested. AcuExchange is set up to configure chiropractic services into service groups. Entering more than one code will cause errors on the request. r. Add Another Service Click the button to add another line of Service to the referral. Once you click the button a new section of Outpatient Services fields will appear below your previous service and you can BCBSVT AcuExchange Provider Manual Page 43 of 85

44 continue to enter additional services as needed. There will be an Icon next to any additional services you choose to enter in the event that you need to delete it. s. Clinical Rational for Admission You MUST enter the following information in the clinical rationale section when submitting a request for non contracting provider or facility not found in your search or the request will not process correctly. Facility name Provider s full legal name Address Mailing address if different Phone number including area code UR department fax number UR department contact person UR department phone number including area code and any applicable extensions Patient s medical record number for that facility if known. You may enter pertinent clinical data that explains why the patient is being admitted if you elect not to attach the clinical documentation you already have. If you elect to type the information here please ensure that it is complete. If we do not have enough information to make a determination your request will take longer to process as we will request the needed information from you. History, S+S, Treatment Plan, Pervious Admissions, etc Abnormal Clinical Findings, Labs, Tests, X-rays, etc Adding an Attachment AcuExchange allows you to add a document to a request. It can be used to attach such things as diagnostic reports, lab results, progress notes, even color photos. There is no limit on the number of attachments you can add to a request. You can add an attachment to the separate service lines. The attachments will also be viewable by the Reviewer. BCBSVT AcuExchange Provider Manual Page 44 of 85

45 a. Click the Icon to bring up the attachments window. b. Click the browse button to find the file or document you wish to attach to this request. (A window will appear giving you access to your computers files). c. Select the document you want and either double click the file or highlight and click Open to attach it to the Request. d. The filename will appear in the field next to browse. e. Once you submit the request the attachment will be saved with the record. Submitting a Request Once you ve finished filling in all mandatory fields and any other pertinent fields, select the submit request button at the top right of the screen. This saves the request and transfers it to BCBSVT s Task List. It also makes it available for viewing and follow-up on your current requests tab. BCBSVT AcuExchange Provider Manual Page 45 of 85

46 Canceling a Request If you decide you do not want to submit a request you do have the option to Cancel It. 1. Click the Cancel button on the upper right hand portion of the screen. 2. It will give you a warning message: 3. Click OK to close out your screen and cancel your request. Requesting an Extension or Additional Services AcuExchange allows you to add service lines to your outpatient requests. This section details how to add a service line to your outpatient request. 1. Click the New Message Button on the right side of the screen. 2. This will take you to the resubmission field. Select the radio button to the left of the words Extension/ Additional Services. NOTE: This does not mean you are resubmitting the request. It just indicates to the BCBSVT that this message is related to an existing request. BCBSVT AcuExchange Provider Manual Page 46 of 85

47 3. Complete the Required Fields: a. Entered By This field is required. It identifies the person who entered the information, so you can be contacted if there are any questions. To save time, once you ve entered your name it will auto-populate on subsequent screens until you log out. b. Additional Requested Services This is also required. Here you will enter the number of units or days you are requesting. c. Request Date This defaults to today s date and time and should not be changed. d. Start Date This should reflect the date intended for starting these additional services. You can use the calendar to select this or type the date in. e. Service Type Use the binoculars (look up) to select the appropriate service type from the list. f. Provider This defaults to the individual provider logged in. If you are logged in as a group, use the look-up to find the provider in your group who is requesting the extension. g. Procedure Although you can save/submit your note without a procedure code, if we do not know what you are requesting it may take longer to process your request as we may request additional information. For this reason it is strongly advised that you enter a procedure code in this field. BCBSVT AcuExchange Provider Manual Page 47 of 85

48 4. End date, attachments, notes and clinical information supporting your request for the extension should be entered as well. Click the icon to attach any necessary documents to your message. NOTE: The magnifying glass icon will expand the comments in a separate window so you can read without having to use the scroll bar. 5. Click the submit button to send your message. The message will appear on the current status tab along with your initial request and on the reviewer s Task List. 6. Once the BCBSVT responds to your message it will appear on this screen and you can choose to select the reply or completed button. NOTE: If for some reason the correspondence is incorrectly flagged as completed and needs to be reopened, return to this screen and click the not completed button and add your changes. BCBSVT AcuExchange Provider Manual Page 48 of 85

49 New Outpatient Request Submission Tab Quick Reference 1. Click on the New Outpatient Request Tab. 2. Entered By: Enter the name of the person entering the information. 3. Phone: Enter your telephone in case the Reviewer needs to contact you. 4. Member ID: Enter the member ID and dependent code without the prefix. (For an FEP member enter the R prefix; for an NEHP member enter the three letter prefix.) For Blue Cross and Blue Shield of Vermont members you must enter the dependant code. 5. Retro Request: Check Yes if patient has already been admitted; check No if patient has not been previously admitted. 6. Setting: Click the Icon to select. 7. Provider (1 st Line) The attending Provider- provider that is attending the service. Use the icon to select the provider attending the service(s). 8. Provider (2nd Line) Facility. Click the Icon to select the appropriate facility for our facility list. If the facility you are referring the member to is a noncontracting facility, enter provider in the External Provider ID field. You MUST enter the following information when entering a non contracting facility into the Clinical Rationale Section or the request will not process correctly. Facility name Provider s full legal name BCBSVT AcuExchange Provider Manual Page 49 of 85

50 Address Mailing address if different Phone number including area code UR department fax number UR department contact person UR department phone number including area code and any applicable extensions Patient s medical record number for that facility if known. 9. Provider (3rd Line) - If you need to enter additional providers (such as a primary care physician), click the Icon to select another provider. If the additional provider is a non-contracting provider (most providers not close to our borders do not contract with BCBSVT) enter provider in the External Provider ID field. You MUST enter the following information when entering a non contracting provider into the Clinical Rationale Section or the request will not process correctly. Facility name Provider s full legal name Address Mailing address if different Phone number including area code UR department fax number UR department contact person UR department phone number including area code and any applicable extensions Patient s medical record number for that facility if known BCBSVT AcuExchange Provider Manual Page 50 of 85

51 10. Diagnosis: Enter the diagnosis or click the icon to select. You may add additional diagnoses. 11. Number of Services: Enter the number of services requested. 12. Service Type: Click the icon to select the level or type of service requested. 13. Request Date: Defaults to today s date and time and should not be changed. 14. Start Date: Will default to today s date but can be changed by using the icon. 15. End Date: Default to today or select a different date by using the Icon. 16. Procedure: Enter the procedure or click the icon to select. Although the procedure code is not required we recommend that one is entered to prevent the reviewer from possibly requiring additional information and delaying the decision. 17. Rank: Use the icon to select the Rank for the Procedure. 18. Add Another Service: Click to add another service. Repeat steps 16 and 17. BCBSVT AcuExchange Provider Manual Page 51 of 85

52 19. Clinical Rationale for Admission: If you choose not to attach notes to the authorization you may manually enter pertinent clinical data in the first field available. When you are referring to a provider who you could not find a record for you must enter the provider information (to include their name, mailing address and fax or phone information) in the second field available. 20. Attachments can be added by clicking on the icon. 21. Submit or Cancel Request: Press to submit or cancel the request being entered. BCBSVT AcuExchange Provider Manual Page 52 of 85

53 Chapter Six Viewing Correspondence and Working with Existing Requests The current requests screen is the first screen you see when you log into AcuExchange. This screen acts as a worksheet to show you all of the requests created by or assigned to you, the provider or role. It also allows you a quick, easy way to search for requests and track their status. This screen is also referred to as the main browse. Main Browse for an Individual Provider Primary providers and office mangers will be able to see all requests where you are the submitter or requesting provider as well as any requests submitted by another provider that lists you as another provider taking part in this member s care. If you are in the role of the requesting, servicing, or PCP you can see the request, check the details of the request, and of course, check the status of that request. If you are in the role of requesting, you can also send and receive correspondence to and from BCBSVT. When you first log in the screen may be blank; however if your office or facility sends requests requiring prior approval frequently, then there will be several requests listed. You can tell you have requests because the screen will display a note saying records found # on the upper left side of the screen. You can enter up to 999 records to be retrieved by changing the retrieve limit and then clocking the show requests button. Clicking on the show requests will show you the requests you have on file with us. Action Required If an action is required on your part, you will see a blinking green dot in the 1 st column of the main browse, next to the request. Once you open the request and complete the required actions the green dot will disappear. BCBSVT AcuExchange Provider Manual Page 53 of 85

54 The current requests screen, or main browse, is set up in column format. Here you can view all of the following (you can also sort or filter on many of these) data elements: 1. - This column will contain a Green Blinking Light if the request needs immediate action. Once action is taken on that request the blinking green dot will disappear. 2. Primary Provider The admitting physician for the request. 3. Member Name The first and last name of a patient. 4. Member ID The unique ID associated with a patient. 5. Request Date The date when the request was made. 6. POS (Place of Service) indicates if the request is an Inpatient (IP) or Outpatient (OP) Request. 7. Transaction Type Specifies whether the request is for an authorization or referral BCBSVT does not use referrals in this system. 8. Service Type A description of the authorization service if the auth/referral is approved, otherwise it is the description of the request/service. 9. Status The status of the request. It can be approved, suspended, or denied. 10. Secondary Provider Any secondary provider/facility associated with the request. 11. Entered By - Identifies the person who entered the information, so they can be contacted if there are any questions. 12. Request ID The authorization Number that the request is associated with. You can use the entire search and filter capabilities explained in chapter three of this manual in this main browse or current requests screen. Detailed Review Double click on the request you wish to access to open it. The request will open on the current status tab. BCBSVT AcuExchange Provider Manual Page 54 of 85

55 Current Status Tab The current status tab tracks all submitted inpatient and outpatient requests. It displays detailed information related to the service items requested and the overall authorization. The correspondence field provides an area for notes between the provider and reviewer. The current attachments area displays attachments. NOTE: This screen will function and look the same for both inpatient and outpatient requests. General Information Mini Browse The mini browse at the top of the screen will display each of the service line items for the authorization. (See image above) Service Items The service line items will be displayed in descending order according to the entry date; therefore the most recent item will be on top. The service items area is populated with information regarding the service request that is selected in the mini browse. Authorization Totals The authorization totals area is a summary of information entered by the reviewer. BCBSVT AcuExchange Provider Manual Page 55 of 85

56 Correspondence The correspondence section will display all tasks associated with the highlighted service line item. A task is a message sent to and from BCBSVT that triggers actions. The tasks will be displayed in descending order of entry date with the most recently created task on top. Once you ve created a new request, a message is displayed in this correspondence field. This default message is automatically entered, saving you time. It also displays the name of the requestor, i.e. Shelby, in the image above, which is based on the name entered in the entered by (first name) text field on the original request. Viewing Existing Correspondence As discussed in previous chapters, you will know when there is correspondence that you need to take action on because there will be a blinking green light on the current requests screen beside the request. To view the correspondence on all requests, if there is actions required or not, open the request. On the current status tab, scroll down to the correspondence section. If the correspondence is larger than the viewing box, it will have a scroll bar inside it; use this to see the full text. New Message When you need to request a cancellation of an existing request, submit additional information, ask a question, voice a concern, or request an extension you will use this BCBSVT AcuExchange Provider Manual Page 56 of 85

57 button. BCBSVT does not see correspondence you enter in a note on AcuExchange. You must enter a new message to send clinical information or request extensions. Creating a New Message The new message button allows providers to communicate with BCBSVT. It is used to ask questions, add additional information to a request, ask questions and ask for a request to be deleted. For outpatient authorizations it can be used to request extensions as well. 1. Click the New Message Button on the right side of the screen BCBSVT AcuExchange Provider Manual Page 57 of 85

58 2. This will take you to the resubmission field. Select a radio button to specify what your correspondence is concerning. NOTE: This does not mean you are resubmitting the request. It just indicates to the BCBSVT that this message is related to an existing request. 3. A new message creates a task for BCBSVT to take action. Each of these options is explained below. a. Request for Deletion Use this when you no longer need the authorization. An example of this is a cancelled procedure. Requests will not be deleted as that would permanently and completely remove them from the system, but they will be closed. b. Additional Info Use this when you are submitting additional information regarding your request for authorization. c. Question/Concern Use this when you need us to take an action other than closing an authorization or reviewing additional information. d. Extension/Additional Services is covered in chapter five and is only available on an outpatient request. An inpatient request will not have this button in the resubmission box. BCBSVT AcuExchange Provider Manual Page 58 of 85

59 4. The entered by field is required. It identifies the person who entered the information, so you can be contacted if there are any questions. To save time, once you ve entered your name it will auto-populate on subsequent requests until you log out. 5. Click the Icon to attach any necessary documents to your message. 6. Type your comments, questions, concerns, or requests in the comment field. If you are asking to delete a request, be sure to explain why. NOTE: The magnifying glass icon will expand the comments in a separate window so you can read without having to use the scroll bar. 7. Click the submit button to send your message. The message will appear on the current status tab along with your initial request and on the reviewer s task list. 8. Once the BCBSVT responds to your message it will appear on this screen and you can choose to click the reply or completed button. NOTE: If for some reason the correspondence is incorrectly flagged as completed and needs to be reopened, return to this screen and click the not completed button and add your changes. BCBSVT AcuExchange Provider Manual Page 59 of 85

60 Assessments An assessment is a function used in AcuExchange for you to provide the BCBSVT with additional information to determine if the criterion meets the requirements for an automatic approval. Here is the list of automatic approval assessments available: Capsule Endoscopy Chiropractic services Continuous Positive Airway Pressure or BiPhasic Positive Airway Pressure (CPAP/BIPAP) unit Genetic Testing for Pregnancy Monitored Anesthesia for an Endoscopy Non-emergency ambulance transport Oral Appliances for Obstructive Sleep Apnea Sleep Studies Varicose Vein Surgery BCBSVT AcuExchange Provider Manual Page 60 of 85

61 To access an assessment form you must be on the current request tab. Instructions on assessments are in a later chapter of this manual. Notes Notes are used by BCBSVT to document actions taken that are related to the request. You will use the note button only to provide contact information for non-contracting providers inside and outside the state of Vermont when you are referring members to them. Creating a Note Notes do not trigger any notification to BCBSVT. Since notes are a default tool in the AcuExchange, users MUST NOT use as a method to communicate with BCBSVT. You can use notes to record things such as medical records, non-contracting provider information and information you use internally such as I called Amy at BCBSVT to see why this authorization is still suspended on Monday, June 17, 2013 at 9:36 a.m. 1. Click on the notes button. This will take you to a screen where you can add a new note. BCBSVT AcuExchange Provider Manual Page 61 of 85

62 2. Click the new button to create a new note. This will take you to a screen that has a large text box. 3. Enter the provider s information and then click save. Your note will show up in the mini-browse at the top of the screen. NOTE: Once a note is created it can t be deleted. BCBSVT AcuExchange Provider Manual Page 62 of 85

63 You have now successfully added a note, which you and the reviewer can view however; the reviewers may never review your note unless you send a message specifically requesting them to do so. Requests with notes attached to them will be flagged with an icon so you ll know immediately if a record has a note associated with it. Reminder that notes must not be used to correspond with BCBSVT. Notes should be used only for provider use. Use a message to correspond instead. Viewing a Note There are two radio buttons shown at the top of the New Notes screen. a. View all for: Service Displays only notes associated with the particular service record. b. View all for Group Displays all notes associated with the entire Authorization. BCBSVT AcuExchange Provider Manual Page 63 of 85

64 The contents area displays the contents of the selected note. In the example above it is the decision verbiage BCBSVT entered in the note for the approval. Reports Run reports (currently only two reports are available) and review determination and request for additional information letters regarding your authorization from the reviewer. Instructions on reports are in this manual. BCBSVT AcuExchange Provider Manual Page 64 of 85

65 Chapter Seven Automatic Approvals and Assessments Types of Automatic Approvals Automatic approvals are systemically approved outpatient authorizations where an assessment has been completed that meets clinical criteria based on BCBSVT medical policies. The following procedures may qualify for an automatic approval: Capsule Endoscopy Chiropractic Services Continuous Positive Airway Pressure or BiPhasic Positive Airway Pressure (CPAP/BIPAP) unit Genetic Testing for Pregnancy -Trisomy 21 Monitored Anesthesia for an Endoscopy Non-Emergency Ambulance Transport Oral Appliances for Obstructive Sleep Apnea Sleep Study Adult Varicose Vein Surgery Eligibility Messages Once you complete and submit the outpatient request tab for one of the services above an eligibility message will appear. The image below is an example of the expected message. Capsule Endoscopy: (CPT: ) Chiropractic Services: (CPT: 71100, 72010, 72020, 72040, 72050, 72052, 72070, 72074, 72080, 72100, 72110, 72114, 72120, 72170, 72200, 73000, 73010, 73020, 73030, 73040, 73050, 73060, 73070, 73090, 73100, 73110, 73115, 73120, 73140, 73500, 73510, 73520, 73550, 73560, 73562, 73564, 73590, 73600, 73610, 73620, BCBSVT AcuExchange Provider Manual Page 65 of 85

66 73630, 73650, 73660, 97032, 97033, 97034, 97035, 97110, 97112, 97140, 97530, 98940, 98941, 98942, 98943, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99251, 99252, 99253, 99254, 99255, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350) *** Chiropractic codes: Only enter the primary (one) code for services requested. AcuExchange is set up to configure chiropractic services into service groups. Entering more than one code will cause errors on the request. Continuous Positive Airway Pressure or BiPhasic Positive Airway Pressure (CPAP/BIPAP) unit: (HCPCS: E0601, E0470, E0471, E0472) Genetic Testing for Pregnancy Trisomy 21: (CPT: 81599) Monitored Anesthesia for an Endoscopy and Colonoscopy: (CPT: 00810, 00740) Non-Emergency Ambulance Transport: (HCPCS: A0425, A0426, A0428) Oral Appliances for Obstructive Sleep Apnea: (HCPCS: E0485 and E0486) Sleep Study Adult: (CPT: 95800, 95801, 95806, 95807, 95808, 95810, and HCPCS G0398, G0399, G0400) Varicose Vein Surgery: (CPT: 36468, 36469, 36470, 36475, 36476, 36478, 36479) What is an Assessment? An assessment is a tool used in AcuExchange for users to provide the BCBSVT with the clinical information needed for a systemic review of information, which may result in an automatic approval. The questions range from general data entry fields to very specific medical information. The questions on the assessments are tailored to the type of authorization request. The answers to the assessment questions determine if approval criteria is met. If the request is automatically approved your request you will see a popup message. There are only two decisions; approved or referred for clinical review. Approvals systemically take minutes to reflect an approved status. The current status tab will show a suspended status until the refresh occurs. BCBSVT AcuExchange Provider Manual Page 66 of 85

67 How to Complete an Assessment Once you have completed your authorization request and submitted it, double click on your authorization from the current request tab and follow the instructions below: 1. Click on the assessment button from the menu on the right on the current status tab of the outpatient request. 2. Click on the new button from the menu on the right. 3. Click on the assessment corresponding to the service entered on the outpatient authorization. BCBSVT AcuExchange Provider Manual Page 67 of 85

68 4. Complete the assessment by answering the questions on the form. BCBSVT AcuExchange Provider Manual Page 68 of 85

69 5. Click save button from the menu on the right. If the data entered is sufficient to prompt an approval, AcuExchange will display an approval popup message, shown below. The system will take minutes to refresh and reflect the approval. If the information entered is not sufficient, the message below will popup. Click the ok button and return to the current requests tab. BCBSVT will process your request as soon as possible. You can monitor the status in AcuExchange. BCBSVT AcuExchange Provider Manual Page 69 of 85

70 Chapter Eight Reports What are reports? Reports are images of letters sent by BCBSVT or standard generic queried data within the requests that can be previewed or printed. The report buttons are used to view a decision or request for additional information letter regarding your authorization submitted by the reviewer, obtain a summary of the information you entered into the authorization or obtain a listing of all requests you submitted. How to Review a Decision or Request for Additional Information Letter If a decision or request for additional information letter is available once clicked on the authorization from the current request tab the open report folder icon will show on the report tab. To view the letter, follow the instructions below: 1. Click on the reports tab from the menu on the right on the current requests tab 2. Highlight the letter you wish to view by clicking on the line. When it is selected the line will be blue. BCBSVT AcuExchange Provider Manual Page 70 of 85

71 3. Click view image button next to the done button. You may get warnings as the adobe product opens the letter. If you click through them the letter will open so you can view or print it. How to run a report specific to a request 1. To run a report specific to an inpatient or outpatient request you have submitted find the authorization in your current requests. 2. Double click on the request to open it BCBSVT AcuExchange Provider Manual Page 71 of 85

72 3. Click on the inpatient or outpatient request tab (only the applicable is available) 4. Click on the reports button from the menu on the right 5. Click the new button from the menu on the right BCBSVT AcuExchange Provider Manual Page 72 of 85

73 6. Select the inpatient authorizations detail report if you are in an inpatient request or the outpatient authorizations detail report if you are in an outpatient request. 7. Select preview or print depending on your desired action. How to run an aggregate report 1. Click on the current requests tab and click on the report from the menu on the right. 2. This will open the report listing for you: BCBSVT AcuExchange Provider Manual Page 73 of 85

74 3. Select the one you want (in this example the top report is for inpatient requests and the bottom one is for outpatient requests) and click the preview or print button. Disregard all the other group options. 4. Complete any prompts that pop up such as a start and end date for a report: 5. Click next all prompts but the last prompt, which will be finish. At the end of the prompts your report will preview or print based on your previous selection. BCBSVT AcuExchange Provider Manual Page 74 of 85

75 AcuExchange Appendix A General Terminology and Icons General Terminology AX: An abbreviation for the AcuExchange online prior approval tool. AcuExchange User: A provider, physician, facility, clinician or other role assigned in the Provider Resource Center role with AcuExchange user account access AcuExchange Administrator: An application specialist who has privileges to modify the AcuExchange options through the security settings. BCBSVT: Blue Cross Blue Shield of Vermont. Reviewer: A member of the Blue Cross and Blue Shield of Vermont s medical staff assigned to processing AcuExchange requests. Request: A new authorization or referral record created by an Acuexchange user. Main Toolbar Icons Workflow Help Shows helpful text pertaining to the screen you are currently viewing. The text can be turned on and off. Open Reports Folder Access the reports module to run reports that have been set up by BCBSVT. On any screen in AcuExchange, you have the ability to select and run reports. By clicking the icon at the top of the screen, you will have access to the Report Selection screen where you can select from various reports that your system administrator set up. Previewing or Printing a General Report: 1. Click the icon to access the report selection window. 2. The View Option Filter will default to show you all available reports. 3. Select and highlight the report you wish to preview/print from the right hand side of the screen. 4. Click the Preview or Print Button. 5. If the report contains any prompts these will appear and you can answer the questions as necessary. BCBSVT AcuExchange Provider Manual Page 75 of 85

76 6. It will then generate your report using any information you may have provided in the prompts. Security Settings Allows users to change AcuExchange password and address. Exit Application Exit the AcuExchange portal. Basic Icons Calendar Lookup Brings up a calendar for you to select the date to assign to a field AcuExchange Lookup Brings up a look up search window where you can select from a list of available options for a particular field Drop Down Data Window Displays a drop down window that provides detailed information related to that field. Attachment Brings up the attachment window. Click to attach clinical information housed on your computer or network file locations. BCBSVT AcuExchange Provider Manual Page 76 of 85

77 AcuExchange Appendix B Provider Roles Provider Roles Provider Roles are required for all providers on an authorization. For inpatient requests the first role defaults to attending provider and the second role defaults to facility. For all outpatient requests the first role defaults to requesting provider. The second position should be either the servicing provider role or one of the out of state providers. Facility Use the facility on either an inpatient or an outpatient request. The facility is required for inpatient admissions, including skilled nursing facilities, inpatient rehabilitation facilities, private duty nursing and hospitals/medical centers. Attending Use the attending physician for an inpatient authorization when the attending provider is a BCBSVT participating provider. Requesting Use the requesting provider when the provider is the party requesting g the patient receive the care. Servicing Use the servicing provider on outpatient requests to identify who will be rendering care or providing equipment or supplies. PCP List the primary care physician on the request (inpatient or outpatient) in the third role field if applicable. Adding the member s PCP to the request enables that provider (if he or she is registered with AcuExchange) to see the status of this request and receive copies of the notification of decision and any request for additional information letters we send. If the PCP is unknown or is the requestor, do not use this code. Out-of-State Provider We have a few providers who are located outside of Vermont who are participating with us and therefore able to locate in the provider lookup feature. If you are referring a member to a provider who is not participating with BCBSVT, then use the out-of-state provider as a last resort. Use the provider type or role of OOS Provider and put that provider s actual name, address, phone and/or fax in the clinical rationale section on the authorization request. If the provider is an out-of-state provider or non-contracted provider then a generic out of state provider number should be used which is Enter into the BCBSVT AcuExchange Provider Manual Page 77 of 85

78 external provider ID search field of the AcuExchange LookUp window. The out of state provider should be the only record retrieved. See image below. You MUST enter the following information when entering an Out of State facility and/or provider into the Clinical Rationale Section or the request will not process correctly. Facility name Provider s full legal name Address Mailing address if different Phone number including area code UR department fax number UR department contact person UR department phone number including area code and any applicable extensions Patient s medical record number for that facility if known Out-of-State Hospital - We have a few facilities/hospitals that are out of Vermont who are participating with us and therefore able to locate in the provider lookup feature. For those facilities who are not participating with us (in or out of state), or as an absolute last resort when you cannot find one you are looking for, you will use the provider type or role of OOS Hospital. If the facility or hospital is out-of-state or non-contracted then a generic out of state provider number should be used which is Enter into the external provider ID search field of the AcuExchange LookUp window. The out of state provider should be the only record retrieved. See image below. You MUST enter the following information when entering an Out of State facility and/or provider into the Clinical Rationale Section or the request will not process correctly. Facility name Provider s full legal name Address Mailing address if different Phone number including area code UR department fax number UR department contact person BCBSVT AcuExchange Provider Manual Page 78 of 85

79 UR department phone number including area code and any applicable extensions Patient s medical record number for that facility if known Do not use the Alt_Recipient or BB_OB code roles. BCBSVT AcuExchange Provider Manual Page 79 of 85

80 AcuExchange Appendix C AcuExchange Frequently Asked Questions QUESTION How do I register for AcuExchange? AcuExchange works in which browsers? ANSWER Access the Provider Resource Center (PRC). Once the user is registered for the PRC their user ID for AcuExchange is created. The user must complete the registration process detailed in Chapter one Accessing AcuExchange of the AcuExchange Provider Manual. AcuExchange is a web-based program that functions best when accessed via Internet Explorer (IE) version seven (7) or FireFox version three (3). In addition, more recent versions of either browser are acceptable. Allow pop-ups messages and verify the Override Automatic Cookie Handling box is unchecked. Follow these instructions to verify this setting: 1. Open your internet browser 2. Go to the Tools menu 3. Click on Internet Options 4. Click on the Privacy tab See images to change setting based on browser type BCBSVT AcuExchange Provider Manual Page 80 of 85

81 Is AcuExchange secure? What if I have tried unsuccessfully to login three (3) times and now I am not able to log in? What happens if the AcuExchange portal times out? What if there are topics not covered in this document? Yes - AcuExchange is a secure system that follows HIPAA guidelines. If a user fails to log in after three attempts they need to close all the web browsers and try again after waiting 20 minutes. If they do not close the browser first it will not work. If the login issues continue, access Chapter Two AcuExchange Login Process and Troubleshooting of the AcuExchange Provider Manual for additional assistance. The application will timeout after one (1) hour and you will be required to close all of your browsers and log back in to continue using it. Access Chapter Two AcuExchange Login Process and Troubleshooting of the AcuExchange Provider Manual for additional assistance. Call us at or send an to AcuExchange@BCBSVT.com PASSWORDS What are the password rules? 1. Password length: Passwords must be between eight (8) and 40 characters 2. Restricted Characters: These characters are not allowed: + / \ 3. Character Varieties: Passwords must have 3 of the 4 character varieties: (upper case alpha, lower case alpha, numeric, special) 4. Dictionary Words: Words that are found in the dictionary cannot be used 5. Account Name: Passwords can only contain three (3) consecutive characters of your account name. 6. Patterns: Passwords cannot contain more than three (3) consecutive patterned characters (2222aaaaa, , ABCDEFGH, etc) 7. Password Reuse: Passwords cannot be reused until 24 months have passed 8. Unique Passwords: Consecutive passwords cannot have matching sequences of four (4) or more characters. BCBSVT AcuExchange Provider Manual Page 81 of 85

82 I am getting an error message, what do I do? Why isn't it allowing my password hint? I am getting an error message that says error setting account telling me the username and password already exist, what do I do? Access Chapter Two AcuExchange Login Process and Troubleshooting of the AcuExchange Provider Manual for additional assistance. Verify that the password is not part of the password hint. Access Chapter Two AcuExchange Login Process and Troubleshooting of the AcuExchange Provider Manual for additional assistance. If you get the error, close all the browsers, go back in, and try again to log in. Access Chapter Two AcuExchange Login Process and Troubleshooting of the AcuExchange Provider Manual for additional assistance. MINOR TECHNICAL ISSUES I am getting the too many failed logins error, what do I do? How do I attach clinical information? Close all web browsers and wait 20 minutes. Log back into the PRC and then access AcuExchange. Advise the provider to access Chapter Two AcuExchange Login Process and Troubleshooting of the AcuExchange Provider Manual for additional assistance. When entering an authorization in AcuExchange click on the yellow paper-clip. Adding an attachment to a New Authorization Request: 1. Click the Browse button to find the file or document you wish to attach to this Request. (A window will appear giving you access to your computers files). 2. Select the document you want and either double click the file or highlight and click Open to attach it to the Request. 3. The filename will appear in the window. 4. You can now choose to click Browse to add more attachments, Delete to delete the attachment, or Close to go back to the request window. The attachments will be saved with the record. Adding an attachment to an existing Authorization: 1. Double-Click to open the authorization request 2. Click the New Message button 3. Scroll down to the bottom of the screen to the Resubmission Section. After filling in the details for the new message, click on the Attachments Icon. A new window will open up. 4. Click on the Browse button in the upper right. BCBSVT AcuExchange Provider Manual Page 82 of 85

83 5. Navigate and select the file you want to load into AcuExchange. 6. Click Open. The new file is loaded into AcuExchange. 7. Click "Close" to return to the New Message section. What types of attachments are accepted? How do I request an extension? What is the difference between a message and a note? How do I view letters? What does the green blinking light on the far left mean? I entered a request and a pop up message told me to complete an assessment. What is an assessment? Microsoft Word, Microsoft Excel, TIF, JPEG, PDF, GIF, etc. Most types are accepted. Click New Messages and choose Extension/Additional Services. Enter your name and click submit. Access the AcuExchange Provider Manual for additional assistance. You should always use a message instead of a note when communicating with BCBSVT. The notes are not viewable by BCBSVT. Notes are for internal provider use only. Access the AcuExchange Provider Manual for additional assistance. Letters can be viewed on the Attachments tab within AcuExchange. Click on the attachment and a list of available letters or attachments will be listed. Choose the applicable letter. Access the AcuExchange Provider Manual for additional assistance. The green blinking light means this service request needs your attention. A task was created in AcuExchange by BCBSVT. We are requesting additional information in order to complete our review. Access the AcuExchange Provider Manual for additional assistance. An assessment is a function used in AcuExchange for you to provide the reviewer with additional information. Here is the list of automatic approval assessments available: Capsule Endoscopy Chiropractic services Continuous Positive Airway Pressure or BiPhasic Positive Airway Pressure (CPAP/BIPAP) unit Genetic Testing for Pregnancy Monitored Anesthesia for an Endoscopy Non-emergency ambulance transport Oral Appliances for Obstructive Sleep Apnea Sleep Studies Varicose Vein Surgery BCBSVT AcuExchange Provider Manual Page 83 of 85

84 How do I create a filter? A provider in our practice is not listed, how do I get them listed? Access the AcuExchange Provider Manual for additional assistance. Filters decrease the number of records retrieved when using the search wizard in AcuExchange. You can access the search wizard by clicking on the green bar at the top of each column on the Current Request tab. Once you have set you search criteria, save the filter. Saved filters are helpful and save time because you will not have to reapply the search criteria each time you access the search wizard. Filters can be set for any column in a browse view, and there are no limitations on the number of filters that can be used. Saved filters are specific to a user's login ID. Several things could be happening. You do not have any requests listed or; You are not associated with the tax ID provided when the PRC registration occurred or; There was a data feed error, in which BCBSVT must investigate. Please verify the information you entered is accurate and if you find errors, correct any deficiencies and then click request account button. Access Chapter Two AcuExchange Login Process and Troubleshooting of the AcuExchange Provider Manual for additional assistance. If these actions do not resolve the issue, contact Customer Service to determine if the provider is still active in our system. If the provider is not active then this message is correct. If the provider is an out-of-state provider or noncontracted provider then a generic out of state provider number should be used which is Enter into the external provider ID search field of the AcuExchange LookUp window. The out of state provider should be the only record retrieved. See image below. You MUST enter the following information when entering an Out of State facility and/or provider into the Clinical Rationale Section or the request will not process correctly. Facility name BCBSVT AcuExchange Provider Manual Page 84 of 85

85 Provider s full legal name Address Mailing address if different Phone number including area code UR department fax number UR department contact person UR department phone number including area code and any applicable extensions Patient s medical record number for that facility if known A provider who left our practice is listed, how do I get them off our list? Account is disabled Provider not found in list It may take up to 72 business hours to process a termination request submitted through the PRC. If it has been more than 72 business hours, please call us at or AcuExchange@BCBSVT.com as there may be an issue. If your account is disabled it means you're no longer contracted with us. Call us at or AcuExchange@BCBSVT.com as there may be an issue. It may take up to 72 business hours to process a termination request submitted through the PRC. If it has been more than 72 business hours, please call us at or AcuExchange@BCBSVT.com as there may be an issue. BCBSVT AcuExchange Provider Manual Page 85 of 85