North Carolina Medicaid and Health Choice ProviderConnect User Guide

Transcription

1 Medicaid and Health Choice ProviderConnect User Guide

2 About This Guide This ProviderConnect User Guide is specific to Medicaid (NC Medicaid) and Health Choice (NC Health Choice). There are several links and functions contained on the ProviderConnect homepage and throughout the software that are not relevant to NC Medicaid and NC Health Choice. This User Guide addresses only the links and functions relevant or applicable to NC Medicaid and NC Health Choice. Last

3 Table of Contents 1 INTRODUCTION... 4 PROVIDERCONNECT OVERVIEW... 4 CONTACT INFORMATION PROVIDERCONNECT LOG ON... 5 ACCESS PROVIDERCONNECT... 5 NEW USER REGISTRATION... 5 LOG IN PROVIDERCONNECT NAVIGATION... 9 NAVIGATION BAR YOUR MESSAGE CENTER USE NEXT AND BACK BUTTONS MEMBER INFORMATION SEARCH MEMBER VIEW MEMBER AUTHORIZATIONS View Authorization Letter View Authorization Details SEND INQUIRY TO CUSTOMER SERVICE VIEW CLINICAL DRAFTS AUTHORIZATION LISTING VIEW MY RECENT AUTHORIZATION LETTERS ENTER AN AUTHORIZATION REQUEST SEARCH A MEMBER REVIEW DEMOGRAPHICS CAPTURE PROVIDER ENTER REQUESTED SERVICES Submitting the ITR or Initial Criterion 5 Requests Submitting the ORF2 or Psych Testing or TCM-IDD Requests SAVE REQUEST AS DRAFT SUBMIT A DISCHARGE MY ONLINE PROFILE NETWORK SPECIFIC INFORMATION Last

4 1 Introduction ProviderConnect Overview ProviderConnect is an online system that gives providers an easy-to-use application for completing everyday service requests. This system will allow users to access information 24 hours per day/seven days per week. Providers will be able to use ProviderConnect to: Submit authorization requests View authorizations and print and/or download authorization letters Submit discharges Submit a secure inquiry to Customer Service NC Medicaid providers can NOT use ProviderConnect to: Verify eligibility and/or benefits of recipients Submit a claim or check claim status Change provider specific information currently in the ValueOptions system, such as provider address; changes to provider information must be made through Computer Sciences Corporation (CSC) Each user must have a valid ValueOptions Provider ID. Contact Information For assistance with any technical problems (such as connecting to or accessing the site) please call our e-support Help Line at during business hours Monday through Friday 8AM - 6PM ET or you can an Applications Support Specialist at e- SupportServices@valueoptions.com Last

5 2 ProviderConnect Log On ProviderConnect is a web-based application that can be accessed from the ValueOptions web site. Access ProviderConnect To access ProviderConnect: 1. Enter the URL in the web browser. 2. Click on the Providers link. (the Provider Services page will display) New User Registration New users must register to access ProviderConnect. 1. Click on Register. Last

6 The Provider Online Services Registration screen will display. 2. Fill out the fields. Note: The fields with a red asterisk are required. 3. Enter the provider/agency name in the Last Name field exactly as it is registered with Medicaid. 4. Enter the name of the person to contact at the office in the Contact Name field. 5. Enter the provider number in the Provider ID field. If you have multiple sites and services contact the Helpdesk ( ) to set up a Group Practice account versus having to register each site and service. Enter the nine- digit Federal ID number or Social Security number in the Tax ID field. 6. Enter the provider s primary address in the Primary Address field. Note: The address must be in an abc@xyz.com format. 7. Enter the same address in the Verify Primary Address field. 8. Enter a ten-digit phone number without dashes in the Phone Number field. 9. Enter a ten-digit number without dashes in the Fax Number field. A password must be created on the same Provider Online Services Registration screen. To create a password: Last

7 1. Enter a password in the Select a Password field. Passwords: Must be between 8-10 characters in length May contain numbers Can contain lowercase and uppercase letters Cannot contain spaces or special characters Are case sensitive 2. Enter the same password in the Confirm New Password field. 3. Create a question in the Password Reminder field. 4. Enter the answer to the question in the Password Reminder Answer field. 5. Click Submit. Log In To log in to ProviderConnect: 1. Click Log In. 2. Enter the user ID and password. 3. Click Log In. Last

8 4. Click I Agree on the ProviderConnect Use Agreement Page. Last

9 3 ProviderConnect Navigation Users have two options to navigate ProviderConnect. The first option is to use the hyperlinks on the Main Menu screen. The second option is to use the hyperlinks on the Navigation Bar. Main Menu The Main Menu screen contains eight options, five of which are relevant: Find a Specific Member (authorizations) Enter an Authorization Request Review an Authorization View Clinical Drafts View My Recent Authorization Letters Last

10 Navigation Bar The Navigation bar contains numerous options, eight of which are relevant: Home Specific Member Search Authorization Listing Enter an Authorization Request View Clinical Drafts Reports My Online Profile Network Specific Information A user can access a specific section by clicking on the hyperlink on the navigation bar. Your Message Center Your Message Center is located on the Home Page to provide a secure message center to ensure confidentiality and to comply with HIPAA requirements. Providers can send messages to and receive messages from ValueOptions through the Your Message Center section. Providers can view: Inquiries sent by the provider in the last 30 calendar days that have not been responded to by a ValueOptions Customer Service Representative (CSR) The last five inquires sent that were responded to by ValueOptions A Message Center Inbox that displays all of the inquiries for the Provider logged by the system A Message Center Sent box that displays all of the inquiries sent by the Provider Details of a specific inquiry Last

11 To view the Inbox: Click the Inbox icon. The Message Center Inbox screen will display. To view Sent items: Click the Sent icon. The Message Center Sent screen will display. Use Next and Back Buttons In ProviderConnect, several processes require filling information out on more than one screen. Use the Next and Back buttons located on the bottom of the screens to navigate to the next screen or to return to a previous screen. If these buttons are not used, the information that was entered may be lost. Last

12 Note: Do NOT use the Next and Back arrows on the Internet browser s toolbar. Last

13 4 Member Information A user can search for and access information for a specific member through the Specific Member Search section of ProviderConnect. ProviderConnect can not be used to verify recipient benefits, eligibility, or to submit a claim for NC Medicaid or NC Health Choice. Search Member To search for a member: Click on either the Specific Member Search link on the navigation bar or on the Find a Specific Member (authorizations) button on the Main Menu page. Error! The Eligibility & Benefits Search screen will display. To retrieve member information: 1. Enter a member ID number in the Member ID field. This is the recipient s NC Medicaid ID number or NC Health Choice ID number. 2. Enter a date in the Date of Birth field. Note: Enter information in MMDDYYYY format only. 3. Enter the member s first and last names to further refine the search (this step is optional). 4. Click Search. Last

14 Once the search has been completed, the member s information is displayed. Demographics Tab The Demographics screen displays member-specific information such as ID, name, date of birth, etc. Please disregard the information in the eligibility section as a recipient s eligibility can not be verified through ProviderConnect. Eight buttons are located at the bottom of the screen, four of which are relevant: View Member Auths Displays all of the authorizations for the selected member Enter Auth Request Authorization requests can be submitted electronically (see chapter 7) Send Inquiry (see Send Inquiry to Customer Service section) Last

15 View Clinical Drafts (see chapter 8) View Member Authorizations Click on the View Member Auths button on the Demographics tab. Entering values into the Auth # and/or Service From and Service Through fields is optional. Click Search. The Authorization Search Results screen displays. This screen contains information on member-specific authorizations. Clicking on the hyperlinks in this screen enables users to view authorization letters and authorization detail information. View Authorization Letter To view an authorization letter: 1. Click on a View Letter icon on the Authorization Search Results screen. 2. Click the View hyperlink to display the authorization letter. The letter will display. Last

16 Note: As of October 1, 2011, adverse determination letters will also display in ProviderConnect. View Authorization Details To view authorization details: 1. Click on the View Member Auth button on the Demographics screen. The Authorization Search Results screen will display. 2. Click the desired Auth # hyperlink on the Authorization Search Results screen. The information for that authorization will display on three screen tabs: Auth Summary, Auth Details, and Associated Claims (not relevant for NC Medicaid and NC Health Choice). Auth Summary Tab Click on the Auth Summary tab to view the following information: Member ID Authorization Number Client Auth Number (Prior Authorization Number) NPI # for Authorization (N/A) Authorization Status (always Open) From Provider Admit Date Discharge Date Last

17 Auth Details Tab Click on the Auth Details tab to view the following information: Submission Date Service Code Modifier Code Service Class Description Dates of Service Visits Requested/Approved Visits Actually Used (Not applicable to NC Medicaid & NC HealthChoice) Status (always reads Open for NC Medicaid & NC HealthChoice) Reason Enter Auth Request Refer to Chapter 7: Enter an Authorization Request of this user guide for detailed instructions on how to enter an authorization request (Request for Services). Last

18 Send Inquiry to Customer Service In addition to contacting Customer Service by telephone ( ), providers can submit recipient specific customer service inquiries via ProviderConnect. Providers receive written responses from Customer Service that will appear in the Inbox of the Message Center in ProviderConnect within five business days. There are two screens from which to submit an inquiry to Customer Service; the Auth Summary tab and the Demographics tab. Use the Auth Summary tab Send Inquiry function for: Authorization questions Requests to withdraw an authorization request Submit additional/missing information (as an attachment); if directed by ValueOptions staff to fax the requested information to the designated Lack of Information fax line, then follow the direction to fax the information rather than using the Send Inquiry function The following screen appears after clicking the Send Inquiry button. Complete the requested information, attach documentation (if applicable) and click Submit at the bottom of the page. Last

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20 Use the Demographics tab Send Inquiry function to: Submit Provider Change Attestation forms (Demographics tab) Note: TCM-IDD Provider Change requests should be submitted as an Authorization Request with the completed Provider Change Attestation Form attached.

21 The inquiry will be sent to the ValueOptions Customer Service Center. A confirmation of the submission and an inquiry number will be displayed. View Clinical Drafts Refer to Chapter 8: Save Request as Draft of this user guide for detailed instructions on how to save a request as a draft prior to submission and how to access a saved draft request.

22 5 Authorization Listing In this section of ProviderConnect, a user can search for information on provider-specific authorizations. To access the Authorization Listing section: 1. Click either on Authorization Listing on the navigation bar or on Review an Authorization on the Main Menu screen. The Search Authorizations screen will display. 2. Click View All to see all authorizations for the provider. The Search Results screen will display all of the authorizations. Note: Results can be sorted by Member ID, Member Name, Authorization Number, or Service. Or 3. Enter a number in the Authorization # fields or Client Authorization # field 4. Enter a date range in the Effective Date and Expiration Date fields. 5. Click Search. The Search Results Screen will display the specified authorization(s).

23 For detailed information on the Search Results section (including the Auth Summary and Auth Details tabs), refer to the View Authorization Details section of this user guide. Providers can also download a spreadsheet of authorization activity which occurred over a seven day period from the Search Authorizations screen. 1. Select the Provider ID, if needed. 2. Delete any values from Vendor ID, Member ID, Authorization # and Client Auth #. These must be completely blank. 3. In the fields Activity Date From and Activity Date To enter a date range of no more than 7 days. 4. Select whether you want the downloaded file to be delimited by commas or pipes. 5. Click Download, and choose where to save the file. You can open the file in Microsoft Excel or any other spreadsheet program.

24 6 View My Recent Authorization Letters Providers can access authorization letters multiple ways in ProviderConnect but the most direct method is clicking View My Recent Authorization Letters from the ProviderConnect Home page. This initiates a search for authorization letters created in the last 7 days. Note: Authorization approval letters created since March 1, 2010 can be retrieved using this link from the Home page. Adverse Determination letters created since October 1, 2011 can be retrieved using this link as well. Providers should use the procedure discussed in Chapter 4 (View Member Authorizations) to retrieve authorization approval letters created prior to March 1, The Search Authorization Letters screen displays a listing of the letters created in the previous 7 days (150 maximum records display per page). A Next hyperlink will display if the search yields more than 150 authorization letters for the chosen time period. Search parameters such as the Provider ID, Member ID, Letters From, and Letters Through can be changed to modify the search.

25 Letters that have not yet been viewed are identified as New and those already viewed show the date it was Last Viewed. To view a letter, click View on the right hand side of the screen. The authorization letter will display and can be printed, downloaded as a PDF, or both. Close the letter to return to the Search Authorization Letters screen.

26 7 Enter an Authorization Request The Enter an Authorization Request function enables users to electronically submit authorization requests online. To access the Enter an Authorization Request section: 1. Click on either Enter an Authorization Request on the navigation bar or on Enter an Authorization Request on the Main Menu screen. The Disclaimer screen will display. 2. Read the disclaimer. 3. Click Next. Search a Member The Search a Member screen will display. 1. Enter the member s ID in the Member ID field. This is the member s NC Medicaid ID number or NC Health Choice ID number.

27 2. Enter the member s date of birth in the Date of Birth field. 3. Enter the requested start date in the As of Date field so the request is submitted under the applicable benefit plan (Medicaid vs Health Choice) 4. Click Search. Review Demographics The Demographics screen will display. 1. Review the member s information. 2. Click Next.

28 Capture Provider The Provider screen will display. 1. Click the Capture button to capture the provider s information. If this is a Group Practice Account, make sure to capture the provider ID number from the dropdown menu that matches the requested level of care. Note: Clinical Home providers submitting initial Residential/PRTF or provisionally licensed providers submitting Outpatient or requests for Therapeutic Foster Care--use any direct enrolled provider number available from the Provider ID drop down menu. 2. Click Next. Enter Requested Services The Requested Services Header screen displays next. The level of service that is selected on this screen determines which additional fields will display on this screen and which screens need to be completed. There are two options for the level of service: Select Inpatient/HLOC/Specialty for completion of the ITR or for submitting Initial Criterion 5 requests. Select Outpatient for completion of the ORF2 or for submitting TCM-IDD requests and Psychological Testing requests. The steps for entering an Inpatient/HLOC/Specialty request will be covered in the next section, followed by steps for entering an Outpatient request Note: Directions are given for all of the fields on a screen; however, only the fields with an asterisk are required. Submitting the ITR or Initial Criterion 5 Requests For an Inpatient/HLOC/Specialty level of service: 1. Enter a date in the Requested Start Date field. 2. Select Inpatient/HLOC/Specialty from the Level of Service drop-down list.

29 3. Select an option from the Type of Service drop-down list. 4. Select the appropriate service from the Level of Care drop-down list. See the Requesting Services Grid below as a guide. 5. Select an option from the Type of Care drop-down list. 6. Enter a date in the Admit Date field. The admit date is the date of first contact with this recipient by your agency for this episode of care. This date remains the same on all concurrent/subsequent requests. Requesting Services Grid: The following services should select INPATIENT/HLOC/SPECIALTY as the Level of Service: Service: Select Level of Care as: Select Type of Care as: Community Support Team COMMUNITY SUPPORT TEAM Select appropriate option Assertive Community Treatment Team ASSERTIVE COMMUNITY TREATMENT Select appropriate option Psychosocial Rehabilitation PSYCHOSOCIAL REHAB Select appropriate option Intensive In-Home INTENSIVE IN-HOME Select appropriate option Child/Adolescent Day Treatment DAY TREATMENT Select appropriate option Multisystemic Therapy MST Select appropriate option Residential (group home level II-IV) RESIDENTIAL CHILD CARE Select appropriate option Therapeutic Foster Care FOSTER CARE Select appropriate option Facility Based Crisis FACILITY BASED CRISIS Select appropriate option Substance Abuse Intensive IOP/SOP Select appropriate option Outpatient Therapy Substance Abuse Comprehensive SACOT Select appropriate option Outpatient Therapy Opioid Treatment OPIOID TREATMENT Select appropriate option Substance Abuse Non-Medical NCMC ONLY SA NON MED RESI OVER Select appropriate option Community Residential Treatment 21 Substance Abuse Medically Monitored NCMC ONLY SA MED MONITORED RESI Select appropriate option Community Residential Treatment Ambulatory Detoxification NCMC ONLY AMBULATORY DETOX Select appropriate option Non-Hospital Medical Detoxification NCMC ONLY NON-HOSPITAL MED Select appropriate option DETOX ADATC NCMC ONLY MEDICALLY Select appropriate option SPVSD/ADATC MH/SA Targeted Case Management TARGETED CASE MANAGEMENT Select appropriate option Inpatient INPATIENT Select appropriate option Criterion 5 SPECIALTY CHILDREN S PROGRAMS Select appropriate option PRTF PRTF Select appropriate option 7. Attach all required documentation i.e., PCP, Discharge Plan, Assessment, etc. Does this Document contain clinical information about the member: Select Yes

30 Document Description: select based on document being attached Click Upload File button Click Browse button Find and select the document, double click the file or click Open button Click Upload button Note: Acceptable file formats are Word, Adobe, Excel, and Text files. Note: Documents that are required to display original signatures must be in PDF format. 8. Click Next. Initials vs Concurrents Providers do not mark online submissions as either Initial or Concurrent. The system will identify the request as either Initial or Concurrent based on built-in logic. If a concurrent request is entered correctly, ProviderConnect will prompt the following screen for processing a concurrent request or discharge. Click the appropriate button based on your request.

31 A concurrent review is identified by matching the following elements from the previous authorization: o Member o Provider o Level of Service o Type of Service o Level of Care o Type of Care o Admit Date (this date remains the same on all concurrent/subsequent requests) o Requested Start Date (or date of submission) is no more than 1 day after the last authorized day. NOTE: Providers should not be deterred whether the system identifies the request Initial or Concurrent. A screen with ten tabs will display. Note: Each field on every screen will be covered; however, only the fields with asterisks are required. The Level of Care screen is completed first. 1. Enter the treatment in the Treatment Unit/Program field. Please type the level of care being requested in this field. 2. Enter a name in the Member s Guardian field. 3. Select an option from the Member s Current Location drop-down list. 4. Select an option from the Primary Referral Source drop-down list. 5. Enter the Utilization Reviewer contact name and phone number. This is the person ValueOptions will contact should there be any clinical questions. 6. Click Next.

32 The Currents Risks screen will display next. To complete this screen: 1. Select an option from the Precipitant (Why Now?) drop-down list and provide the following information in the precipitating event text box: current behaviors the recipient exhibited causing you to request this service; include root cause or particular history; include progress or lack of progress during the reporting period. There is a limit of 2000 characters in this field. 2. Please note at the beginning of the precipitating event text box if any of the following apply: Provider Name and NPI for Initial Residential/PRTF requests Retrospective request due to member s Medicaid eligibility and include dates of service requested for the retrospective authorization period Additional Units request for current authorization period EPSDT request

33 3. Fill out the Member s Risk to Self section. This entails an assessment of any current suicidal ideation (SI), plans and intent. Utilize the free text box to provide additional information regarding recent attempts or gestures or if rating is 2 or Fill out the Member s Risk to Others section. This entails an assessment of any current homicidal ideation (HI), plans and intent. Utilize the free text box to provide additional information regarding recent attempts or gestures or if rating is 2 or 3.

34 5. Click Next. The Current Impairments screen displays next. 1. Rate the severity of each impairment. 2. Click Next. The Diagnosis screen displays next. 1. Select Diagnosis codes for the Axis I and Axis II sections.

35 2. Enter Diagnosis information for the Axis III, Axis IV, and Axis V sections. 3. Indicate Overall Severity of Psychosocial Problems. 4. Indicate Course of Illness. 5. Click Next. The Treatment History screen will display next. 1. Fill out the Psychiatric Treatment in the Past 12 Months section. 2. Fill out the Substance Abuse Treatment in the Past 12 Months section.

36 Note: If Is member currently on psychotropic medication? is set to No, the Psychotropic Medications tab will not be accessible. 3. Fill out the Additional History section. 4. Click Next. Information must now be entered on the Psychotropic Medications screen. Note: If Is member currently on psychotropic medication? from Treatment History tab is set to No, the Psychotropic Medications tab will not be accessible. 1. Click the hyperlink to select a medication in the Medication field. Do not type-in the medication name.

37 Note: Click on the Medication hyperlink to view the Select Medication Code window. 2. Enter the amount in the Dosage field. 3. Select an option from the Frequency drop-down list. 4. Select Yes or No for the Side Effects field. 5. Select Yes or No for the Usually adherent field. 6. Select an option from the Prescriber drop-down list. 7. Select an option for Is Medication found to be effective? 8. Repeat steps one through seven for each medication. Note: if the psychotropic medication is not listed in the table, select the option for Other and type in the name of the medication. 9. Click Next.

38 The Substance Abuse screen displays next. 1. Check all Substance Abuse types that apply. For each selected substance: 2. Select an option from the Total Years of Use drop-down list. 3. Select an option from the Length of Current Use drop-down list. 4. Enter an amount in the Amount of Use field. 5. Select an option from the Frequency of Use drop-down list. 6. Enter a date in the Date Last Used field. 7. Select all Withdrawal Symptoms that the member is experiencing. Note: This field is required if the Type of Service is Detoxification. 8. Fill out the member s vitals in the Blood Pressure, Temperature, Pulse, Respiration, and Blood Alcohol fields. Enter information regarding UDS.

39 The ASAM/Other Patient Placement Criteria section must be filled out next. 1. Select Low, Medium, or High for the Dimension 1, Dimension 2, and Dimension 3 fields if the Type of Service is Detoxification. 2. Select Low, Medium, or High for the Dimension 1 through Dimension 6 fields if the Type of Service is Substance Abuse. 3. Click Next. The Treatment Plan screen will display next. Click Next as the Treatment Plan tab will not be used at this time since the PCP is attached already. The Treatment Request screen will display next. 1. Select Yes or No for the Certificate of Need Required field. 2. Select Yes or No for the Is Family/Couples Therapy Indicated field. If Yes, enter a date in the Date of First or Next Scheduled Appointment field.

40 1. Check all that apply for the Treatment Request Information fields. 2. Indicate the number of units being requested for a specific time period in the free text fields. Ex: 200 units per 90days 3. Select an option from the Primary Reason for Continued Stay drop-down list. (Required for Concurrent requests) 4. Select an option from the Primary Barrier to Discharge drop-down list. (Required for Concurrent requests) 5. Check all applicable Baseline Functioning behaviors. If Other is checked, describe the behavior in the text box. (Required for Concurrent requests) 6. Enter a date in the Expected Discharge Date field. (Required for Concurrent requests) 7. Enter a date in the Estimated Return to Work Date field. Check N/A if the information is not available or not applicable. (Required for Concurrent requests) 8. Select an option from the Planned Discharge Level of Care drop-down list. 9. Select an option from the Planned Discharge Residence drop-down list. 10. Click Submit.

41 The Determination Status/Results screen will display next. Once the request has been submitted, buttons for printing and/or downloading the results and/or request to your computer are at the bottom of the page. Click Print Authorization Result to print determination status/results of authorization request. Click Print Authorization Request to print the authorization request. Click Download Authorization Request to download the authorization request to your computer as a pdf or xml file. Submitting the ORF2 or Psych Testing or TCM-IDD Requests The following services should select OUTPATIENT as the Level of Service: Service: Select Level of Care as: Select Type of Care as: Outpatient OUTPATIENT Select appropriate option Psych Testing OUTPATIENT Psych Testing Mobile Crisis Management MOBILE CRISIS Select appropriate option TCM-IDD (select Type of Service = Developmental Disability ) Targeted Case Management Select appropriate option

42 For an Outpatient level of service: 1. Enter a date in the Requested Start Date field. 2. Select Outpatient from the Level of Service drop-down list. 3. Select an option from the Type of Service drop-down list. Note: For TCM-IDD requests, select Developmental Disability. 4. Select an option from the Level of Care drop-down list. 5. Select an option from the Type of Care drop-down list. Note: For Psych Testing requests, select Psych Testing. 6. Attach all required documentation i.e., PCP, Service Order, Assessment, Psych Testing form, CTCM, NC SNAP, etc. Does this Document contain clinical information about the member: Select Yes Document Description: select based on document being attached Click Upload File button Click Browse button Find and select the document, double click the file or click Open button Click Upload button Note: Acceptable file formats are Word, Adobe, Excel, and Text files. 7. Click Next.

43 The Outpatient request generates the ORF2 form or a Short form (for TCM-IDD and Psych Testing requests). For the Short form (TCM-IDD and Psych Testing requests), the following screen will display: Note: required forms (CTCM, Psychological Testing Form, etc.) should still be attached to the request. For the ORF2 form, the following screens will display: 1. Type of Services 2. Current Risks 3. Diagnosis 4. Treatment History 5. Treatment Plan 6. Psychotropic Medications 7. Requested Services 8. Results The first tab is the Type of Services

44 1. Enter a Contact Name and Phone # 2. Enter a name, if applicable, in the Member s Guardian field. 3. Select an option for Is member currently receiving disability benefits? field. 4. Enter Attending Provider Name and Credentials.* 5. Enter Attending Provider Medicaid #.* Note: up to three Provider Medicaid ID #s can be entered, separated by commas and no spaces 6. Enter Attending Provider Telephone #. 7. Enter Billing Provider Name and Credentials. 8. Enter Billing Provider Medicaid #. 9. Enter Referring Provider Name (if applicable). 10. Enter Referring Provider Medicaid # (if applicable). *Provisionally licensed providers note: enter the provisionally licensed individual s name and provisional credential as the Attending Provider Name. If billing through the LME, enter the LME s NPI as the Attending Provider Number. If billing incident to a Medicaid enrolled physician, enter the Medicaid enrolled physician s NPI as the Attending Provider Number. If requesting authorization for reserve therapists, enter up to three NPIs in the Attending Provider Number field, separated by a comma,. Ex: 610####,591####,610####

45 11. Click Next. The Current Risks screen displays. This screen contains two sections: Current Risks and Current Impairments. In the Current Risks section: 1. Enter a rating in the Member s Risk to Self field. 2. Enter a rating in the Member s Risk to Others field. Note: Click on the hyperlinks to display the rating information windows. In the Current Impairments section: 1. Select options for all of the fields. 2. Click Next.

46 Note: If a rating of 2 or higher is selected for the Weight Change Associated with a Behavioral Diagnosis Eating Disorder field, additional fields will be displayed that will need to be completed. Note: If a rating of two or higher is selected for the Substance Abuse/Dependence field, additional fields will be displayed that will need to be completed. Information must now be entered on the Diagnosis screen. This screen has three sections:

47 Axis I and Axis II Axis III and Axis IV Axis V On the Axis I and Axis II section: 1. Select an option in the Diagnosis Code 1 field for the Axis I section. The Description field will auto-populate. 2. Select an option in the Diagnosis Code 1 field for the Axis II section, if applicable. The Description field will auto-populate. Note: When a user clicks on the hyperlinks, windows will display that contain codes and descriptions. If applicable (these fields are not required), in the Axis III and Axis IV sections:

48 1. Select an option from the Diagnosis Code 1 drop-down list in the Axis III section. Enter up to three Axis III Diagnoses, if applicable. 2. Select all psychosocial problems that apply in the Axis IV section. In the Axis V section: 3. Enter a number in the Current GAF Score field. 4. Click Next. Information must now be entered on the Treatment History screen. 1. Check the applicable boxes in the Psychiatric Treatment in the Past 12 Months section. Complete additional fields as prompted. 2. Check the applicable boxes in the Substance Abuse Treatment in the Past 12 Months section. Complete additional fields as prompted. 3. Check the applicable boxes in the Medical Treatment in the Past 12 Months section. 4. Click Next.

49 Information must now be entered on the Treatment Plan screen. 1. Select an option from the Reason for Continued Treatment drop-down list. 2. Select an option from the Type of Treatment drop-down list.

50 3. Select an option from the Frequency of Sessions drop-down list. 4. Answer the questions in the Medication management? section. 5. Answer the questions in the Family psychotherapy? section. 6. Answer the questions in the Individual psychotherapy? section. 7. Answer the questions in the Group therapy? section.

51 8. Answer the remaining questions. 9. Click on the Treatment Guidelines Interventions hyperlink to pick appropriate intervention(s). After selecting appropriate intervention(s), click Submit. 10. Enter Narrative in the Narrative Entry box provided, if needed. Ex: indicate if this is a retrospective request due to change in member s Medicaid eligibility. Click to open selection pop-up 11. Click Next.

52 Information must now be entered on the Psychotropic Medications screen. 1. Click the hyperlink to select a medication in the Medication field. Do not type-in the medication name. Note: Click on the Medication hyperlink to view the Select Medication Code window. 2. Enter the amount in the Dosage field. 3. Select an option from the Frequency drop-down list. 4. Select Yes or No for the Side Effects field. 5. Select Yes or No for the Usually adherent field. 6. Select an option from the Prescriber drop-down list. 7. Select an option for Is Medication found to be effective? 8. Repeat steps one through seven for each medication. Note: if the psychotropic medication is not listed in the table, select the option for Other and type in the name of the medication. 9. Click Next.

53 Information must now be entered on the Requested Services screen. 1. Select a Place of Service. 2. Enter the CPT or HCPC Code. 3. Enter a Modifier (if applicable). 4. Enter the # of Visits/Units. Enter a record for each individual service being requested. Clicking the Submit button on the Requested Services screen generates the Determination Status/Results screen. The following information is displayed on this screen: Determination Status Pended Message Subscriber Information Provider Information Authorization Information Reason Code for Determination Print Authorization Results button Print Authorization Request button Download Authorization Request button Return to Provider Home button

54 Once request has been submitted you have options for printing and/or downloading the results and/or request to your computer. Click Print Authorization Result to print determination status/results of authorization request. Click Print Authorization Request to print the authorization request. Click Download Authorization Request to download the authorization request to your computer as a pdf or xml file.

55 8 Save Request as Draft The Save Request as Draft functionality allows a provider to save an authorization request as a work in progress prior to submission. The provider has the option to save the authorization on each tab/screen. The draft will be maintained for 30 days. After 30 days the draft request will expire and a new request will be required. The Save Draft Request function will display as a Save Request as Draft button on the Request for Services header. To save a draft of an authorization request: 1. The Save Request as Draft button may be selected on any of the subsequent screens. (Save Request as Draft Button) 2. After clicking the Save Request as Draft button, the following pop up message will appear advising the user how long the draft will be available for viewing and modification. The message also indicates that attachments will not save with this draft; any attachments will need to be added again prior to submission.

56 3. After clicking OK, users will receive a message stating the Draft Request has been successfully saved. To view saved draft requests from the Home page, click on either of the View Clinical Drafts hyperlinks. Click View link to view a Read Only version of the saved draft request. Click the Open link to modify or continue with the Request for Authorization. To delete a draft request, check the box to the left of the saved draft record, and click the Delete Request Drafts button. Saved Clinical Request Drafts that have expired within the last 30 days will display at the bottom of the screen under Expired Clinical Request Drafts heading.

57 PROVIDERCONNECT VA.LU 0PTIO S ProviderConnect User's Guide Y! -_S:! -i!- 9. _1?_ ':1- :> Please select the: Provider ID below to view and dick the Search Request button to view Saved and Expired Clinical Request for a different provider. * Pro"Jider ID INCMC vi Se.a.rch Request Drafts v _d_ li!'ii e_g\l st_!jr _ Saved request drafts will automatically expire 7 days after the Initial Saved Date Delete Request Drafts Initial Sa ṿed Date MemberJD Member Name Provider ID LevelOf Service LevelOF Care Type Of Care Authorized User Requested Start Date...,r 3/31/2010 ':1 '3'3'9'9'9'9'9Z MEMBER, TEST NCMC IP COMMUNITY SUPPORT TEAM 03/31/2010 D 04/0E./2010 '9'9'9':1'9'9'9'9'9Z MEMBER, TEST NCMC IP Community Support 03/15/2010 View Q.Qm ll?'j?_ir:<:? (;li _i('_ l- e'i_u"_t _J?_r _fts _ Provider ID LevelOf Service LevelOF Care Type Of Care AuthorizedUser RequestedStart Date No EKpired Draft Requests to display Last

58 9 Submit a Discharge Providers can submit discharges via ProviderConnect when terminating services to a member. To submit a discharge: First navigate to the correct authorization for the member by clicking either the Authorization Listing or Review an Authorization hyperlinks from the ProviderConnect Home page (can also navigate to the correct authorization by clicking Find a Specific Member and then View Member Auths). The Search Authorizations Screen displays: 1. Enter information into the Member ID, Authorization #, Client Authorization # or Effective Date/Expiration Date fields to navigate to the specific authorization from which the member is to be discharged. 2. Click Search. Last

59 The Authorization Search Results screen displays: 1. Click the Auth # hyperlink for the relevant authorization. The Auth Summary tab displays which contains the Complete Discharge Review button. Providers can initiate the discharge by clicking this button BUT to ensure that this is the correct authorization and treatment episode, from which the member needs to be discharged, click the Auth Details tab to display the dates of service of this authorization. From the Auth Details tab: 1. Click Complete Discharge Review. Last

60 The Discharge Information screen displays: 2. Enter the clinical information requested in the required fields (at minimum). 3. Click Save Discharge Information button at the bottom of the screen in order to submit the discharge to ValueOptions. The Results page displays next providing confirmation that the discharge was successfully transmitted to ValueOptions. Data on the results page includes member information, provider information, the related authorization number and level of care the member was discharged from, and the discharge date. Providers have the option of printing the results page by clicking the Print Discharge button at the bottom of the screen. Last

61 No further action is required for submitting a discharge. Additional confirmation that the discharge was submitted to ValueOptions is found by navigating to the related authorization for which the discharge was submitted. The Auth Summary tab now displays the discharge date. Last

62 10 My Online Profile In this section of ProviderConnect, users can access and modify their own information. To access this section, click on the My Online Profile link in the navigation bar. A screen containing two sections will display: The Modify Profile section contains information that cannot be changed (e.g., Provider ID, Provider Name, and Tax ID). In the Editable Profile Details section, however, the user can edit information (e.g., Address, Phone Number, and Password). Last

63 PROVIDERCONNECT VA.LU 0PTIO S ProviderConnect User's Guide To edit provider information: 1. Enter the new information in the Editable Profile Details section. 2. Click Update Profile. PROVIDERCONNECT VALUEOrTIONS ValueOptions Home PrOVIder Home Contact Us log Out Home EDI Homepage Specific Member Search Authorization Listing Enter an Authorization Request Claim Listing and Submission My Online Profile My Practice Information Provider Data Sheet Compliance Handbooks Forms Network Specific Information ]',f?cli.!'ro_file Required fields are denoted by an asterisk ( * ) adjacent to the label. This page contains 'I'our information. To protect your privacy, do not walk away from 'I'our computer while this information is being displayed. We recommend you close your web browser when you are finished with this session,because your personal information will remain in your web browser's memory until you close the browser. Provider ID Provider Name Tax ID lo1ss IBARRY The following form is pre filled with your Profile information. You can modify any of this information by simply entering new information and pressing the Update Profile button. When you press this button,this page will be redisplayed showing the changes you ha...e made. Education Center E -- ḏ - iṯ- a - ḇḻe-- P -- ṟo -- f - i - l - e -Ḏ-- e - ṯa -- iḻs --- < : - = Contact Us * Address *Verify Address Secondary Address *Phone No (1) Fax Number Password Confirm New Password *Password-reminder Hint I l *Password-reminder answer 1.L.l2;;,3;_4-5''-6_'7,8;_9' ' Would you like to requestadditionalseryices? Following are the services a...ailable with indication of the ser.,.ices you are currently registered for. To request additional items, check the appropriate box. Claims Inquiry Claims Submission Em a il No tification Update Profile D Click to receive Notifications from ValueOptions 2006 ValueOptions Return to ValueOptions Home I Return to Provider Home IContact Us I Privacy Statement: ITerms and Conditions Last

64 11 Network Specific Information Users can access network-specific information in this section of ProviderConnect. To access the Network-Specific Information screen, click Network Specific Information on the navigation bar. The Network-Specific screen will display. The network specific information for NC providers can be found by clicking on the hyperlinks shown below. Health Choice Medicaid Last

65 Examples of network information that can be accessed from these links are: Clinical and administrative forms as well as instructions for completion Resources explaining the authorization process Links to relevant websites (e.g. DMA, DMH/SA/DD) Upcoming Provider Training Opportunities Last