Provider Portal Training

Transcription

1 Provider Portal Training This training guide will provide information on the benefits of using NaviNet (Provider Portal) and a guide on how to navigate the NaviNet system. First, to access the provider portal open up the internet using either Internet Explorer or Google Chrome. Once the browser has opened go to the web link listed below: Once the web page loads the user can enter in their username and password, then click the sign in button. After signing in the user will be presented with the Choose Profile screen where one can search for a provider profile using any of the below options: Group name Office Name Plan Name Office TIN/Account Number City State Username Created By: WBA Page 1 of 18

2 Depending on the information entered to conduct the profile search, Navinet will either pull up a specific provider profile or a list of provider profiles from which the user can select. In the example below a search was conducted using a City name. As shown in the above example, if the search produces multiple results the user will simply hit the select button on the right hand side of the screen next to the name of the provider that they wish to select. This will then navigate the user to a screen where they will select a specific role. Office Role Group Role Super User Role Created By: WBA Page 2 of 18

3 After the user selects the role they would like to use then the Profile Homepage will appear. From this Homepage the user will be able to see an FAQ section as well as NaviNet message updates. Also located on the Profile Homepage is the Workflow Tab which provides the user with two options: My Health Plans Practice Documents We will ONLY be using the My Health Plans selection to access the gateway provider portal information. Note: Provider Documents are documents the providers utilize within their own practice and as such is something that we at Gateway should never access. Created By: WBA Page 3 of 18

4 When the user clicks on My Health Plans, this will populate the health plans the provider is currently participating with to the right and the user then selects the health plan of their choice to view the information related to that specific plan. This will then navigate the user to the selected Health Plans message center. Within the message center, it may offer various pieces of information such as: Important Announcements Messages from the Health Plan Link to the Health Plans Website (by clicking on their logo) Hours of Availability Provider Tools (Link to the plans Prism website to look up participating providers, pharmacies, and a link to the OTC Benefit Catalog, etc.) Forms Contact Us (Telephone Numbers to provider services and a link to the plans website) Created By: WBA Page 4 of 18

5 In addition to the features listed above, on the top left hand side of the screen. The user has a selection of various links to choose from in the Workflows for this Plan box. Created By: WBA Page 5 of 18

6 Claims Status Inquiry The Claim Status Inquiry link will redirect the user to the Claim Status: search screen. Here the user can search for specific claims by filling out the appropriate details and see the status of the claims on if they are still pending, paid, or denied. Eligibility and Benefits Link The Eligibility and Benefits link allows providers to find out if a member is currently active with plan and the member s current benefit information by searching by either the member id or the member s name and date of birth. Created By: WBA Page 6 of 18

7 Referral Status Inquiry Link The Referral Status Inquiry link allows the user to see what referrals are currently on file with Gateway. Users will be able to search by Member Name, Member ID/Provider Search or by a Referral number if they have one. Member Name Search Created By: WBA Page 7 of 18

8 Member ID/Provider Search Referral Number Search Created By: WBA Page 8 of 18

9 Provider Directory Link The Provider Directory link will redirect the user to our Prism website. NIA RadMD Authorizations Link The NIA RadMD Authorizations link will redirect the user to the NIA Website (radmd.com). This website is where the user can submit a NIA Authorization to be reviewed for approval. Created By: WBA Page 9 of 18

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11 Enhanced Gateway Provider Features Link The Enhanced Gateway Provider Features link will redirect the user to Gateway s Provider Portal page. There are a variety of actions available to Gateway providers on the Gateway Provider Portal page which can be accessed by selecting the appropriate link on the left hand side of the screen. These options include the following: Authorizations Tab o My Authorizations -This screen is where the user can submit authorization requests and search for authorization requests. (Please refer to the Submit Authorizations Electronically Training Guide for more detailed information. This is located by clicking the Instruction Manual Tab within the provider portal.) Created By: WBA Page 11 of 18

12 o Prior Authorizations This is the screen where the provider can look up any CPT code and verify if this requires an authorization by the Health Plan or by NIA. Created By: WBA Page 12 of 18

13 If the user wishes to check to see if a code need authorization by NIA. The user will click on the following link named NIA, which will redirect the user to the NIA website. If the user would like to check to see if a specific code requires the Health Plans Authorization. The user will click on the link named Click Here, as shown below. Created By: WBA Page 13 of 18

14 Once the user clicks on the hyperlink, this will redirect the user to the code look up webpage. At the bottom of the page, the user will first select the Line of Business. (Please note: At this time this is only for Pennsylvania Medicaid and Pennsylvania Medicare. In the near future, the other lines of businesses will be added.) Once selected the lines of business, the user will then select if they are searching by CPT Code or HCPCS Code. Created By: WBA Page 14 of 18

15 After selecting the proper option in the search criteria s. The user will type in the code they wish to search in the Code to Search Field. If the code populates a selectable name, the user can select the option and it will populate the authorization details. This will also populate if the code does not require authorization. Created By: WBA Page 15 of 18

16 Complaints This is where the participating providers can submit complaints to the Provider Relations Department. o The provider will fill out the form and options accoridngly on this webpage. Once filled out and attached the documents needed, this will be sent secure messaging to the Provider Relations Department. Created By: WBA Page 16 of 18

17 Claims o Batch Claims Search This is where the users can search processed claim information and their associated check or batch check amounts. (Please refer to How to Check Search in the Knowledge Center for more detailed information.) Help & Support o Help & Support FAQ This is where the user can locate the Frequently Asked Questions. Created By: WBA Page 17 of 18

18 Instruction Manual This is where the instruction manual is on how to submit an authorization. Provider Directory This is will link the providers to our PRISM search. Secure Messaging (Please refer to the Provider Messaging Training Guide for more detailed information. This is located at the bottom of the home page for the secure messaging section named User Guide.) My Account This is to view the user, group, and office details. Log Out This is to log out of the provider portal section. Created By: WBA Page 18 of 18