Provider Web Portal by jzl15230

VIEWS: 5 PAGES: 19

									Web Prior Authorization
 Request Instructions




Division of Medical Assistance Programs
              March 2009
                                       Contents

Introduction ................................................................................. 1
Who can submit Web PA requests............................................ 1
Before you submit a Web PA request ....................................... 1
How to search for a PA request................................................. 2
How to submit a Web PA request.............................................. 5
  Step 1: Enter base information .................................................................5
  Step 2: Enter PA line items.......................................................................8
  Step 3: Enter PA notes ...........................................................................11
  Step 4: Review PA confirmation .............................................................13
  Step 5: Complete and submit supporting documentation.......................14
     PA requests for Division of Medical Assistance Programs (DMAP),
     Acumentra or ICM...............................................................................15
     PA requests to Addictions and Mental Health Division (AMH)............15
     Pharmacy PA requests .......................................................................15
What happens after DHS receives your PA request .............. 16
How to copy an approved PA request .................................... 17
Introduction
The Prior Authorization section of the Provider Web Portal gives providers the
ability to submit online prior authorization (PA) requests for Oregon Medicaid fee-
for-service (FFS) clients. Web PA also allows providers to search, review, and
track the status of their PA requests.
Note: PA approval does not guarantee eligibility or payment of services and it does
not override program guidelines and limitations. It is always the provider’s
responsibility to verify recipient eligibility and benefit plan coverage for each date
of service.


Who can submit Web PA requests
Not all providers will be able to submit Web PA requests. The Provider Web Portal
is only available to enrolled DHS providers with a National Provider Identifier
(NPI) registered with DHS (if their provider type is eligible for NPI).
   If you are authorized to submit PA requests on the Web, you will have Prior
   Authorization Submit and Prior Authorization Inquiry roles listed in the
   “Available Roles” of the Clerk Maintenance screen.
   If you want staff to perform Web PA functions for your office, review their
   clerk roles and add the PA roles to their list of Assigned Roles.


Before you submit a Web PA request
The list below will help you to better understand what needs to be done prior to
submitting a Web PA request.
   1. Before starting a PA request, verify that the recipient is eligible on the date
      of service for the services rendered. For clients enrolled with an OHP
      managed care organization (MCO), request PA from the MCO.
   2. Use the Web portal’s PA search function to see if a PA for the same client,
      dates of service, units of service and procedure(s) already exists. If it does,
      do not submit a new PA.
   3. Verify that you are signed on and are acting on behalf of the correct
      provider. It is crucial to make sure you are logged on under the correct
      provider number because this is the provider who will receive the PA notice.


                 Web PA Instructions Handbook – March 2009                              1
   4. You must complete and submit the PA request in its entirety in order to save
      the data entered. Partially completed PA request data cannot be saved.
   5. The session will end after 20 minutes of inactivity. Any work or changes
      that have not been submitted will be lost.


How to search for a PA request
Select “Prior Authorization,” then “Search.” The following screen will appear:




The PA search screen allows you to search prior authorization requests to
determine if a PA already exists or to determine the status of a PA.

Field descriptions
Field                     Description
Prior Authorization       Number assigned to a Prior Authorization request.
Start Date                Search criteria that indicate when to begin the PA
                          search.
NDC                       This field allows the user to narrow the search
                          parameters by NDC code.
Procedure                 A code to uniquely identify a procedure.
Diagnosis                 The ICD-9-CM diagnosis code.
Client ID                 Identifies the recipient who received service from
                          provider.
Client Name               The recipient name.
Status                    Status of the prior authorization.
PA Assignment             Indicates the service type of the prior authorization.
Service Provider ID       The provider identification number that uniquely
                          identifies the service provider.
Revenue Code              The Revenue Center Code.

                Web PA Instructions Handbook – March 2009                          2
To conduct a PA search
You must enter at least one of the following criteria to conduct a PA search: Client
ID, Prior Authorization Number, Diagnosis, Service Provider, or service code (e.g,
Procedure, NDC, or Revenue Code).
Step Action                                    Response
1    Enter valid search criteria:
        Prior Authorization Number
        Client ID
        Start Date
        NDC
        Procedure
        Diagnosis
        Service Provider and/or
        Revenue Code.
2    Select Search.                            If found, the PA will display.
                                               If the system is unable to find the
                                               PA, verify the search criteria and
                                               conduct another search.

PA search results
This screen shows the PA search results in a list format and displays records
matching the search criteria. This list will contain summary information about the
PA and shows the PA status. If multiple results display, the PA number will be a
hyperlink to a PA information screen.
PA search results may include requests with statuses of Approved, Pending, or
Evaluation. “Approved” requests have been approved by DHS, and will display the
authorized Effective and End Dates, Authorized Units and/or Dollars.




Field descriptions
 Field                     Description
 Prior Authorization       Prior Authorization number.
 Client ID                 Identifies the recipient who received service from
                           provider.
Last Name                  The last name of the recipient.

                 Web PA Instructions Handbook – March 2009                           3
Field                    Description
First Name               The first name of the recipient.
Status                   PA current status.
PA Assignment            Identifies type of service to which a prior authorization
                         request or requests are assigned.
Start Date               Indicates when to begin the PA search.
Procedure                A code to uniquely identify a procedure.
NDC                      The National Drug Code used to uniquely identify a
                         drug.
Revenue Code             The revenue center code.
Service Provider         The provider identification number that uniquely
                         identifies the service provider.

To view PA search results
 Step Action                                  Response
   1    Click the line item link that you     The PA information screen will
        want to view. Clicking the link       display.
        will direct you to the PA Detailed
        Info screen.




                Web PA Instructions Handbook – March 2009                        4
How to submit a Web PA request
Step 1: Enter base information
Select “Prior Authorization,” then “New.” The following screen will appear:




This screen allows you to enter PA base information. It is the first screen of the PA
request process.

Field descriptions
Shaded boxes are required to process your PA request.
 Field                    Description
 Client ID*               Identification number of recipient.
 First Name               Recipient's first name.
 Last Name                Recipient's last name.
 MI                       Recipient's middle initial.
 Date of Birth            Recipient's date of birth.
 Vendor Patient Account The Vendor's Patient Account Number.
 Number
 PA Assignment*           Indicates the type of service to which a prior
                          authorization request or requests are assigned (i.e.,
                          home health, durable medical equipment, hospital).



                 Web PA Instructions Handbook – March 2009                          5
Field                   Description
Special Considerations* This indicates if there are any special circumstances or
                        considerations surrounding the Prior Authorization.
                        This is for informational purposes only.
Referring Provider ID   Identification number of the referring provider.
Attachments*            Indicates if there are any attachments (e.g.,
                        prescription or physician’s order). Refer to your
                        provider guidelines for any attachments you need to
                        submit to DHS for PA review.

                          The default value for this field is NO. If there are
                          attachments, you will need the PA Coversheet for
                          Supporting Documentation.
Clerk                     Provider clerk that entered the prior authorization.
                          Defaults to logon user. Consists of User Name, First
                          Name, and Last Name.
Diagnosis Number          If more than one diagnosis code is entered, the system
                          will automatically indicate the number 1 thru 5 based
                          on the primary diagnosis, secondary, tertiary, etc.
Diagnosis Name            The description of the ICD-9 diagnosis code.
Diagnosis Code            ICD-9 diagnosis code associated with the PA. Up to 5
                          diagnosis codes can be entered.
Provider ID               Provider for prior authorization. Defaulted from login
                          provider.
Note: To submit a pharmacy PA, select ‘Pharmacy’ from the PA Assignment drop-
down list. Then on the next screen, select NDC Code from the Service Type Code
drop-down list, fill in the NDC field and the NDC Lock field.

To add base information
 Step Action                                Response
  1   Enter data in the required fields     Note: The Date of Birth, Last
      (Client ID, PA Assignment, Special    Name, First Name and MI will
      Considerations, and Attachments).     automatically populate.
  2   Enter data in the Vendor account
      number and referring provider ID.
  3   Click the Add button.                 Diagnosis fields activate.
      The “add” button will activate the
      diagnosis code field and will allow
      you to search for a diagnosis code.
               Web PA Instructions Handbook – March 2009                           6
Step Action                                   Response
 4   Enter diagnosis code(s). Or, use the
     search link to look up the diagnosis
     codes. Up to 5 diagnosis codes can
     be entered.
 5   Click the Next button.                   Data saves.

To update base information
 Step Action                                  Response
  1   Select the line item to be updated.     Data populates detail fields in the
                                              Base Information screen.
  2     Enter data in the required fields
        (Client ID, Special Considerations,
        PA Assignment, Attachments).
  3     Enter data in the Vendor account
        number and diagnosis code 1-5.
  4     Click the Next button.                Data saves.




                Web PA Instructions Handbook – March 2009                           7
Step 2: Enter PA line items
This screen allows you to enter multiple line items. You must enter a Service Type
Code to indicate the type of code (e.g., procedure code, Revenue Center Code, or
National Drug Code) that describes the services you are requesting PA for.
If you are requesting more than one specific code, then enter a line item for each.
Enter information for the first line item on the screen. To add more lines, click the
“Add” button.




Field descriptions
Shaded fields are required to process your PA request, if applicable.
Field                       Description
Line Item                   This represents the line-items (or details) of a Prior
                            Authorization record. There can be up to 10 line-items
                            per PA record.
Service Type Code*          Drop-down list to indicate the service type code (i.e.,
                            ICD-9 code, NDC, Procedure Code, or Revenue code).
ICD-9                       Code indicates the type of diagnosis. Search look up
                            option can be used instead of typing in the diagnosis.
Procedure*                  Dynamic field that appears when Procedure code
                            (ICD-9 or HCPCS) is selected from the Service Type
Thru Service                The thru procedure code is used to represent a range of
                            procedure codes.
Modifier 1                  This is a procedure code modifier. Modifiers 1-4 are
                            only visible when Procedure is selected from the
                            Service Type Code.
                 Web PA Instructions Handbook – March 2009                              8
Field                    Description
Modifier 2               This is a procedure code modifier.
Modifier 3               This is a procedure code modifier.
Modifier 4               This is a procedure code modifier.
Tooth                    Indicates the tooth number.
Quad                     Indicates the tooth quadrant. Dynamic field that
                         appears when Dental is selected from the Service Type
                         Code drop-down list.
NDC Lock                 Drop-down list to indicate NDC Lock. Only visible
                         when NDC is selected from the Service Type Code.
NDC*                     Dynamic field that appears when NDC code is
                         selected from the Service Type Code selection list.
                         This field is required when an NDC is selected.
Revenue Code*            Dynamic field that appears when Revenue Code is
                         selected from the Service Type Code drop-down list.
Status                   The status of the PA line item. It will be in
                         “evaluation” status until the DHS makes a decision on
                         the PA.
Service Provider ID      The service provider's identification number. The
                         provider ID entered can be either the National
                         Provider Identifier (NPI) or the Medicaid Provider ID
                         (MCD).
Requested Eff Date*      This is the requested Prior Authorization start date.
Requested End Date*      This is the requested Prior Authorization stop date.
Requested Units          This is the number of units requested for the Prior
                         Authorization.
Requested Dollars        This is the dollar amount requested for the Prior
                         Authorization. Must be greater than 0.
Authorized Eff Date      This is the authorized Prior Authorization start date.
Authorized End Date      This is the authorized Prior Authorization stop date.
Authorized Units         This is the number of units authorized for the Prior
                         Authorization.
Authorized Dollars       This is the dollar amount authorized for the Prior
                         Authorization.
Balance Units            Number of units for the balance for the prior
                         authorization.
Balance Dollars          Dollar amount for the balance for the prior
                         authorization.


                Web PA Instructions Handbook – March 2009                         9
Field                     Description
Quantity Used Units       Number of units for the quantity used for the prior
                          authorization.
Quantity Used Dollars     Dollar amount for the balance for the prior
                          authorization.

To add a line item
 Step Action                                 Response
  1   Select the service type code from      Data entry fields are activated
      the drop-down list (i.e., ICD-9,       based on service type code
      NDC, procedure code, revenue           selection.
      code).
  2   Enter date in the Procedure, NDC,
      or revenue code fields based on the
      service type selected.
  3   Enter the Service Provider ID,
      Requested Effective Date and
      Requested End Date.
  4   Enter data in the remaining
      applicable fields.
  5   Click the Next button.                 Data saves.

To update a line item
 Step Action                                 Response
 1    Select the line item to be updated.    Data populates detail fields in the
                                             Line Item screen.
2       Enter updated data in the Procedure
        code, Thru Service, Tooth, Quad,
        NDC, Revenue Code, Service
        Provider ID and Requested Eff
        Date fields.
3       Enter updated data in the Modifier
        1, Modifier 2, Modifier 3, Modifier
        4 and Requested Units fields.
4       Click the Service Type Code and
        NDC Lock drop-down arrows, and
        select an item from the list.
5       Click the Next button.              Data saves.


                Web PA Instructions Handbook – March 2009                          10
Step 3: Enter PA notes
This screen allows you to add notes for DHS to consider when reviewing your PA
request. You can add a line for each note. Each note can contain 4,000 characters.




Field descriptions
 Field                     Description
 Description               Free form text for the external text (note). Up to 4000
                           characters per box.
Line Item                  This is the line item of the prior authorization.
Spell check                Launches spell check for the Description field.

To add notes
 Step Action                                  Response
  1   Click the Add button.                   Activates the notes screen.
  2   Enter data in the Description field.
  3   Click the Save button.                  Data saves. After the save button is
                                              selected, the PA Number will
                                              display.

To delete notes
 Step Action                                  Response
  1    Choose the line item to be deleted.    Data populates fields in the Notes
                                              screen.
   2    Click the Delete button.              Dialog displays to confirm deletion.
   3    Click the OK button.                  Item deletes.

To update notes
 Step Action                                  Response
  1   Choose the line item to be updated.     Data populates detail fields in the
                                              Notes screen.
   2    Enter updated data in the
                Web PA Instructions Handbook – March 2009                            11
Step Action                              Response
     Description field.
 3   Click the Save.                     Data saves.




              Web PA Instructions Handbook – March 2009   12
Step 4: Review PA confirmation
After submitting a PA request online, a PA confirmation screen will display above
the Notes screen with the prior authorization number and the PA status.
This screen confirms that your PA information was saved successfully. Print this
screen or write down the prior authorization number for your records.




                Web PA Instructions Handbook – March 2009                          13
Step 5: Complete and submit supporting documentation
You can click the “Coversheet” button on the Notes screen to print the EDMS
Coversheet and use it as a coversheet for supporting documentation you send to
DHS. This coversheet is required for PA requests to DMAP.
   When selected from the Notes page, the Prior Authorization number and
   Document Type will automatically populate on the form.
   Make sure to also complete the Client and Provider ID fields on the form. This
   allows DHS to associate the request with the appropriate provider and client.




                Web PA Instructions Handbook – March 2009                        14
PA requests for Division of Medical Assistance Programs (DMAP),
Acumentra or ICM
Fax any required documentation to the Office of Document Management (ODM)
at 503-378-5814 for routine requests and 503-378-3435 for immediate/urgent
requests.
   Submit the EDMS Coversheet (DHS 3970) as the cover sheet for all PA
   documentation submitted.
   Refer to DMAP’s provider guidelines for required documentation.

PA requests to Addictions and Mental Health Division (AMH)
Mail or fax any required documentation to AMH:
      AMH Medicaid Policy Analyst
      500 Summer Street NE, E86
      Salem, OR 97301
      Fax 503-947-5546

Pharmacy PA requests
Fax any required documentation to the Oregon Pharmacy Call Center at 800-346-
0178. Refer to the pharmacy provider guidelines for required documentation.




               Web PA Instructions Handbook – March 2009                    15
What happens after DHS receives your PA request
Once you submit your PA request on the Web, the status of the PA will initially be
in “evaluation” status.
   Until DHS reviews and approves your request, the PA number on the PA
   confirmation screen can ONLY be used to track the status of the PA.
   You can check the status of the PA as often as you want. See PA search to track
   the status of the PA.
Once all necessary documentation has been received and processed, the PA will be
updated indicating a status with any associated restrictions noted. The PA
expiration date is also stated.
   If the PA is approved, the PA request status will change to “approved.” Only
   after the PA is approved can you use the prior authorization number to submit a
   claim.
   If the PA is denied, no updates or modifications can be made to the original PA.
   You must submit a new PA for consideration by DHS.




                Web PA Instructions Handbook – March 2009                       16
How to copy an approved PA request
You can copy existing PAs using the Copy PA button at the bottom of the screen.
Once copied, you can update the PA data and submit the copied PA as a new PA.
Step Action                                 Response
1    Search for a PA for the client or      A list of matching PA requests
     service you want to request PA for.    displays.
2    Select the PA request you want to      PA information for the request
     copy.                                  displays, with a “Copy PA” button at
                                            the bottom of the page.
3       Click the “Copy PA” button at the   A copy of the completed PA
        bottom of the page.                 displays.

                                            “Save” and “Cancel” buttons replace
                                            the “Copy PA” button.
4       Update all required and/or
        applicable fields.
           • Base information
           • Line items
           • Notes
5       Click the save button.              A message at the top says the save
                                            was successful.

                                            A new PA number displays in the
                                            PA number field at the top of the
                                            screen.

                                             The “Copy PA” button appears at
                                             the bottom of the screen.
6       Click the Coversheet button to print The EDMS Coversheet displays with
        an EDMS Coversheet, if needed.       the PA number and Document Type
                                             fields populated.
        Submit any required documentation
        to DHS.




                Web PA Instructions Handbook – March 2009                        17

								
To top