NHPNet User Guide Updated August 2017
Table of Contents Introduction... 3 How to Register for NHPNet... 6 Your Profile... 16 User Administration... 22 Authorizations & Referrals... 33 Provider Enrollment Portal... 37 My Managed Groups... 38 Affiliating a New Provider to Your Group... 39 How to Open or Close a PCP Panel... 46 How to Terminate a Provider... 48 Demographic Changes... 51 Claims Status... 54 Explanation of Payments (EOPs)... 59 Primary Care Provider (PCP) Changes... 62 Eligibility... 67 Reports... 74 Site Documents... 86 Key Indicators & Alerts... 87 Table of Contents 2 of 93
Introduction NHPNet Overview NHPNet allows providers access to Neighborhood Health Plan member information under the context of the provider site the user is associated with. NHPNet supports access to multiple provider sites with a single account if required. Neighborhood Health Plan strives to protect the privacy of each member s Protected Health Information (PHI) and other personally identifiable information. User actions are audited regularly. Your access to NHPNet is subject to the approval of the designated site administrator of the provider site you are associated with as well as NHP Provider Relations. User access to their provider site information must be renewed every 365 days. Accounts inactive for 90 days or more are subject to automatic terminations. Accessing NHPNet A link to NHPNet is available from the provider section of NHP s website at nhpnet.org. Registration is required in order to access NHPNet Supported Browsers NHPNet currently supports the following browsers: Microsoft Internet Explorer Versions 6, 7, 8, and 9 Mozilla Firefox (PC, MAC, LINUX) Google Chrome (PC, MAC, LINUX) NHPNet s User Interface NHPNet s user interface consists of 3 sections: Top Navigation Bar, Accessible Functions Bar and the page content. Top Navigation Bar The Top Navigation Bar appears on every page within NHPNet. It allows users to switch the currently selected provider site in addition to offering quick links to common functions. Section 1 Introduction 3 of 93
To switch the provider site you are currently accessing click on the drop-down box. When applicable, this will bring up a list of other provider sites the user has access to. Click on the provider site name to switch to that provider site. The user can switch currently selected sites at any time during the login session. The following quick links are provided when hovering on your name: Provider News - brings you to important announcements relevant to NHP s provider network Contact NHP provides options for contacting NHP staff User Guide (PDF) a link to the NHPNet User Guide Your Profile allows access to view/edit the user profile settings Sign Out logs you out of NHPNet Accessible Functions Bar The Accessible Functions Bar appears on every page within NHPNet. It lists the full NHPNet functionality for the currently selected provider site. Hovering over a category will bring up a drop-down list of available functions. Clicking on a function button will bring you that option specific to that function. Each function is relative to the currently selected site as displayed in the Top Navigation Bar. For example, clicking on the Authorizations & Referrals function you will provide Authorizations and Referral information specific to the site shown in the Top Navigation Bar. Forgotten Password The I Forgot My Password link within the NHPNet login page allows users to reset their password upon logging in and providing a contact phone number and answering the selected security question. Users unable to provide this information must contact their User Administrator for assistance with password recovery. If a site does not have a User Administrator, the user can contact the NHPNet Research Team at prweb@nhp.org for assistance. Forgotten Login The I Forgot My Login link within the NHPNet login page allows users to retrieve their login ID by entering their email address. Their login ID will be sent to them via email a few minutes after submitting the request. Section 1 Introduction 4 of 93
Locked Accounts A user s account may become locked as a result of too many failed login and/or password reset attempts. If this occurs, users can contact their User Administrator for assistance with password recovery. If a site does not have a User Administrator, the user can contact the NHPNet Research Team at prweb@nhp.org for assistance. NHP Contact Information The NHPNet Research Team is available for assistance and can be reached via email at prweb@nhp.org or via telephone at 855-444-4NHP (4647). Section 1 Introduction 5 of 93
How to Register for NHPNet Step 1 1. Access NHPNet via the direct URL: www.nhpnet.org 2. Locate the registration button on the right-side of the page. 3. Click on the registration link to proceed to the User Agreement page 3 Section 2 - How to Register for NHPNet 6 of 93
Step 2 1. Read the terms of the NHPNet User Agreement. 2. Click I Accept This Agreement to proceed. Section 2 - How to Register for NHPNet 7 of 93
Step 3 1. Read the helpful hints and then click OK to proceed. Section 2 - How to Register for NHPNet 8 of 93
Step 4 1. Type your site s name in the Site Name box. A drop down list will appear and you can select your appropriate site. You can enter the full name or part of the name to yield results. 2. Enter your Tax Identification Number in the TIN field 3. Click Verify 1 2 3 Section 2 - How to Register for NHPNet 9 of 93
Step 5 Enter a Login ID. We recommend using your email address if possible. Please review the login criteria below carefully. Step 6 Enter a password. Please review the password criteria below carefully. Tips & Hints Please write down your password and security question answer because this information is not stored in our systems and cannot be retrieved. Section 2 - How to Register for NHPNet 10 of 93
Step 7 Select a security question from the drop down arrow and answer it. Please review the security question criteria below carefully. Tips & Hints Please write down your password and security question answer because this information is not stored in our systems and cannot be retrieved. Step 8 1. Select yes or no in the drop down box if you will be a User Administrator for this site. Please click the NHPNet User Administrator Application link if you are going to be a User Administrator. 2. Type in the reasons for site access. Below are a couple sample reasons. 1 2 Section 2 - How to Register for NHPNet 11 of 93
Step 9 1. Enter Your Demographic Information. The demographic information should be the user who is filling out the online application. Please do not fill out this in someone else s name. 2. Click Submit 1 2 Section 2 - How to Register for NHPNet 12 of 93
Step 10 If you successfully registered online for NHPNet you will see the confirmation box below and receive a confirmation email. If you do not see a confirmation box (see below) or did not receive a confirmation email then you did not successfully register online and will have to register again. Tips & Hints After successfully completing the online registration application please allow 24-48 hours for processing. If you have not been approved after 48 hours please contact the NHPNet Research Team at prweb@nhp.org. If you are requesting user administrator site access then please make sure you completed the NHPNet User Administrator Application. Failure to fax in the form after registering online will delay your approval. Section 2 - How to Register for NHPNet 13 of 93
How to Fill Out a User Administrator Application 1. Please print a NHPNet User Administrator Application 2. The user administrator application needs to be filled out accurately in order for your NHPNet account to be approved. Please make sure you: Have a valid signature and title of the approving executive. Unless you are the owner of the practice you cannot sign for yourself. Use the group NPI of the practice or physician, not their individual NPI. 3. A user administrator application is required for every group NPI you need site access to so you might have to fill out multiple forms Tips & Hints If you are registering as a user administrator then please fill out the online registration application prior to faxing in the User Administrator Application. Failure to complete the online application prior to faxing the User Administrator Application will delay your approval for NHPNet. If you registered as a regular user please contact your site administrator to be approved for NHPNet. Section 2 - How to Register for NHPNet 14 of 93
Example: Completed NHPNet User Administrator Application Click here to obtain a blank form. Section 2 - How to Register for NHPNet 15 of 93
Your Profile Step 1 1. Select Your Profile within the Resources drop-down list, or from the dropdown list when hovering over your name. Step 2 1. The next page brings up Profile Options, divided into four pages: a. Account Settings b. User Information c. Site Access d. User Agreement a. b. c. d. Section 3 Your Profile 16 of 93
Step 3 Account Settings 1. Account Settings allows users to view their login ID, reset their password or their security question, and also update preferences. Step 4 User Information 1. User Information allows users to update their demographic information. Section 3 Your Profile 17 of 93
Step 5 Site Access 1. Site Access allows the user to: Request new site access Submit a request to the User Administrator to renew a user s site access View their currently available sites Monitor site access expiration View site permissions Verify the User Administrator for the selected site Request to be removed as a user if access to NHPNet is no longer required 3 1 2 2a. 2. Click Permissions to view your currently available features. a. If you need access to a feature not currently available, click Administrators to contact your User Administrator for permission access. 3. Click to request access to a new site. Section 3 Your Profile 18 of 93
4. The Request Site Access window will appear. a. Enter the name (or partial name) of the site for which you need access. b. Click Select c. Enter the site s Tax ID. d. Enter the reason(s) for your request. e. Select yes or no in the drop down box if you will be a User Administrator for this site. Please click the NHPNet User Administrator Application link if you are going to be a User Administrator. The form must be faxed to NHP prior to facilitate your account approval. If you are not requesting User Administrator access, your account will need to be approved by the User Administrator for the requested. f. Click Submit Section 3 Your Profile 19 of 93
Step 6 NHPNet User Agreement The NHPNet User Agreement Tab allows you to view the terms that a user administrator or other user accessing NHPNet have. Section 3 Your Profile 20 of 93
Section 3 Your Profile 21 of 93
User Administration User Administrators have access to three main functions under User Administration. From the home page, hover over User Administration to display the links. Site Access Requests Manage Site Users Provider Group Details Site Access Requests The Access Requests tab will display all pending user registrations, exluding requests for User Administrators (these users are only approved by NHP staff. 1. Click Approve/Deny to review the request 1 Section 4 User Administration 22 of 93
2. To approve the request, click Approve. A new window will open. 3. Click OK 2 3 Section 4 User Administration 23 of 93
There are four permission tabs: E-Business Dashboards Reports Other E-Business 1. Select the appropriate permissions. 2. Click Submit to assign the permissions. 1 2 Section 4 User Administration 24 of 93
Dashboards (only available if a participating site) 1. Select the appropriate permissions. 2. Click Submit to assign the permissions. 1 2 Reports 1. Select the appropriate permissions. 2. Click Submit to assign the permissions. 1 2 Section 4 User Administration 25 of 93
Other 1. Select the appropriate permissions. 2. Click Submit to assign the permissions. 1 2 Manage Site Users The Manage Users tab will display all active users that currently have access to NHPNet to your site. From this feature you can renew accounts and also manage permissions. 1 2 3 4 5 1. Renew a. A User Administrator can only renew a regular user. b. Renewing a regular user gives that user 365 days of access. Section 4 User Administration 26 of 93
c. After clicking Renew, a pop-up window will appear confirming a successful transaction. 2. Manage Permissions (divided into four Permission tabs) a. E-Business b. Dashboards (not available for all sites) c. Reports d. Other a. E-Business 1. Permissions can be set for the various functions under E-Business 2. Once you ve select the appropriate permissions, click Submit 1 2 Section 4 User Administration 27 of 93
b. Dashboards 1. Dashboards are not available for all sites 2. Permissions can be set for the various Dashboard reports 3. Once you ve select the appropriate permissions, click Submit 1 c. Reports 1. Permissions can be set for the various functions under Reports 2. Only sites participating in the Patient-Centered Medical Home Initiative can retrieve these reports 3. Once you ve select the appropriate permissions, click Submit 2 1 2 3 Section 4 User Administration 28 of 93
d. Other 1. Permissions can be set for the various functions under Other The User Administrator permission can only be set by NHP staff. 2. Once you ve select the appropriate permissions, click Submit 1 2 3. View Details Shows demographics for a selected user. Section 4 User Administration 29 of 93
4. Audit User Allows a User Administrator to view usage history for a selected user. 1. Select a Start Date and an End Date 2. Click Submit 1 2 Details are displayed on the next page. Section 4 User Administration 30 of 93
5. Remove User Clicking Remove User will remove the user s access to the selected site. 1. Click OK to confirm. 1 2. A confirmation window will open. Click OK to close. 2 Section 4 User Administration 31 of 93
Provider Group Details The Provider Group Details tab will give you information about your currently selected site. Tips & Hints The designated User Administrators for a provider site manages and determines NHPNet access and permissions for all users within their site. This individual is responsible for monitoring access and utilization for all users within their site and process updates (terminations, editing of permissions, etc) in a timely manner. NHP staff will not alter or in any way modify access for a specific user when a User Administrator has been established. To provide continuous support (vacations, etc) it is strongly recommended that two User Administrators be appointed for each provider site. User Administrators can approve access, change access, remove access, and audit user s access to NHPNet features. A request to be designated as the User Administrator requires approval by the NHPNet Research Team and evidence that the request has been approved internally within the user s entity. Once approved, User Administrators are granted default access to all NHPNet functions. Please note that User Administrator must contact the NHPNet Research Team at prweb@nhp.org for assistance with NHPNet access (i.e. renew access, locked accounts, etc). Section 4 User Administration 32 of 93
Authorizations & Referrals There are multiple Authorization and Referral Status Options you can choose from. 1. If you have the authorization/referral number, or NHP Member ID, enter the number directly from the home page. Select the appropriate lookup type from the drop-down list. 2. Click Go. 3. For additional search options (all authorizations/referrals for your site), click here. 4. If you have access to Submit or Revise Authorizations and Referrals, click Submit or Revise to access this function. Please refer to the Online Authorization and Referral User Guides for step-by-step instructions on how to Submit or Revise Authorizations and Referrals. 1 2 3 4 Section 5 Authorizations & Referrals 33 of 93
To View an Authorization or Referral by ID 1. Select the View Authorizations & Referrals by Authorization/Referral ID option from the drop-down box. 2. Enter the Authorization/Referral ID in the Authorization/Referral field 3. Click Go 1 2 3 Section 5 Authorizations & Referrals 34 of 93
To View an Authorization or Referral for a Member 1. Select the View Authorizations & Referrals by Member ID option from the drop-down box. 2. Enter the NHP Member ID number in the Member ID Field a. If you do not know the NHP Member ID then you can find it using the Lookup Member ID button. 3. From the drop-down box, select the time period for authorizations or referrals status on your selected member 4. Click Go 1 2 3 4 2 A Section 5 Authorizations & Referrals 35 of 93
To View an Authorization or Referral for This Site 1. Select the View Authorizations & Referrals for This Site option 1 2. From the drop-down box, select your Display option. By default, All Authorizations/Referrals Relating To This Site is selected. 3. Select which processes or finalized status(s) you want to view. 4. Limit your search by Authorization/Referral Date, or Date of Service. 5. Select a start and end date. By default, the report chooses the most recent two weeks of data. 6. After selecting your options, click the Apply button 7. Once your report is rendered, click Actions to export the data to PDF, Excel, CSV, etc 7 2 3 4 5 Section 5 Authorizations & Referrals 36 of 93 6
Provider Enrollment Portal 1. On the NHPNet home page, click on the Go button on the Provider Enrollment Tab. If you do not see this link, contact your User Administrator for access to this function. The Provider Enrollment page appears. The page is divided into three sections. Section 6 Provider Enrollment Portal (PEP) 37 of 93
My Managed Groups This area displays all groups associated with the Tax ID(s) from your NHPNet accessible groups. Clicking on a group in this section will allow you to generate the following provider enrollment transactions: Affiliating a new doctor Download a completed HCAS form Opening or closing a panel Terminating an affiliation Submitting demographic changes to NHP s Provider Enrollment team Section 6 Provider Enrollment Portal (PEP) 38 of 93
Affiliating a New Provider to Your Group Follow these steps to enroll a new provider to your group. If the provider does not already exist in NHP s system, you will need to complete all the fields that are included on a standard enrollment form. If the provider already exists in NHP s system, many fields will already be prepopulated with the data we currently have on file. Select the appropriate group under My Managed Groups. Then click Enroll A New Provider Under This Group as displayed in the screen shot below. Section 6 Provider Enrollment Portal (PEP) 39 of 93
Add Provider To Group window will display. Enter the NPI of the individual provider you are requesting to be added to your group, then click Submit. On the Provider Information screen, you will enter demographic information for the provider you re adding to your group. Any field with a red dot beside it will be required. You can also uploading supporting documents by using the Attach File function at the bottom of the page. Section 6 Provider Enrollment Portal (PEP) 40 of 93
The Provider Practice Locations section is next. Here is where you ll enter information on the role and locations where your provider is practicing. You can also add hospital privileges. As a reminder, the effective date of the affiliation is ultimately decided by NHP s credentialing committee based on receipt of all required information. Complete this section, then click Submit. Section 6 Provider Enrollment Portal (PEP) 41 of 93
Click Add Practice Location to display a pop-up window which allows you to select other locations in your practice. Please include all locations where your provider will be practicing. You must enter role information for each location. The response pop-up will display confirming your submission to NHP. Section 6 Provider Enrollment Portal (PEP) 42 of 93
The Transaction Detail page will display. Click the Download HCAS Form button to produce an electronic copy of the HCAS form you just completed. You must enter the SSN and Date of Birth for confirmation. Section 6 Provider Enrollment Portal (PEP) 43 of 93
The completed HCAS form will display as a PDF. Your request will be displayed on the Home Page under Your Recent Transactions Section 6 Provider Enrollment Portal (PEP) 44 of 93
If the provider is already in NHP s system, many of the fields will be prepopulated. You can report new information or changes via the Note to NHP field. Use the Add New Specialty to report additional specialties not already listed. Use the New Practice Locations section to indicate role(s) at each new affiliation location. Section 6 Provider Enrollment Portal (PEP) 45 of 93
How to Open or Close a PCP Panel On the PEP Home Page, select the practice location to display the provider roster. Click Manage next to the provider s name. All current affiliations will display. Click the Open/Close PCP Panel link. Section 6 Provider Enrollment Portal (PEP) 46 of 93
Select Open or Closed from the drop-down for each practice location where you are making a change. Click Submit. The pop-up confirmation window will display and you will see your request in the transaction history on the Home Page. Section 6 Provider Enrollment Portal (PEP) 47 of 93
How to Terminate a Provider On the PEP Home Page, select the practice location to display the provider roster. Click Manage next to the provider s name. All current affiliations will display. Click the Terminate link. Section 6 Provider Enrollment Portal (PEP) 48 of 93
Select a Termination Reason from the drop-down list, and include a Terminate Date (must be current date or future date). Indicate in the Note to NHP free-text box any additional information that may be relevant for NHP s Enrollment Staff. Select the check-box for each location which you are terminating. If you terminating a PCP, we must receive instructions on where to move their panel to complete transaction. Include these instructions in the free text field. Your request will be delayed if you leave this field blank. Click Submit at the bottom of the page. (Note: Click Toggle All if you would like to select all locations) Section 6 Provider Enrollment Portal (PEP) 49 of 93
The pop-up confirmation window will display and you will see your request in the transaction history on the Home Page. Section 6 Provider Enrollment Portal (PEP) 50 of 93
Demographic Changes Demographic change requests can be submitted for changes at a group level or for individual providers. To make a demographic change for a location, select the practice location on the home page. Click the Notify NHP of Incorrect Group Information link. Section 6 Provider Enrollment Portal (PEP) 51 of 93
Select the appropriate change type from the drop-down (more choices will be added in the future). Use the Details field to include all necessary information relating to your demographic change. Use the Attach File link to uploading supporting documentation for your request. Click Submit. The pop-up confirmation window will display and you will see your request in the transaction history on the Home Page. Section 6 Provider Enrollment Portal (PEP) 52 of 93
To make a demographic change for a provider, select the practice location on the home page. Your location s provider roster will now display. Click Manage next to the provider s name. Click the Notify NHP of Incorrect Provider Information link. Select the appropriate change type from the drop-down (more choices will be added over time). Use the Details field to include all necessary information relating to your demographic change. Use the Attach File link to uploading supporting documentation for your request. Click Submit. Section 6 Provider Enrollment Portal (PEP) 53 of 93
Claims Status There are multiple Claims Status Options you can choose from. 1. If you have the claim number, enter the number directly from the home page. 2. Click Go. 3. For additional search options (by Member ID, all claims for your site), click View additional search options 1 2 3 Section 7 Claims Status 54 of 93
Additional Search Options To View a Claim by Claim Number 1. Select the View Claims by Claim Number option from the drop-down box. 2. Enter the NHP Claim Number in the Claim Number Field 3. Click Go 1 2 3 Section 7 Claims Status 55 of 93
To View Claims for a Member 1. Select the View Claims by Member ID option from the drop-down box. 2. Enter the NHP Member ID number in the Member ID Field 3. If you do not know the NHP Member ID then you can find it using the Lookup Member ID button. 4. From the drop-down box, select the time period for claims status on your selected member 5. Click Go 1 3 2 4 5 Section 7 Claims Status 56 of 93
To View Claims for This Site 1. Select the Show All Claims for This Site option 1 2. A report window will pop-up. By default, paid claims for the most recent 30 days are displayed. 3. Select which Process and Finalized Status(s) you want to view 4. From the drop-down, choose if you want to view claims by submission date, check date or service date 5. Select a start and end date. By default, the report chooses the most recent week. 6. After selecting your options, click the Apply button 7. Once your report is rendered, click Actions to export the data to PDF, Excel, CSV, etc 7 3 5 4 6 Section 7 Claims Status 57 of 93
Tips & Hints Selecting the Show All Claims for This Site option will give you a report that mirrors your weekly Explanation of Payment (EOP) in an Excel format. For additional assistance interpreting these reports, please contact the NHPNet Research Team at prweb@nhp.org Claims Status Descriptions In Process Status(s): PAY DENY PEND REV WARN Finalized Status(s): PAID DENIED REVERSED Descriptor Set to pay, will appear on EOP. Set to deny, will appear on EOP. To be adjudicated by NHP. Original claim payment set to be retracted resulting in a R1 claim. Claim or individual claim line may be denied for lack of authorization or other claim edit rule. Descriptor Claim has paid and appeared on an EOP. Claim has denied and appeared on an EOP. Original claim payment has been retracted. Section 7 Claims Status 58 of 93
Explanation of Payments (EOPs) 1. From the home page, click within the Check Date field. 2. A calendar window will pop-up. Choose the appropriate EOP date. 3. Click Go. 2 1 3 Section 8 Explanation of Payments 59 of 93
4. A pop-up download window will open. Depending on the file size of the EOP, it may take up to 60 seconds or more for the file to appear. 5. The EOP will open as a PDF. Save the file to a location of your choosing. Section 8 Explanation of Payments 60 of 93
Tips & Hints For assistance with downloading EOPs, please contact the NHPNet Research Team at prweb@nhp.org In addition to downloading EOPs, you can also sign up for Electronic Funds Transfer (EFT) and/or Electronic Remittance Advise (ERA - 835). Click on the EFT/ERA link on the main page and follow the on-screen instructions to complete the process. Section 8 Explanation of Payments 61 of 93
Primary Care Provider (PCP) Changes Follow these steps to change a member's PCP within your practice. Step 1 2. From the home page, go to the Primary Care Provider Changes field. 3. Within the Member Information field, you can lookup a member by name (or partial name), NHP Member ID, or Social Security Number. 4. Once you ve entered search information, click Go 1 2 3 Section 9 Primary Care Provider (PCP) Changes 62 of 93
Step 2 1. Choose the member you have searched for. 2. Click Select 1 2 Section 9 Primary Care Provider (PCP) Changes 63 of 93
Step 3 1. The Site drop-down box will show your affiliated sites (typically satellite offices). If the member is seeing a PCP at an affiliated site, select that site from the drop-down list. Otherwise, continue to the PCP listing below. 2. Choose the the new PCP you wish to assign to this member and click Select. a. Only PCPs with open panels are available. If you wish to open a PCP s panel, please contact prweb@nhp.org to initiate the request. 1 2 Section 9 Primary Care Provider (PCP) Changes 64 of 93
Step 4 1. Enter the effective date of the PCP change. 2. Confirm that you have the patient s consent to make the change by selected the check box. 3. Click Submit 1 2 3 Section 9 Primary Care Provider (PCP) Changes 65 of 93
Step 5 This screen will show you the pending PCP changes for your site. It takes 1-2 business days for the change to be effective. Tips & Hints Users can change/correct PCP information for all active NHP members. The attestation box confirms you have the patient s consent to initiate the PCP change. If the PCP you want to assign to the member is not accepting new patients then you cannot select them through NHPNet. Please contact the Provider Services Line at 855-444-4NHP (4647) to change the member s PCP. Section 9 Primary Care Provider (PCP) Changes 66 of 93
Eligibility 1. Go to the NHP Eligibility tile on the NHPNet home page. 2. Select the Lookup Member By criteria from the drop-down box. 3. You can search for a NHP by Member ID, Name or Date of Birth. 1 2 Section 10 Eligibility 67 of 93
To Search by Member ID 1. Select the Member ID option from the drop-down box. 2. Enter the NHP Member ID in the Member ID field 3. Click Go 1 2 3 Section 10 Eligibility 68 of 93
To Search by Member Name 1. Select the Name option from the drop-down box. 2. Enter the name or part of the name in the Name field 3. Click Go 1 2 3 Section 10 Eligibility 69 of 93
To Search by Date of Birth 1. Select the Date of Birth option from the drop-down box. 2. Enter the member s date of birth in the Date of Birth field 3. Click Go Section 10 Eligibility 70 of 93
1 2 3 Search Results Page 1. If you search by date of birth or name, you will then see the search results page. 2. The Current Status column will indicate if the member is currently enrolled. 3. Select the appropriate member, click View. Section 10 Eligibility 71 of 93
2 3 Eligibility Page 1. Eligibility information will be displayed on the screen. 2. You can also view co-pays, deductibles and coinsurance for specific services. There is also a link to the Summary of Benefits page for detailed benefit information. Section 10 Eligibility 72 of 93
Section 10 Eligibility 73 of 93
Reports The Reports function is divided down into three sections: Clinical Reports PCMHI Reports (only accessible if site participates in PCMHI) Enrollment Reports Clinical Reports The Clinical Reports function is divided into two sections: Reports for Hospitals Reports for PCP Sites Section 11 Reports 74 of 93
Reports for Hospitals If you are a hospital site, you can view a report listing your inpatient admissions on a quarterly basis. 1. Click Quarterly Hospital Admissions Report. A window will pop-up. 1 2. The report defaults to the most recent quarter available. Click the drop-down to choose a different time period. 3. Click Apply 4. Once the report is rendered, click Actions to export the data to PDF, Excel, CSV, etc. 2 4 3 Section 11 Reports 75 of 93
Reports for PCP Sites You can also view clinical reports for PCP sites. Some of the reports offered: Asthma and Diabetes reports ER site summary reports Infant and adolescent screening reports For example, Asthma Management Members Needing Screening or Testing will produce a report showing members who are identified as having asthma but may have not been appropriately prescribed medication during the measurement year. 1. Click Asthma Management Members Needing Screening or Testing. A window will pop-up. 1 Section 11 Reports 76 of 93
2. The report defaults to the most recent measurement year. 3. Click Actions to export the data to PDF, Excel, CSV, etc. 3 2 Questions on the clinical reports? Please refer to the Clinical Reports User Guide for additional assistance. Section 11 Reports 77 of 93
PCMHI Reports (Patient-Centered Medical Home) Patient Centered Medical Home Initiative Reports are displayed if you are involved in the PCHMI initiative. This feature is only available to sites currently engaged in the Patient Centered Medical Home Initiative. Read more here: www.mass.gov/hhs/medicalhome Section 11 Reports 78 of 93
Enrollment Reports The Enrollment Reports function is divided into four sections: Member Roster Report Member Transaction Report Redetermination Report Site Provider Report Section 11 Reports 79 of 93
Member Roster Report This report will display all members assigned to PCP's within the currently selected site. 1. Click Member Roster Report. A window will pop-up. 1 2. The report defaults to the current date. a. Select the date range you wish to view b. Select either all or specific NHP products c. Select a PCP or PCPs d. Click Apply Section 11 Reports 80 of 93
e. Once the report is rendered, click Actions to export the data to PDF, Excel, CSV, etc. 2a. 2e. 2b. 2c. 2d. Member Transaction Report This report will display all member transactions for the currently selected site according to the criteria selected. 1. Click Member Transaction Report. A window will pop-up. Section 11 Reports 81 of 93
1 2. The report defaults to the current date. a. Select the date range you wish to view b. Select the transaction type you wish to view c. Click Apply d. Once the report is rendered, click Actions to export the data to PDF, Excel, CSV, etc. 2d. 2a. 2b. 2c. Redetermination Report This report will display all members for the currently selected site with recent Medicaid and Connector redetermination dates. 1. Click Redetermination Report. A window will pop-up. Section 11 Reports 82 of 93
1 2. Once the report is rendered, click Actions to export the data to PDF, Excel, CSV, etc. 2 Tips & Hints The report is updated ad hoc by MassHealth. The report includes MassHealth members whose coverage is due to expire within the next 30 days. To the extent a provider s system allows it, the data can be used to flag patients upon registration that their coverage is at risk such that registration staff can remind the patient Section 11 Reports 83 of 93
The report can also be downloaded for primary care sites to initiate mailings, telephonic outreach, etc. For additional assistance in interpreting these reports, please contact the NHPNet Research Team via email at prweb@nhp.org. Site Provider Roster Report This report displays all NHP enrolled providers affiliated with the selected site. The report defaults to the current date unless the user selects otherwise. When reviewing the NHP Provider Roster Report please note the following: PCP Panel Explanation Y Closed Practitioner is currently closed to new patients Y Open Practitioner is open to patient assignments Y N/A Denotes a covering PCP, not subject to member assignments. N N/A Denotes a Specialty provider. No panel assignment applies. Changes to a practitioner s panel status should be reported to NHP s Provider Enrollment team at pec@nhp.org. NHP s Provider Relations Managers also review panel status at each provider visit. 1. Click Site Provider Roster Report. A window will pop-up. Section 11 Reports 84 of 93
1 2. The report defaults to the current date. 3. To verify your site s provider roster for a prior date, click the calendar icon to choose a new date. 4. Click Apply 5. Click Actions to export the data to PDF, Excel, CSV, etc. 5 2 3 4 Tips& Hints Use this report to verify credentialing status, panel status and effective date. Section 11 Reports 85 of 93
Site Documents Site documents section is where you can find electronic files that have been uploaded by NHP staff for you to view and download. Step 1 5. Select Site Documents within the Resources drop-down list. Step 2 1. Click Download to retrieve the corresponding document. Section 12 Site Documents 86 of 93
Key Indicators & Alerts Key Indicators On the right-hand side of the home page, you ll see what we call Key Indicators. These measures are hosted on the main page to bring actionable information to the forefront. Key Indicators is divided into three sections: 1. Quality Measures 2. Patient Utilization 3. EDI Claims (837) Submission 1 2 3 Section 13 Key Indicators & Alerts 87 of 93
Quality Measures a) Breast Cancer Timeline: 12 months ending Previous Month adjudicated through Previous Month The report displays members between the ages of 42-69 years and who have not had a mammogram to screen for breast cancer (based on HEDIS definitions) during the measurement year. Women that had a bilateral mastectomy or for whom there is evidence of two unilateral mastectomies are excluded. b) Diabetes Timeline: 12 months ending Previous Month adjudicated through Previous Month The report displays members between the ages of 18-75 years with diabetes (type 1 and type 2), who are continuously enrolled in the current year and who have not received HbA1C tests (based on HEDIS definitions) during the measurement year. c) Asthma Timeline: 12 months ending Previous Month adjudicated through Previous Month The report displays members between the ages of 5-50 years who are identified as having asthma, who are continuously enrolled in the current and previous year and who have not appropriately prescribed medication (based on HEDIS definitions) during the measurement year. Under Members Needing Screening/Testing, click on the indicated number to pull up a report showing impacted members specific to your site. Only users with permission to view Clinical Reports will be able to run this report. Section 13 Key Indicators & Alerts 88 of 93
Patient Utilization a) ER Visits Count Timeline: Monthly data as of last day of the previous month A monthly report that identifies NHP members who have had an ER Visit within the last one month and the details of the visit. In addition, the report identifies the number of ER visits and non-emergent visits in the past 12 months. 1 b) Generic Drug Dispense Rate Timeline: Monthly data as of last day of the previous month The generic dispense rate (GDR) is the proportion of all prescriptions dispensed as generic, i.e., the number of generic fills divided by the total number of prescriptions. c) Inpatient Admissions Timeline: Claims for most recent 30 Dates of Service The report identifies NHP member hospital admissions and the details of the admissions. 2 1. Click on the indicated number to pull up a report showing impacted members specific to your site. Only users with permission to view Clinical Reports will be able to run this report. 2. The dashboard link is only available if the selected site is participating Dashboard site and if the user has the appropriate permission. Section 13 Key Indicators & Alerts 89 of 93
EDI Claims (837) Submission Electronic Submissions Timeline: Daily data as of the previous day Daily status of electronic claims submitted the previous day. Paper Submissions Timeline: Daily data as of the previous day Daily status of paper claims submitted the previous day. The dashboard link is only available if the selected site is participating Dashboard site and if the user has the appropriate permission. Section 13 Key Indicators & Alerts 90 of 93
Alerts On the NHPNet home page, you ll notice small icons containing numbers as part of the following tiles: 1. Claims Status 2. Authorizations & Referrals 3. NHP Eligibility 1 2 3 Section 13 Key Indicators & Alerts 91 of 93
Hover over the numbered icon to reveal the drop down box. Clicking on a link will bring up the corresponding report Once your report is rendered, you can then change parameters and export the data to PDF, Excel, CSV, etc Alerts: Claims Status Alerts: Authorizations & Referrals Alerts: NHP Eligibility Section 13 Key Indicators & Alerts 92 of 93
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