Idaho Medicaid: Continued Stay Review Submission Update. February 20 and February 22, 2018

Transcription

1 Idaho Medicaid: Continued Stay Review Submission Update February 20 and February 22, 2018

2 Agenda Telligen Provider Portal Extend Continued Stay submission Date of Service changes Provider Address updates Reasons to submit reviews through the Portal Q&A 2

3 Provider Portal Training for Continued Stay Review Submission 3

4 Telligen Portal Concurrent Review Submission Update Telligen has improved the continued stay review submission process to make submission easier. Log in to the Telligen Provider Portal at idmedicaid.telligen.com Use the Sign In link on the top right corner of the page. 4

5 Patient Portal: Case ID Search the queue for previously submitted Prior Authorization or Concurrent review A User can search for a case using the search fields or by navigating through the pages. Once the case has been located, click on the Case ID field to select it. 5

6 Case Details: Request Continued Stay When you select the Case ID, the system opens the Case Details page. Use the details at the top to confirm that you have selected the case for the correct person. If this is the correct case to extend, click on the Request Continued Stay button. If this is not the correct case, you can click the done button and return to the queue. 6

7 Provider Portal: Extend Review New Reference ID is assigned If Admission date has changed from what was submitted on Prior Authorization, select Yes here. If not, select No. Enter any relevant information necessary to support why stay should be extended. 7

8 Provider Portal: Admission Date Change If admission date has changed, enter the correct Admit date in the box provided. Send an to with the Case ID and the correct admission date so that the information can also be updated in MMIS. 8

9 Auto Authorization Follow the Auto-Authorization screens, if applicable, to document any necessary clinical data. 9

10 Attach Clinical Documentation Upload any necessary clinical documentation to support the extension. All uploaded documents are scanned and checked for viruses. If you upload a document and you receive a red X on the accepted document type, you will need to delete the document and try a different one. 10

11 Summary and Attestation Finalize the review by reviewing all of the information at the top. Always confirm that the Admit date is correct. Type Username in the box and click the Done button to submit. 11

12 Tips and Tricks Do not enter a discharge date for Concurrent/Continued Stay Reviews. If a discharge date was entered, the original review submission process will need to be followed. The Extend Continued Stay Button is available for 31 days following the date the review was completed as approved or partially approved. 12

13 Dates of Service Changes 13

14 How to Process Date of Service Changes Two options for date of service changes: If the date of service change is for an Outpatient procedure that has already been approved and the procedure has happened, send a secure with the Member s name, Medicaid ID Number, Reference ID, Authorization Number, and actual date of service, to MedicaidQIO@dhw.idaho.gov If the date of service change is for an Inpatient stay or for a review that has not been completed yet, send a secure with the Member s name, Medicaid ID Number, Reference ID, Authorization Number, and actual date(s) of service, to blavarello@telligen.com 14

15 Provider Address Updates 15

16 Important: Update Any Address Changes with Molina Telligen sends letters to Providers for all approved, partially approved, and denied reviews and any Additional Information Requests. These letters contain PHI to allow the provider to identify the member that the review was for. Telligen receives a daily Provider file that contains all of the providers and their addresses so that reviews can be processed correctly and efficiently. If the provider address is not correct in the Molina system, the letters are going to incorrect addresses which could result in an information breech. 16

17 Important: Update Any Address Changes with Molina Telligen does not have the ability to make any updates. Please see the information below found in the Idaho MMIS Provider Handbook. Provider File Updates After enrolling, any updates that need to be made to the provider file can be done through the online portal at the Molina Medicaid website. Once on the home page, click on the Provider Enrollment link and choose either Provider Maintenance-Demographic or Provider Maintenance (Full) to electronically maintain your provider record. If you are unable to make updates via the online portal, providers must notify Provider Enrollment, in writing, when there are changes in their status. 17

18 Important: Update Any Address Changes with Molina Provider maintenance forms may also be found at Molina Medicaid. The written notice must include the provider name and current NPI or Medicaid provider number. Status changes include: Change in address (or change in any other provider s address, if a group practices) New phone number Name change (individual, group practice, etc.) Change in ownership Change in tax identification information Change in provider status (voluntary inactive, retired, etc.) must be written notification Add/update/end date of rendering providers Add/update/end date of service locations 18

19 Important: Update Any Address Changes with Molina The link below should get you to the correct page to initiate the provider address change. spx Click on Provider Maintenance Demographic This will take you to the Idaho Provider Record Update. For further assistance with the enrollment process, contact a Molina Provider

20 Telligen Provider Portal 20

21 Telligen Portal How the Provider Benefits Information and timing Portal submission equals quicker turnaround The Telligen Provider Portal is a web application that allows healthcare providers to submit review requests When you upload a document to the Portal you will receive an confirmation When a determination is made on your request, you will receive an notification When you access the portal, you can view the status of all requests and the authorization number Save time and telephone calls by utilizing the Portal 21

22 Registration Process Overview The registration packet can be downloaded from the website at: Once downloaded, three sections will need to be completed. Section 3: Executive Agreement Section 4: Security Administrator Agreement Section 5 Security Administrator Registration Form To comply with security requirements for the State of Idaho and with HIPAA hitech standards, we do require that page 5 of the request be notarized 22

23 Important Numbers Website: IDMedicaid.Telligen.com Call Center: (866) Help Desk address: Phone number of Boise office: (866) Utilization Review Fax number: (866) Case Management Fax Number: (888)

24 Implementation Information Questions 24