User Guide. Provider Portal

Transcription

1 User Guide Provider Portal

2 Table of Contents Getting Started 2 Website URL 3 Website Layout/Menu Links Basics 4 Alerts/Selecting IPA 5 Search Methods 6 Indicator Icons Using the Provider Portal 7 Provider Search 8 Auth Request - Referral Request 9 Can t Find Member/Provider 10 Diagnosis/Procedure 11 Additional Information 12 Review/Submit/Attach/Print 15 Claim Search/Eligibility 16 My Members/Reference 17 My Documents/Sign Out Frequently Asked Questions 20 Obtain access to the portal 20 Obtain additional web accounts/users 21 Access to other groups or providers 21 Can t find claims 22 Can t find member 22 Can t find provider 23 Alternate method to submit auth 23 Request new econsult login 24 Print authorization letters 24 Contact us 13 Auth Search 14 My Auth i

3 Getting started Website URL Visit our website to sign up for our Provider Portal or to Login: To sign up for our Provider Portal click Online Form To login click Provider Portal Login 2

4 Website Layout Menu Links IPA Name Menu Links Home (Select IPA) Providers (Provider Search) Auth Request (Submit Referral) Auth Search My Auth My Hospital Members My econsults Claim Request* Claim Search Upload Claim File* Eligibility (Member Search) My Members (Members assigned to your Provider Portal account) Reference (Diagnosis, Procedure, POS, CPT Modifier) My Documents (Eligibility & Cap Reports) Sign Out (HIPAA Privacy) Switch (Change Current IPA) IPA s (Listing of IPA s linked to your tax ID) *Not available for use at this time. 3

5 Basics Alerts Alerts display when MedPoint Management UM staff requires more information on any Authorization Once Mark as Read the message is removed but can be accessed again by checking the Show Read Items Selecting IPA Click on Switch Click on desired IPA IPA Name 4

6 Search Methods four four A simple search works best Example above uses the first 4 characters of first and last name all other fields are left blank or default Do a simple name search first, if that doesn t work click Reset and try other individual fields (Refresh page if it gets stuck) four four Advanced Search For advanced search options look for links like the one above More Referral Search Options Familiarize yourself with these advanced search options as they are useful for narrowing down long search lists 5

7 Indicator Icons Update in progress Indicator Wait for this to complete before clicking on any other link This will disappear once the update is complete Internet Browser Indicator Pay close attention to your internet browser wait indicator If your browser or Web Portal get stuck click on the Refresh Icon on your internet browser, or open a new tab and try again You may only be logged into one computer at a time, if you try to login from a second computer using the same account it will log you off the first computer. See FAQs number 2 on page 20 6

8 Using the Provider Portal Providers (Menu Link) Unkn Unkn First select the correct IPA as discussed on page 4 If you know the provider name Use Simple Search Technique as discussed on page 5 For a list of providers that belong to a specific specialty click on Specialty If the search comes up empty try a different specialty within the same medical field (only use if appropriate) Once you find the provider you may click Copy to Auth Request (start referral) 7

9 Auth Request - Referral Request IPA Name four four Verify the correct IPA is selected as discussed on page 4 Click on Open Search Panel to bring up the yellow boxes Searching for member use simple search technique Searching for provider use specialty field The best way to select a provider is to use the provider tab (see page 7) If you have the Provider Number (NPI#) enter it in Enter Provider ID and click tab on your keyboard Completed View (see below - Some information greyed out for HIPAA Privacy) 8

10 Auth Request - Can t Find Member/Provider If you cannot find the member, you can still submit the Authorization by clicking on the I can t find the member (or provider) button Fill out the additional required information which will help our agents when updating the Eligibility data for the member Although there is no Submit button shown in the yellow boxes you may continue filling out the Auth request form and click Review once all fields are complete IPA Name 9

11 Auth Request - Diagnosis/Procedures Fill out diagnosis Codes (see page 15 to search for codes). If the code is found in the Top 50, click drop down list, find code then click Add Not found - click Search Diag Codes... and use simple search method (see page 5) You may also use ICD 9 codes (for Diagnosis Codes) Once you have entered a code in Diag Code 1 click Validate Codes Now... Follow the same steps for Procedures (up to 10 CPT codes) (If the codes you are looking for are not found see page 15 to search using different search criteria. If that does not work you may make a side note on the message section) 10

12 Auth Request - Additional Information Include the following in Additional Information section 1. Name of practitioner submitting request: 2. Specific issue to be addressed by consultant: 3. Pertinent H & P exam details: 4. Relevant treatment history including medications /lab/x-ray/other test results: 5. Is co-management requested? 6. Are you requesting that the specialist take over treatment of the problem? 11

13 Auth Request - Review/Submit/Attach/Print Review and verify data entered If everything looks good click Submit Referral Request Take note of the Web Reference Key, attach additional documentation or medical notes, and print Verify that the auth was entered correctly by going to My Auth (see page 14) Make sure you choose the correct IPA (see page 4) before clicking on My Auth Auths take 2-3 hours to post onto your My Auth 12

14 Auth Search Verify the correct IPA is selected IPA Name Use Simple Search Method discussed in Page 4 four four Click on More Referral Search Options to narrow search criteria (Only if needed) Displayed data (Auth#, Status, Member ID, Member Name, etc - click on links to expand) 13

15 My Auth Verify the correct IPA is selected. Checking My Auth after submission allows you to verify the submission was successful, see status, and view details including ability to print authorization letter for any auths entered under your User ID My Hospital Members (List of all your Members admitted to the hospital) View - Member name, Auth #, Diagnosis, Procedure Code(s), Admit Date, Discharge Date IPA Name My econsults (List of all your econsults) 14

16 Claim Search Verify the correct IPA is selected Use Simple Search Method discussed in Page 4 four four Eligibility Verify the correct IPA is selected. Use Simple Search Method four four MPM Eligibility is updated monthly, some health plans twice a month. For current eligibility check the health plan website 15

17 My Members Verify the correct IPA is selected. Members assigned to the Provider/User logged in (Note you may not sort or export My Members data) Reference Search for the proper code to use when entering Auths Search Procedure Codes, Diagnosis Codes, Place of Service, CPT Modifier(s) - Useful when Submitting Auths 16

18 My Documents View Cap Reports, Claim EOB Reports, and Eligibility Reports Ability to search for all files or only today s files Ability to filter on file type, category, and dates PDF, Microsoft Word, RTF formats, and Excel Sign Out Please remember to sign out for HIPAA Privacy reasons. Signing out also ensures that no one else has access to the data while you are away from your desk. 17

19 Frequently Asked Questions 1 How can I get access to the portal? 2 How can I obtain additional web accounts/users? 3 How can I get access to other groups or providers on the web? 4 Why can t I find any of my claims on the site? 5 Why can t I find my member? 6 Why can t I find the provider? 7 How else can I submit an auth/referral? Your own footer 18

20 Frequently Asked Questions Your own sub headline 8 How can I request new econsult login accounts? 9 How do I print authorization letters? 10 How do I contact you for additional assistance? Success is the sum of small efforts, repeated day-in and day-out. ~Robert Collier 19 19

21 1. How can I get access to the portal? 1. Visit our website 2. Click on Online Form 3. Fill out form 4. Type NA for any information you are missing 5. Click Submit (24 hour processing time) 6. You will receive with Login ID and Password once your account is created 2. How can I obtain additional web accounts/users? 1. Visit our website 2. Click on Online Form 3. Fill out form 4. Type a brief description of your request in the Your Message field 5. Type NA for any information you are missing 6. Click Submit (24 hour processing time) 7. You will receive with Login ID and Password once your account is created 20 20

22 3. How can I get access to other groups or providers on the web? 1. Visit our website 2. Click on Online Form 3. Fill out form 4. Type a brief description of your request in the Your Message field 5. Type NA for any information you are missing 6. Click Submit (24 hour processing time) 7. You will receive with Login ID and Password once your account is created 4. Why can t I find any of my claims on the site? 1. Your user account may needs to be updated to ensure that the proper provider tax IDs are linked (follow the diagram and wait 48 hours to process change and update claims on your account) 2. The claim(s) are not in our system 3. You submitted via Office Ally (allow 5 business days processing) 4. The claim posted on our database under a different tax ID number. 5. Inquire at webclaiminquiry@medpointmanagement.com 21 21

23 5. Why can t I find the member? 1. It takes 24 hours for members to show up online after they are added in our database 2. Your user account may needs to be updated to ensure that the proper provider tax IDs are linked (follow the diagram and wait 48 hours to process change and update claims on your account) 6. Why can t I find the provider? 1. It takes 24 hours for providers to show up online after they are added in our database 2. Your user account may needs to be updated to ensure that the proper provider tax IDs are linked (follow the diagram and wait 48 hours to process change and update claims on your account) 3. If you are non-contracted you might have to submit W-9 to provider services providerservices@medpointmanagement.com 22 22

24 7. How else can I submit auth/referral? 1. All authorizations/referral submissions must be done through our Provider Portal. 2. Visit our website 3. Click on Online Form 4. Fill out form 5. Type NA for any information you are missing 6. Click Submit (24 hour processing time) 7. You will receive with Login ID and Password once your account is created 8. How can I request new econsult login accounts? (HCLA only) Contact econsult help desk at between 8:00AM 5:00PM. They will assist you in creating new user accounts, and/or assisting with any econsult issues

25 9. How do I print authorization letters? 1. Visit our website 2. Click on Provider Portal Login 3. Enter login information 4. Go to Auth Search or My Auth 5. Once authorization is identified, click on the authorization number and the authorization details will display (see image below) 6. Click on Print Friendly Version 10. How do I contact you for additional assistance? If you have a technical question or having problems on our site, please send us an at mpmweb@medpointmanagement.com or call us at ext