RAF Application Instructions and Frequently Asked Questions. Version 4.1 8/01/2015

Transcription

1 RAF Applicatin Instructins and Frequently Asked Questins Versin 4.1 8/01/

2 Table f Cntents Backgrund fr the RAF Infrmatin... 2 Lgging In... 2 Member Selectin... 3 Member Diagnstic Prfile Page... 6 Apprved HCC Diagnstic Page... 8 Functins fr Saving, Printing, and Submitting My Submissins Lg Out RAF Applicatin FAQS

3 Banner Health Netwrk - RAF Applicatin Sample Instructins and Examples Nte: The prvider and member infrmatin shwn in the screen prints has been mdified. N Prtected Health Infrmatin (PHI) is included in this dcument. Backgrund fr the RAF Applicatin The Risk Adjustment Factr (RAF) Applicatin has been designed t prvide an nline tl that presents real-time infrmatin abut yur Medicare Advantage members and their chrnic cnditins. The infrmatin cntained in this applicatin prvides a three year diagnstic histry f Risk Adjusted diagnsis based n claims data and is designed t assist the prvider during the member visit. RAF ensures that there are adequate resurces available t care fr ur high-risk Medicare Advantage beneficiaries. Reimbursement is higher fr members with significant illness and lwer fr healthier members. By prviding apprpriate reimbursement based n members verall health status, RAF increases the resurces available fr thse beneficiaries wh require mre cstly and cmplex care. In rder t ensure that the resurces are available t prvide excellent care t ur Medicare Advantage members, it is imperative that accurate and cmprehensive diagnses are cllected and reprted t CMS. The Member Diagnstic Prfile (MDP) Reprt prvides a mechanism fr physicians t review previusly identified diagnses cdes. The MDP Reprt als ensures that prir cnditins are cnsidered during the member visit and subsequently dcumented in the chart. Unlike traditinal paper frms, the infrmatin prvided in the RAF applicatin is cntinually updated with member diagnses cdes based n current claims submissins thus prviding a mre cnvenient and up-t-date prfile f the member. This applicatin cntains all Medicare Advantage members acrss all BHN cntracted Medicare Advantage Plans Incentive reimbursement is available fr BCBS Medicare Advantage members. T be eligible t receive incentive reimbursements please fax a cpy f the MDP frm and the apprpriate chart ntes t Lgging In Prviders/users will find the link t the RAF Applicatin n the BHN website in the secured prvider prtal: If yu dn t already have an accunt set up n the BHN Prvider Prtal, yu can request ne at by selecting LOG ON frm the menu bar, and then select Request Accunt r fllw this link: Clicking n Prvider Tls and selecting RAF Applicatin frm the drp dwn menu frm within the BHN Prtal will take users t the Member Selectin page. 2

4 Member Selectin Users will be asked t fill in certain fields included in the screen print belw (prvider NPI#, member s insurance identificatin number, and member s date f birth). If the user is a prvider, the NPI will be aut-filled. If a user is assigned mre than ne prvider, the Prvider NPI# field will have a drpdwn menu available t chse prvider. Submitting the infrmatin described abve, takes the user t the Cnfirmatin screen: Imprtant: The user shuld check t ensure the PCP identified in the applicatin matches the Prvider NPI entered n the Member Selectin screen. The incentive will nly be issued t the PCP f recrd at the time f the submissin f the Member Diagnstic Prfile (MDP) frm n the next page (after clicking Submit t BHN ). If the NPI f the lgged-in user and the PCP NPI are different, n incentive will be issued. The user is asked t either click n Data is Nt Crrect r Data is Crrect, Cntinue. Using the Data is Nt Crrect selectin, allws the user t mve t the next screen where they can dcument the incrrect r changing data. An will be triggered t, PrviderRelatins@BannerHealth.cm and als the lgged in user s listed in Yur Address as shwn in the screen print belw. The user des have the ptin t change the address if it is nt displaying crrectly r it is nt listed. Nte: This functin encrypts the utbund t ensure security f ephi. The user will be required t enter infrmatin t create an accunt s they can read the first . The passwrd is then the nly data required fr subsequent s frm this applicatin. 3

5 If the user has cme t the screen shwn belw in errr, they can start ver by clicking n the Click Here in the first sentence f this page t retry their entry r the Click Here t Return t Member Selectin link at the bttm f the screen. After selecting the Data is Crrect, Cntinue, ptin, the next screen displays the Member s RAF entries which culd be lng r nne at all, depending n health histry. Clicking n the New RAF Entry will trigger a new recrd fr the year selected. Select New RAF Entry. The Select Effective Year bx will pp-up. The reprting years that are valid will be ptins in the Effective Year drp dwn bx. January f any particular year is the nly mnth where a user can submit a Member s Diagnstic Prfile fr the previus year r the current year. After January 31, the user will nly have the current year as a selectin ptin. If the user needs t enter reasns fr nt submitting an MDP, there are three chices with this Select Effective Year pp-up as shwn belw. Select ne f the exceptin status ptins. The user may g back again and submit data if it becmes available at a later date. 4

6 Example f member in Exceptin status: T remve the exceptin, the user shuld just click n the red X in the Actin clumn (shwn abve) t cntinue and pen a Member Diagnstic Prfile fr the current reprting year. After clicking the red X, the recrd will lk like this example: 5

7 T prceed with entries fr reprting year 2014 (fr this example member) the user shuld click n the Actin edit icn (paper/pencil icn). This will pen the Member s Diagnstic Prfile, plus ther ptins t enter/select fr submissin t BHN. After clicking n the Actin edit icn, the fllwing screen will display: Current diagnses must be dcumented in the encunter nte Member Diagnstic Prfile Page At the tp f the Member Diagnstic Prfile screen, the user shuld ntice the fllwing additinal features: Clicking n the magnifying glass icn lcated in the Member Plan field will trigger a pp-up displaying eligibility histry fr the selected member Clicking the magnifying glass lcatin in the PCP NPI field will trigger a pp-up displaying PCP histry fr the selected member 6

8 The drpdwn bx included in the EMR Cntaining Member s Recrd field t advise BHN what electrnic medical recrd (EMR) the member s legal medical recrd is stred; e.g. NextGen, ecentricity, eclinicalwrks, etc The member s current risk scre will be changed twice per year in the first and third quarters. The BHN Case Management field/check bx may be used t advise BHN f an interest in having a BHN Case Manager assigned t the member. The user must click Save in this field t save the checkmark fr the selected member. If the member is deceased, and we have received a Date f Death (DOD) frm the payer plan, the Member DOB field will have a DOB and DOD date filled in. The DOD will be in red fnt t help bring this t the user s attentin. If the member s DOD is mre than six mnths prir t tday s date, the user will receive this message t alert them the member is nt eligible fr submissin t BHN. In this example, the DOD is 12/23/13: If the user needs t enter a DOD, they can enter the date when clicking n the Select Effective Year as listed in the previus sectin f this dcument. 7

9 Apprved HCC Diagnstic Cdes Page This sectin f the applicatin permits the prvider/user t select the Current Apprved Hierarchical Cnditin Cdes (HCC) fr the reprting year, and manually add any cdes that may nt be in the list. Upn initial lgin, the list f cdes displayed is aut-ppulated frm claims data. Please nte the alert in red at the tp f the screen. This alert is meant t warn the user BHN has an audit prcess and prcedure t check the member s EHR data against the submissin frm this applicatin. Select Current? Y/N Respnse The user shuld select either Yes r N fr each ICD cde represented n this frm. The respnse indicates if the cnditin is bserved and currently being treated. NOTE: Current diagnses must be dcumented and substantiated in the encunter nte(s) 8

10 Add Diagnsis The user is given an pprtunity t Add Diagnsis cdes that are currently bserved and being treated The user receives the fllwing screen t assist with their search f the Apprved HCC cdes fr additin t the Member s Diagnstic Prfile. 9

11 They can search by ICD Cde as well: Once a cde is selected by clicking n the blue plus mark, the user receives a cnfirmatin bx fr saving t the Member s Diagnstic Prfile: The manually added cde is added t the bttm f the member s list with a default answer in the Current clumn f Yes : 10

12 Remve Diagnsis If the abve diagnsis was added in errr, it can be remved by clicking n the Remve Diagnsis ptin. Once clicked, this bx pps up fr the user t click n the red X in the Remve clumn. Shw Older Diagnstic Histry Clicking n the Shw Older Diagnsis Histry ptin belw the Apprved HCC Diagnstic Cdes area will reveal diagnsis cdes received frm claims in past years. Example: Functins fr Saving, Printing, Submitting There are buttns fr users at the bttm f the Member Diagnstic Prfile page. These buttns perfrm varius functins as explained belw. NOTE: AFTER MDP FORM IS COMPLETE, USER MUST SELECT SUBMIT TO BHN Save Respnses This ptin permits the user t save their answers withut submitting and lcking the recrd. Users will need t remember t use this Save feature befre exiting t save 11

13 Print their Y/N respnses if they will nt be using the Submit t BHN ptin until a later time. This ptin permits the user t print the Member Diagnstic Prfile t a printer r created a PDF dcument. If using PDF, the user must have the Adbe Acrbat r PDF sftware available. Here is an example f a printable versin f the Member Diagnstic Prfile: 12

14 Back This ptin permits the user t mve back ne screen Back t Member Selectin This ptin permits the user t g t the beginning f the prcess and select a new member (Member Selectin screen) and prvider. Open ACO fr Member (fr Future Release) This ptin is currently under develpment, and is unavailable at this time Submit t BHN This ptin permits the user t submit respnses (Y/N selectins) t BHN. T be eligible t receive incentive reimbursements fr BCBS Medicare Advantage Members please fax a cpy f the MDP frm and the apprpriate chart ntes t My Submissins left navigatin pane Select a prvider This be a prvider list based n yur lgin t the BHN Prvider Prtal Receive a result set fr yur submissins Click Submit nce a prvider is selected frm the list. All submissins will be listed alng with their status and ther pertinent infrmatin Review histry (view) Click n the View ptin magnifying glass t see mre detailed infrmatin fr items 13

15 that are denied r changed fr varius reasns Lg Out left navigatin pane Select Lg Out frm the left navigatin pane RAF Applicatin FAQ Where d I find the RAF Applicatin? Prviders/users will find the link t the RAF Applicatin in the Prvider Tl drp-dwn menu in the BHN Prvider Prtal n the Banner Health Netwrk website at: T request an access t the BHN Prvider Prtal, users can g t this link: Clicking n the RAF Applicatin frm the Prvider Tls drp-dwn menu frm within the BHN Prvider Prtal will take users t the Member Selectin page. What if I dn t knw my username, r I have been lcked ut? If yu have frgtten yur username, yur accunt has becme lcked due t unsuccessful lgins please cntact the Banner Health Supprt Desk at Supprt is available 24 hurs a day. If yu have questins regarding the RAF applicatin please RAFOps@bannerhealth.cm What if I experience technical difficulties? If at any time yu experience technical prblems while using this website, please cntact the Banner Health Supprt Desk at Supprt is available 24 hurs a day. 14

16 What members can I search fr in this applicatin? This applicatin cntains Medicare Advantage members frm all BHN s cntracted Medicare Advantage plans. What infrmatin must I knw abut the member t use the applicatin? A user must have the member s ID number and member s date f birth. What if the member r PCP infrmatin in the applicatin is incrrect? Click n the Data is Nt Crrect ptin during the Member Selectin prcess, enter a brief explanatin f the issue, and click Submit t send an t Prvider Relatins fr review. Will I receive an incentive reimbursement fr cmpleting and submitting this frm? Incentive reimbursement is available fr BCBS Medicare Advantage members. T be eligible t receive incentives, please fax a cpy f the MDP frm and the apprpriate chart ntes t Will I receive incentive reimbursement if there is a mismatch in PCP in the applicatin? N, nly the PCP displayed as the attributed PCP in this applicatin will receive an incentive reimbursement fr cmpleting the Member Diagnstic Prfile. What if I am unable t reach the patient t schedule an ffice visit and submit the Member Diagnstic Prfile? Select ne f the ptins shwn when selecting the effective year fr submissin. Yur selectin will be recrded in ur database fr reprting purpses. What if the Apprved HCC Diagnstic Cdes listed d nt reflect all the cdes I have charted fr the member? Select the Add Diagnsis ptin and select the apprpriate cdes t be added. If yu add a cde in errr, yu can remve the manual entry. Nte: Claims entries are nt remvable. Select N if they are nt currently bserved fr the member. Will I be able t submit a Member Diagnstic Prfile reprt if my member is deceased? Yes, the member s recrd will remain pen fr 6 mnths inside the applicatin t allw fr submissin if yu have recently had an ffice visit with the patient. Nte: A date f death will appear in the applicatin inside the Member DOB field. Why can t I enter a Nn-Apprved HCC Diagnstic Cde? Only Apprved HCC Diagnstic Cdes are permitted fr submissin t CMS fr RAF calculatin and reimbursement. 15

17 What des Dcumented cdes shuld match the patient medical recrd mean? Once the user submits a Member Diagnstic Prfile fr a member, an audit utilizing the prvider s EMR recrds will take place. The cdes submitted must match the EHR dcumentatin as part f this audit prcess. Can I print the Member s Diagnstic Prfile befre I submit? Yes, it is anticipated that the user may want t print ne r tw days prir t the patient s ffice visit. The printed versin culd be used in the huddle fr the practice team t review all items previusly reprted fr the patient and assist the user with new entries that may need t be made in the RAF Applicatin befre submissin. What if I have questins abut the RAF App, my submissins, r anything else related t RAF? Please the RAF team at RAFOps@bannerhealth.cm. Respnse time is generally within hurs. 16