HealthConnect User Guide

Transcription

1 HealthConnect User Guide

2 What is HealthConnect?... 2 Benefits of HealthConnect... 4 HealthConnect Homepage Initial Setup... 5 Tack Down the Menu Bar... 7 Setting Default Home Page... 7 Add HealthConnect to Favorites... 7 Creating a new User in HealthConnect... 8 Deleting a User in HealthConnect Resetting User Password in HealthConnect Referrals Creating Referrals Claims Hometown Health EOB...26 Clear Claim Connection Reconsiderations Viewing Reconsiderations Uploading Reconsideration Files Eligibility and Summary of Benefits Provider Eligibility List.39 Quality Indicators Provider Directory ICD-9 Codes CPT Codes Formulary Changing Home Page and Quick Links.46 Hometown Health Forms...46 Contact Us..46 2

3 What is HealthConnect? HealthConnect is a secure communication network provided to physicians and their staff enabling them to review and exchange information quickly between offices and payers. Physicians and their staff who subscribe to HealthConnect can rapidly accomplish tasks that previously took hours and involved intensive review by provider office staff members, masses of paper, and waiting for fax machines. HealthConnect offers the ability to: Hometown Health pre-authorization (Referrals) o Online submitting, viewing and printing Hometown Health claims viewing o Claim Reconsiderations o Print an Explanation of Benefits (EOB) Hometown Health eligibility search o Up-to-date status of Hometown Health members eligibility o Summary of Benefits o Member deductible and out-of-pocket information o Member accumulator amounts Hometown Health physician directory o Search the Hometown Health Provider Directory ICD-9 and CPT Code search o Search by keyword or number Hometown Health and Senior Care Plus Formularies o Most current copy of the Hometown Health and Senior Care Plus Formularies MagicWeb/PACS o Picture Archiving Communication System (Clinicians only) EpicCare Link (Electronic Medical Records) o Internet version of the Renown Health Electronic Medical Records system o Access to predefined views of patient data (face sheets, rounds reports, etc.) 3

4 Benefits of HealthConnect HealthConnect enables healthcare professionals to efficiently perform routine tasks including: Day-to-day business processes Clinical processes HealthConnect delivers these functions via an interface customized to provide patient, provider, or health plan-specific information. Using HealthConnect features can: Reduce delays of claims payments Increase customer satisfaction by providing prompt access to key information Improve workflow Reduce administrative costs 4

5 HealthConnect Homepage Initial Setup You must have a HealthConnect user name and password to access HealthConnect. 1. Open Internet Explorer. 2. Go to the tools menu to turn off all popup blockers. You may also have a Yahoo or Google popup blocker enabled on your tool bar. 3. Close Internet Explorer and minimize all programs. 4. Create a shortcut on your desktop. 5. Place your cursor on the desktop. 6. Right click with your mouse. 7. Select New from the menu and shortcut from the next menu. 8. Type in in the location of the item field and click the next button. 5

6 9. Type in a name for your shortcut and click finish. 10. Click on the HealthConnect Icon. 11. Type your HealthConnect user name and password in the window. 12. Review the Statement of HIPAA Security Responsibility. Click I Agree to continue to access HealthConnect. You will see this screen each time you log into HealthConnect. 6

7 13. Tack down your menu to maintain a view of all menu options by clicking on the tack button on the far right side of your screen. 14. Add HealthConnect to your internet favorites by single clicking on Add HC to Favorites. 15. Internet Explorer will then prompt you to add HealthConnect to your favorites. By clicking OK you will successfully add HealthConnect to your menu of favorites. 16. To set your default home page, go to My HC and click Set Home Page. Select from the list of options and click continue. 7

8 Creating New User in HealthConnect **Power users will be required to maintain user lists, which include adding new users and deleting users that no longer require access. 1. Go to My HC and click Manage Users/Roles. 2. Go to Users and click Create User. 3. Enter the New User Account Name and click Next. The user name must be between 4 and 12 characters. 4. Enter the password and address. The password must be at least 8 characters and contain at least 2 letters and 2 numbers. 8

9 5. Add the Roles that you want for the new user. Click Next. Description of Roles user_claims: Allows user to have the capability to view claims. user_clinical: Clinicians only. Other users cannot access claims, reconsiderations, referrals, etc. if selected. user_poweruser: Allows user to have the capability to add or delete new user access. user_reconsiderations: Allows user to have the capability to view and submit claim reconsiderations. user_referrals: Allows user to have the capability to view and submit pre-service referrals. user_upload: Allows user to upload documentation to reconsiderations and referrals. (i.e. Clinical) user_viewall: Will check all boxes with exception to user_clinical. 6. Click Finish to complete the new user set up. 7. Once you click Finish you will see the below message. 9

10 Deleting a User in HealthConnect 1. Go to My HC and click Manage Users/Roles. 2. Go to Users and click Delete User. 3. Click the drop down box. 4. Select the user and click delete. 10

11 Resetting User Password in HealthConnect 1. Go to My HC and click Manage Users/Roles. 2. Go to Users and click All Users. 3. Select the applicable user from the list and click details. 4. The User Summary will display. First, verify of the account is locked, if true click change (See graphic below). 11

12 5. Next, click reset. 6. Input the new password based on the defined criteria and select Submit. 12

13 Referrals To view referrals hover your Status. cursor over referrals on the menu bar. Select Referral All referral options are available in a tabbed view. Users can view the following: Unprocessed, Pending, Approved, Denied, Returned, Archive, and Print View: Unprocessed: includes submitted referral requests waiting to be processed by Hometown Health. Single clicking the will display the request. Single clicking the Clinical). brings up a dialogue box that allows the user to upload a file (i.e. 13

14 Pending: includes submitted information ( i.e. Clinical). referral requests in process but require additional Single clicking the will display the request. Single clicking the Clinical). brings up a dialogue box that allows the user to upload a file (i.e. 14

15 Approved: includes referral requests approved by Hometown Health. Single clicking the will display the request and provide the authorization number. Single clicking the will display the authorization letter. 15

16 Denied: includes submitted referral requests that have been denied by Hometown Health. Single clicking the will display the request. Returned: includes referral requests returned to the requesting physicians office by Hometown Health (i.e. Prior authorization is not required). Single clicking the will display the request. Payer notes will indicate why the request was returned (if applicable). 16

17 Archive: includes all referrals for the previous years. There is a searchable field. Print View: allows the user to search for specific referral request and print a summary of the authorization. The user will need to Filter Referrals A dialogue box will display. filter. Search by entering the patient criteria, then clicking apply Results will be displayed. Click the, then click print referrals. 17

18 The following will print (the actual print will include all information). Tab Settings: will allow the user to customize their preferred view. The selected default will display upon opening. The user will still have access to the other tabs. 18

19 Creating Referrals It can take up to 72 hours for a referral to be processed. 1. Access the referral forms by moving your mouse over the Referrals menu button. Click on the Create Auth Request button to access the referral forms. 2. You will select either the out-patient referral or elective in-patientt referral. 3. Start by typing the patient s last name and press enter or click continue. 4. Choose the patient for which you are creating the referral, from the HTH Eligibility List. The patient information fields will automatically populate with the chosen patient s information. 19

20 5. The selected members information will display. Click go to next step. 6. Type the referring provider s last name and click go. 20

21 7. A listing of all providers from your search criteria, will display in a pop-up. 8. Follow the same process for the Specialist/Facility field. Once you have selected the specialist, click go to next step. 9. Populate the following fields based on patient need. Creation date will auto populate with the date the user is entering the request. 10. Clicking in the expected start date field will render a calendar. Select the appropriate date. Selection of this date will auto populate the expected end date. 21

22 11. Next select the type of service and select go to next step. 12. Start the next section, Diagnosis and Treatment by selecting Yes or No for Consult Only. Then enter the Number of Requested Visits. 13. Type in the ICD9 code for the diagnosis. In the example above we used and pressed the enter key or clicked on go. If you enter 123 and select go, all ICD9 codes that begin with 123 will display in a pop-up. 22

23 14. Click select on the appropriate code. The information will automatically transfer to the referral form. 15. Follow the same process for entering and selecting the correct CPT/HCPC codes. If you have more than two CPT/HCPC codes you can click on the Additional Procedure CPT codes link which will allow four additional codes to be entered. 16. Complete the last section titled Clinical Notes. Enter any necessary clinical notes. You have a maximum of 256 characters available in the clinical notes section. As you type notes you will see how many characters remain available. If you have additional notes or documentation to submit you can upload them by checking upload documents box. 17. Check over all sections to ensure they have been completed. Once complete click on go to next step. 23

24 18. Review the referral request; if it is accurate and complete, click submit referral. 19. When your referral has been correctly completed and submitted, you will see a screen with four options; add a new Out-patient or In-patient referral, create a new referral for an existing patient, view all referrals, or print a referral view. 24

25 Claims 1. Move your curser over the Claims button to access the drop down menu options. If you are not able to see the Claims button move your mouse over the Main Menu button until all options are available (illustrated in the screen shot pasted below.) 2. Single click the Quick Search menu button to search for claims by member last name. Type in the member s last name and click Search. You can search by any of the fields below. 3. View all claims for members with the searched last name. The user can sort columns by single clicking the column title. (i.e. Service will sort claims by the date of service for all patients under the last name searched). 4. To view all patient claims for a given month move your mouse over the Claims button to access the drop down menu options and single click the EOB menu button. 25

26 5. To filter your search further from this screen single click on Refine Search under Search Tools. You will see the following choices to filter your search. Enter our search criteria and click Apply Filter. 6. It is very important that you clear the information you entered to filter your search every time! To do this, click on Clear Search under Search Tools. 26

27 Clear Claim Connection (C3) Under Claims you will find a link to Clear Claim Connection. Clear Claim Connection Disclaimer will appear Click Continue You will need and then click to click the box that states I have read the Terms and Conditions the I Accept button. 27

28 The Menu Bar: (Located at the top of the page) Mckesson Edit Development: Allows you to view information about the process and sources used to develop the Clear Claim Connection edits. Glossary: Allows you to view Clear Claim Connection terminology with regard to claims auditing. About: You are able to view Product Name, Version, and U.S. Patent Number and also information regarding the Clear Claim Connection copyright and licensure information. Help: Assist you with tips while using Clear Claim Connection. Logoff: Allows you to logoff of Clear Claim Connection. Reviewing Procedure Codes: Select a Gender (Mandatory Field) Enter Date of Birth (Mandatory Field) Enter Procedure Code, Modifier (if necessary), and Date of Service (will automatically populate to the current date. (You are able to select multiple inquiries at one time). Click Review Claim Audit Results. 28

29 Procedure Code Research The results of your inquiry will appear letting you know the Description of the code entered and whether or not it will Allow, Disallow or wants you to Review (under Recommend) the selection. Procedure Code Research for Review or Disallow Claims If you want to know why the inquiry came back as Review or Disallow select the procedure code that you would like to review by clicking on the line, then click Review Clinical Edit Clarification 29

30 Review Claim Audit Results Once you click on the Review Claim Audit Result button a description will display letting you know why the inquiry has been Disallowed or is stating to Review. 30

31 Reconsiderations 1. Move your mouse over the Claims button to access the drop down menu options. If you are not able to see the Claims button move your mouse over the Main Menu button until all options are available (illustrated in the screen shot pasted below.) 2. Single click on EOB to view the Claims EOB Page. 3. Click on the to the left of the patient s name to view additional information and start a new reconsideration process. 4. Notice that the reconsideration form has been auto filled with most of the required information. You must complete the Provider Contact/Telephone # field to successfully submit the form. The user can add additional claims for the same member/provider to this request by populating the additional claim numbers. However, the additional claim numbers will be needed prior to submission, they cannot be added later. 31

32 5. Select the type of claim reconsideration you will need. 6. Type or paste any additional reconsideration information into the textt box. Click Submit to process the reconsideration. 32

33 Viewing Reconsiderations 1. Move your mouse over the Claims menu button to access the Reconsideration button. 2. Single click on the Reconsiderations button to view all open reconsiderations. These include reconsiderations that are either pending at HTH or your office. 3. Click next to the member s name to review the reconsideration detail. You can view the member and provider data, notes or comments, HSR# and previously uploaded supporting documents. 4. View the uploaded supporting documents by clicking on yellow file folder. See above screen shot. A dialogue box will display if there is a document attached to the HSR. Click on the blue link and the attachment will display. 33

34 The user can also search for specific HSR s. Click on filter recons. A dialogue box will display, you can search by the following criteria. 5. Be sure to clear filter when you are done searching for the HSR. If you need to upload a document to the HSR, click on the yellow file folder (it should indicate 0 if a file has not been uploaded) for the appropriate HSR. A dialogue box will display. Click on Add uploads and follow the prompts. 34

35 6. If you are unable to upload the document the address and fax number are available on the Reconsideration form prior to clicking the submit button. 35

36 Eligibility 1. Move your mouse over the Eligibility button until the drop down menu buttons are accessible. If you cannot see the menu choices pasted below, move your mouse to the Main Menu button until the menu options in the view below are available. 2. Click on the HTH Eligibility button to view the following page. 3. Type the enrollee s last name, first name, member number, or date of birth to begin the eligibility search. Press the enter key or the click search eligibility. 4. If the member is eligible with Hometown Health a record will be returned (for this search, we used the last name Smith. As you can see it yielded both eligible and ineligible members. (If a member is ineligible, they will have a term date on the far right.) 5. Click on the next to the member name to open the printable view of Enrollee Information. This view includes the member s enrollee information as well as the option to view his/her Summary of Benefits (SOB). 36

37 6. Click the link to view the member s SOB. A new window will open a PDF file that lists the member s SOB. To print a copy of the SOB click on the picture of the printer at the top of the screen or right click and select print. This document is also searchable. You can search by pressing control+f on the keyboard. 37

38 7. To view Deductible and Coinsurance amounts for PPO members scroll down to the bottom of the page. Enrollee accumulator amounts are also visible to the applicable specialty types below. 8. Click the Print option on the upper right-hand side of the screen to print the Enrollee Information. 38

39 Provider Eligibility List 1. The My Eligibility list allows Primary Care Providers to view and print out a list of their enrolled patients. 2. Move your cursor over the Eligibility button until the drop down menu options is accessible. 3. Click on the My Eligibility button to view all currently enrolled patients for the PCP. 39

40 Quality Indicators (Primary Care Physicians Only) 1. The Quality Indicators Tab allows you to view your office s achievement in delivering high quality care with selected quality indicators against the targets set by Hometown Health. These targets may change on an annual basis and are based on national benchmarks. 2. Move your mouse over the Eligibility button until the drop down menu buttons are accessible. 3. Click on the Quality Indicators button to access your information. 40

41 4. Move your mouse over the graph to view the statistics. You will see the number of patients that received care out of the total number of eligible patients. 5. Click on the gold portion of the bar to view patients that have not yet had the test or met the requirement of the indicator. Click on their name and see the demographic information for patient targeting/reminders. The purple portion of the bar is for patients that have completed their indicators. 6. Click on the link to view the process for updating Hometown Health on your achievement of these targets. 41

42 Provider Directory 1. Move your mouse over the Directory button to access the drop down menu options. If you cannot see the menu choices pasted below, move your mouse to the Main Menu button until the menu options in the view below are available. 2. Click on Provider Directory to access the Provider Directory. You can search by the criteria listed below. The Provider Directory will list the following information: Telephone Number Fax Number (if provided) TAX ID Number NPI Number Address Contracted Plans Specialty 42

43 ICD-9 Codes 1. Move your cursor over the ICD-9/CPT button to view the drop down menu options. If you cannot see the menu choices pasted below, move your mouse to the Main Menu button until the menu options in the view below are available. 2. Enter your code or a key word and click on Search Now. For our example we typed 123 in the ICD-9 Description field. This will return all ICD-9 descriptions that include the code 123. View the results of your search. Displayed on the page are all findings for the ICD-9 Codes with descriptions that (for our example) contain the code

44 CPT Codes 1. Move your cursor over the ICD-9/CPT button to view the drop down menu options. If you cannot see the menu choices pasted below, move your mouse to the Main Menu button until the menu options in the view below are available. 3. Click on CPT Search. Enter your code or a key word and click on Search Now. For our example we typed lung in the CPT Search. This will return all CPT descriptions that include the word lung. View the results of your search. Displayed on the page are all findings for the CPT Codes with descriptions that (for our example) contain the word lung. 44

45 Formulary 1. Move your mouse over the Formulary button until the drop down menu buttons are accessible. If you cannot see the menu choices pasted below, move your mouse to the Main Menu button until the menu options in the view below are available. 2. Single click on the 2014 Commercial Formulary button (you will need Adobe Acrobat Reader) to view the formulary list. 3. Single click on the Senior Care Plus button (you will need Adobe Acrobat Reader) to view the formulary list. 4. Search the Formulary by clicking on the binoculars or by pressing control +F on your keyboard. This will bring up a search section on the right side of the page. 45

46 Changing Home Page To change your default Home Page move your mouse over the My HC button to view the different choices. Hometown Health Forms To view and print forms including HealthConnect forms, Authorization Matrices, Provider Materials, Electronic Billing forms, and Lease/TPA Self Funded information click on the Forms link on the upper right portion of the screen. Contact Us To contact Hometown Health Customer Service or HealthConnect Customer Service click on the Contact Us link on the upper right portion of the screen. 1. You can either call Customer Service by phone or submit your question electronically. 46