Connecticut Medical Assistance Program Web Guide Prior Authorization Search

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1 September 9, 014 Connecticut Medical Assistance Program Web Guide Prior Authorization Search The Prior Authorization (PA) Search process allows providers to submit a real-time transaction from the secure Web site to search on a previously submitted PA request. Multiple search criteria can be entered to locate the PA request, and the results are displayed in a series of panels. The provider can review the status of all Prior Authorization requests for their provider ID, view external notes that may have been added during the review process and view the number of units/dollars approved, used, and available. It is recommended that this guide be printed for easy reference when using the prior authorization inquiry tool. Prior Authorization Search The PA search request is completed by entering, at a minimum, either the PA number or Client ID. The search can be further refined by such things as Requested Dates, Authorized Dates, and/or Procedure Code. Once all of the search criteria have been entered, the user selects Search to retrieve all matching records or Clear to clear all entered search parameters. If the required fields are not completed correctly, the PA search result will indicate that there are errors that need to be corrected. The error message(s) will display at the bottom of the PA Search panel. The missing or invalid data must be corrected before the PA search can be successfully executed. Prior Authorization Search Results When a PA search request is successfully executed, the interchange system will return with one of the following responses: If no records match the search parameters, a message displays indicating that no rows were found. Restricting the PA search by entering Requested or Authorized Dates may cause no rows to be found. It is recommended that a repeat search be performed with only the Client ID to ensure that the PA record is not present in interchange. If multiple PA records match the search criteria, the Search Results are listed in sets of ten at the bottom of the same page. The provider clicks Previous and Next to navigate through the pages of results. This list contains summary information about the PA. The user may click any of the column headings to sort the data in ascending order (for example, selecting the Status column heading will sort all of the records in the list by PA Status). The user may click the column heading a second time to sort the records in descending order. Once the appropriate PA request

2 September 9, 014 is located, the provider clicks on the line to open the detailed PA panels. The detailed PA information is displayed on three (3) panels Base Information, Line Item, and Notes. In order to return to the search results of the previous PA search, click on the following Back To Search Results arrow located in the top left portion of the PA panel. If the PA search results in a single PA containing one detail line, the Base Information, Line Item, and Notes panels will automatically display. Base Information Once the appropriate PA request has been located and is selected, the PA Base Information panel is displayed. The user can view basic information about the PA request, such as the client related data and PA assignment. Line Item The Line Item panel is displayed under the PA Base Information panel. This panel shows the detailed information for the PA request. Each line item that exists for the PA request is displayed in a list at the top of the panel with some summary information, such as requested versus authorized units and dollars. To view all information for a specific line item, the provider can click on the line item they wish to view and the detailed information will be displayed in the bottom portion of the panel. Notes The Notes panel displays any external comments that may have been added during the PA review process. A list of fields, their description, and field length are included below for the Prior Authorization Search, Prior Authorization Search Results Section and the detailed Prior Authorization information which includes the Base Information, Line Item and Notes. More detailed PA information is located at by selecting Information, then Publications, and selecting Chapter 9, Prior Authorization. Additionally, the provider can left click on the field names to obtain field level help.

3 September 9, 014 Note: The back button in the top left corner of your Web page should not be used because it will not return the previous Web page. This is for security purposes. Should the back button be clicked, the provider will be required to log back into their Secure Web account. Prior Authorization Search Section Client ID Enter the unique 9 digit identification number of the client. 9 Client Name Search Pharmacy PAs Only Requested Eff Date Requested End Date Authorized Eff Date Authorized End Date Prior Authorization Automatically displays the first and last name of the client based on the client ID entered. Be sure to view this field to validate that you have entered the client ID correctly. Select checkbox to retrieve only pharmacy PA requests. When this checkbox is selected, the fields displayed in the Search Results section differ. Refer to the Prior Authorization Search Results Pharmacy PAs Only section. Enter the requested effective date of the PA request. The format is MM/DD/CCYY. It is recommended that effective dates be left blank to ensure that all PA records for the client are returned. Enter the requested end date of the PA request. The format is MM/DD/CCYY. It is recommended that effective dates be left blank to ensure that all PA records for the client are returned. Enter the authorization effective date of the PA request. The format is MM/DD/CCYY. It is recommended that effective dates be left blank to ensure that all PA records for the client are returned. Enter the authorization end date of the PA request. The format is MM/DD/CCYY. It is recommended that effective dates be left blank to ensure that all PA records for the client are returned. Enter the number assigned to the PA request at the time it was submitted. If the PA number is not available, the Client Autopopulated ID is required. PA Assignment Select the type of the prior authorization. Drop Down PA Assign - Sub For Home Health, Physical Therapy, Occupational Therapy, and Speech Therapy, select the sub assignment type. Valid values are Initial, MFP, Reauth, or Other. N/A 10 Drop Down 3

4 September 9, 014 Prior Authorization Search Section Procedure Enter the Procedure Code for which you want to search. This field has a search option which allows the user to enter search parameters and select the desired code from the search results. 5 Revenue Code Proc/Mod List Procedure Code List Records Enter the Revenue Code for which you want to search. This field has a search option which allows the user to enter search parameters and select the desired code from the search results. Enter the code that uniquely identifies a procedure/modifier list. Enter the code that uniquely identifies a procedure code list. This field has a search option which allows the user to enter search parameters and select the desired code from the search results. The number of records to be displayed in each search results panel. The default is 0 rows. This can be changed to up to 100 rows in each search results panel. 3 Drop Down Prior Authorization Search Results Section Prior Authorization Displays the number assigned to the Prior Authorization 10 request at the time it was submitted. Line Item Displays the detail line number. Authorized Effective Displays the authorized effective date of the request. Date Authorized End Date Displays the authorized end date of the request. Authorized Units Displays the authorized units on the request. 9 Authorized Dollars Displays the authorized dollars on the request. 9 4

5 September 9, 014 Prior Authorization Search Results Section Status Displays the status of the prior authorization line item. 0 Determination Date Displays the date the PA determination was made. PA Assignment Displays the type of the prior authorization. 30 PA Assign Sub Procedure Mod 1 4 Displays the sub-assignment type of the prior authorization. Valid values are Initial, Reauth, or Other. Displays the Procedure Code on the PA request, if Displays the modifier(s) submitted on the PA request, if Revenue Displays the Revenue Code on the PA request, if 3 NDC Displays the NDC on the PA request, if 11 Proc/Mod List Displays the code associated to the procedure/modifier list. Procedure Code List Displays the code associated to the procedure list. Frequency Displays the number of units and type of frequency on the PA request Prior Authorization Search Results Section Pharmacy PAs Only Prior Authorization Displays the number assigned to the Prior Authorization 10 request at the time it was submitted. Line Item Displays the detail line number. Authorized Effective Displays the authorized effective date of the request. Date Authorized End Date Displays the authorized end date of the request. Date Received Displays the date the request was received. Time Received Displays the time the request was received. 6 5

6 September 9, 014 Prior Authorization Search Results Section Pharmacy PAs Only PA Assignment Displays the type of the pharmacy prior authorization. 30 Prescribing/Ordering Displays the prescribing/ordering provider s ID. 10 Provider ID Drug Name Displays the drug name submitted on the request. 100 Status Displays the status of the prior authorization line item 0 Prior Authorization Base Information Section Prior Authorization Displays the number assigned to the Prior Authorization 10 Number request at the time it was submitted. Client ID Displays the unique 9 digit identification number of the client. Last Name Displays the last name of the client. 0 Billing Provider Displays the billing providers NPI or non-medical provider identifier. Diagnosis Displays the diagnosis code, if 0 PA Assignment Displays the type of the prior authorization. 30 First Name, MI Displays the first name and middle initial of the client. 15 Date of Birth Displays the client's date of birth Insurance Estimated Date of Delivery Displays the client s other insurance coverage, if The valid values are Medicare, Other, or None. Displays the Durable Medical Equipment delivery date agreed upon with the supplier, if 9 15 Drop Down Patient Condition Displays the Patient Condition from the PA request. The valid values are Fair (F), Good (G), Excellent (E). Available for user to select when a Pharmacy PA request is in a status of Pharmacy Web PA Awaiting Documentation. When selected, a PA cover sheet will be displayed to be printed or saved for later. The cover sheet includes the fax number. Drop Down N/A 6

7 September 9, 014 Line Item Section Line Item Displays the detail line number. Service Type Code Procedure Code Displays the service code category of the PA request. Valid values are NDC Code, Procedure Code, Procedure/Mod List and Revenue Code. Displays the procedure code submitted on the PA request and its associated description. Drop Down 6 Mod 1-4 Revenue Code/List Proc/Mod List Procedure Code List Displays the modifier(s) submitted on the PA request, if Displays the revenue code or revenue code list submitted on the PA request. Displays the procedure code list that includes modifiers, and the associated description. Displays the procedure code list and the associated description submitted on the PA request. 4 6 Requested Eff./End Dates Requested Units/Dollars Tooth Quad Tooth Surface 1 5 Displays the requested Prior Authorization start and end date submitted on the PA request. Displays the number of units or dollars being requested for the Prior Authorization line-item service. Displays the tooth number submitted on the PA request, if Display the tooth quadrant submitted on the PA request, if Displays the tooth surface(s) submitted on the PA request, if Drug Name Displays the drug name submitted on the PA request, if 11 Status Displays the status of the prior authorization line item. 50 Authorized Units/Dollars Displays the number of units or dollars that were authorized for the line item. This field would be zero for a PA in process. 0 6/ 1 6/ 7

8 September 9, 014 Line Item Section Authorized Eff./End Displays the effective and end dates that were authorized. Dates These would be blank for a PA in process. Used Units/Dollars Displays the total number of units or dollars used to date based on claim submission and would be zero for a PA in process or if no claims were submitted that used the Available Units/Dollars Frequency authorized units or dollars. Displays the total number of units or dollars available to date based on claim submission and would be zero for a PA in process or if claims were submitted that used up all of the authorized units or dollars. Displays the number and type of frequency submitted on the PA. 4 Notes Section Note Number Displays the note number. Multiple notes may exist that were entered by DSS. Date Entered Displays the date that the note was created. Description Displays the note text. 500