[ELIGIBILITY CHECK USER GUIDE] This Document is intended as a user guide for providers who are planning to use the eligibility check system.
Contents I. Introduction... 2 II. Purpose of Document... 2 III. Targeted Audience... 2 IV. How to Sign Up... 3 V. How to download Java Reader (needed for card reading)... 7 VI. How to Log in... 10 VII. How to change password... 11 VIII. How to adjust profile... 13 IX. How to create and submit an eligibility request... 15 A. How to fill request details and submit it... 15 B. How to cancel request... 18 C. How to receive notifications for visits... 19 X. How to see pending requests and search for them... 20 XI. How to see latest answers (active requests) and search for them... 22 XII. How to view latest answers (active requests) details and print it... 23 XIII. How to cancel a request... 26 XIV. How to resubmit a rejected request... 27 XV. How to go to HCP request as an eligible user... 28 XVI. How to view eligibility history and print details... 29 XVII. How to refresh requests... 32 XVIII. How to go to Home Page... 33 XIX. How to sign out... 33 XX. How to Access User Guide... 34 XXI. Document History... 34
I. Introduction Eligibility Check portal allows providers to check their members eligibility and search for their members eligibility history. II. Purpose of Document This User Guide is intended as a series of steps to show how a provider user interacts with the system to establish the business goal of completing a workflow on eligibility check. III. Targeted Audience This document is intended for users logging into the system as providers.
IV. How to Sign Up Trigger: Browse eligibility check portal Outcome: Sign Up 1. Browse eligibility check portal and click sign Up 3. Personal Information Enter First name in field First Name Enter last name in field Last name Enter contact email in field Email (in the format of email@domain.com) 4. Account Details Enter username in field username (in the format of username@domain.com)
5. Account Details Enter password (passwords must have at least 8 characters and contain the following: uppercase letters, and symbols. (e.g. P@ssw0rd) Confirm the same password in field Confirm password 6. Account Details Select secret question and enter answer in field answer 7. Regulatory Information Select regulatory from field Regulatory, HAAD or DHA NE providers must register under DHA to access eligibility
8. Regulatory Information (HAAD or DHA) Enter a valid facility license number Enter a Username which is the user name as registered at the regulatory site Enter Password which is the password as registered at the regulatory site 9. Click Test Connection, to test if the regulatory credentials are valid or not 9.1 Optional: Click cancel anytime, in order to cancel Sign Up
10. Access Check eligibility check and click upload, in order to upload a list of clinicians. Click on template in order to download a template for the clinicians setup 11. Click ok on the pop-up uploading new list of clinicians will overwrite the existing one. Are you sure you want to upload a new list of clinicians? 12. Click on Register 13. Regulatory Information (International provider) Enter the provider code and contract number and click on test connection
14. Check Eligibility Access and click on register 15. For provider administrators Check provider administrator during registration V. How to download Java Reader (needed for card reading) Trigger: Browse eligibility check portal Outcome: Download Java Reader (needed for card reading) 1. Click Download Java (Needed if using card reader) link
2. Download Java 3. Click security tab in the Java Control Panel
4. Click on Edit Site list 5. Click Add 6. Add the portal to the exception site list and click on OK
7. Click OK VI. How to Log in Trigger: Browse eligibility check portal Outcome: Log in 1. Enter username Enter password Check the keep me signed in box in order to remember username and password Click on Login
VII. How to change password Trigger: Browse to eligibility portal Outcome: Change password 1. Click on Forgot password 2. Enter username and click on next 3. Enter the answer to the secret question and click on Save
4. Enter password and confirm password fields 5. Click Save 6. You can click Cancel anytime
VIII. How to adjust profile Trigger: Log in as a provider Outcome: Adjust Profile 1. Follow section VI. to log in 2. Click My Profile 2.1 A. Account details Edit First name, last name, email 2.2 Edit secret question and Secret answer
3. B. Access details Check/uncheck eauthorization/eligibility check Note: Regulatory information is required for eauthorization access 3.1. Click upload in order to upload a new list of clinicians, or overwrite the existing list Click save 4. C. Change password Check change password Enter old password Enter new password Enter confirm password
IX. How to create and submit an eligibility request A. How to fill request details and submit it Trigger: Log in as a provider Outcome: Fill request details and submit it 1. Follow section VI. to log in 2. Click Check Eligibility tile 3. Select Insurer from dropdown (required field)
4. Select clinician 5. Select Service Category between New consultation, follow-up consultation, Diagnostic testing, physiotherapy and Dental Services 6. Enter emirates Id (If emirates Id is checked and once the member official card is entered in the reader, the EID will be read and displayed in this field.) In case emirates id is not available, check Emirates id is not available with member and enter card number
7. Enter mobile number in the required format +971506687123 and click on submit The request will be displayed in the list of pending requests
B. How to cancel request Trigger: Access check Eligibility tile Outcome: Cancel request 1. Follow section VII. A in order to create an eligibility request 2. Click Cancel anywhere while filling details
C. How to receive notifications for visits Trigger: Submit a request Outcome: Receive notifications for visits (parametrized by the administrator) 1. In case the same member has visited the same physician specialty in the last days, as parametrized by the admin 2. In case clinician is not part of network 3. In case same member visited same physician in the last days, as parametrized by the admin 3.1 Check visit is not related to same chief complaint or follow up visit in case it is related to the same chief complaint
4. In case the member is configured as a high utilizer member by the administrator X. How to see pending requests and search for them Trigger: Submit a request Outcome: See pending requests and search for them 1. Access the Eligibility Request summary screen 2. Click on the Pending tab
3. View the pending requests 4. Enter card number or member name or request number inside search field in order to search for pending requests
XI. How to see latest answers (active requests) and search for them Trigger: Submit a request Outcome: See latest answers (active requests) and search for them 1. Access the Eligibility Request Summary 2. View request status: Eligible 3. View request status: Not Eligible
4. Enter card number, status, member name, or request number in search field in order to search inside active requests XII. How to view latest answers (active requests) details and print it Trigger: See latest answers (active requests) Outcome: View latest answers (active requests) details 1. See section IX. In order to see latest answers 2. Click on the request in order to view details
3. View eligibility Request details Request and member info Policy details and benefits 4. Click on Abbreviations in order to view 5. View the fill form of abbreviations
6. Click on general exclusions or schedule of benefits 7. Click Print in order to print the request details 8. Click view all in order to view all cards data
XIII. How to cancel a request Trigger: View the eligibility history Outcome: Cancel a request 1. See section XII. In order to view the eligibility history 2. Click on cancel request in order to cancel a request
XIV. How to resubmit a rejected request Trigger: See latest answers (active requests) Outcome: Resubmit a rejected request 1. See section IX. In order to see latest answers 2. Click on the rejected request in order to view details 3. Click on Resubmission
4. Fill the request details and click on Submit XV. How to go to HCP request as an eligible user Trigger: See latest answers (active requests) Outcome: View latest answers (active requests) details 1. See section IX. In order to see latest answers 2. Click on the request in order to view details
3. Click on Request authorization XVI. How to view eligibility history and print details Trigger: Log in as a provider Outcome: View eligibility history 1. See section VI. in order to log in 2. Click on Eligibility history tile
3. Fill insurer field Fill card number Select status (optional) 4. Select transaction start date (required) and transaction end date 5. Click on Search
6. Click on a request in order to view details 7. Click Print in order to print the details
XVII. How to refresh requests Trigger: Submit a request Outcome: Refresh requests 1. See section IX.A to submit a request 2. Click on Logo in order to refresh answers
XVIII. How to go to Home Page Trigger: Anywhere in the application Outcome: Go to Home page 1. Click on logo XIX. How to sign out Trigger: Anywhere in the application Outcome: Sign out 1. Click on Sign Out at the upper right corner of the page
XX. How to Access User Guide Trigger: Anywhere in the application Outcome: Access the User Guide 1. Follow section XVI to log out 2. Click on User Guide XXI. Document History Name Date Reason For Changes Version Arin Chekijian 14-Jan-2015 Create Document 0.1 Arin Chekijian 04-Apr-2015 Update Document 0.2 Arin Chekijian 14-May-2015 Update Document with sign up and adjust profile implementation Arin Chekijian 07- July -2015 Update document 0.4 Arin Chekijian 09-June-2016 Update document 0.5 Arin Chekijian 05-Oct-2016 Update document 0.6 Arin Chekijian 27-02-2017 Update document 0.7 0.3