MEDICAL RECORDS ELECTRONIC SUBMISSION GUIDE The enhanced Care Improvement Plus Provider Portal allows CIP providers to support claims by uploading electronic health records without leaving the portal. NOW YOU CAN: Upload medical records View medical record upload history Search for medical records Export upload history to Excel Update medical records UPLOAD MEDICAL RECORDS 1. Begin by logging in to the CIP Provider Portal and click the Medical Record link at the top of the page. You will see options for Medical Record Upload and Appeal (Redetermination)/Reconsideration (Technical Denial) Request. 2. Select Medical Record Upload. Note: The provider/ facility name, provider name, and provider email associated with the account are displayed by default. Medical Records Electronic Submission Guide 1
3. Provider Tax ID or NPI Select the provider tax ID or NPI if there is more than one associated with the account. Note: The provider tax ID or provider NPI selection will be displayed based on the account. If there is only one Tax ID or NPI associated with the account, it will be selected by default. 4. Confirmation Email Address If you wish to receive confirmation emails at an address other than the one displayed, enter it in the Confirmation Email Address field. 5. Document ID Enter the document ID in the Medical Record Request Letter section and click Submit. Note: If you need to look up the Document ID, click the Help/Document ID Lookup link. Select the Document ID from the list and click Submit. Note: To upload a medical record using a claim ID rather than a document ID, click the I don t have a document ID link. Note: The document ID can be found on the bottom right corner of the Medical Record Request Letter. 6. Claims This provides a list of the claims associated with the Document ID. Select the claim from the list. Medical Records Electronic Submission Guide 2
7. Member section The member information is displayed automatically based on the selected claim. Verify that the member information is correct. 8. Select the medical record file to upload by clicking the Browse button and then click Submit. If the upload is successful, the following confirmation message is displayed: Note: File format must be PDF, JPEG, TIFF, or XML Maximum file size allowed is 60 MB Note: The last upload will be reflected in the Medical Record Upload History section: Medical Records Electronic Submission Guide 3
VIEW & SEARCH MEDICAL RECORD UPLOAD HISTORY 1. View the medical record upload history any time by clicking the Expanded Upload History button. 2. The medical record upload history is displayed. Filter the list by entering the upload From and To dates, then click Search : Note: The upload history is arranged by upload date, starting with the most recent. 3. To go back to the Medical Record Upload page, click the Back to Upload button. UPDATE A MEDICAL RECORD 1. In the medical record upload history click the Expanded Upload History button. 2. Click the Update button next to the medical record to be updated. 3. The medical record upload page is displayed. Verify the document ID and the member information. 4. Continue by following the Upload Medical Records section of this guide (begins on page 1). Medical Records Electronic Submission Guide 4
EXPORT MEDICAL RECORD UPLOAD HISTORY TO EXCEL 1. In the medical record upload history any time by clicking the Expanded Upload History button. 2. Click the Export to Excel button to export the medical record upload history. 3. Accept the Internet Browser prompt (if displayed) to allow the download. 4. The medical record history will appear as follows: Medical Records Electronic Submission Guide 5
APPEALS, RECONSIDERATIONS, AND PRE-SERVICE REQUEST SUBMISSION GUIDE The enhanced Care Improvement Plus Provider Portal allows CIP providers to support appeals, reconsiderations, and pre-service requests by uploading documentation without ever leaving the portal. NOW YOU CAN: Submit appeals, reconsideration, and preservice requests Upload supporting documentation Submit manual routing requests View and update previous requests Export your history to Excel SUBMIT A REQUEST & UPLOAD SUPPORTING DOCUMENTATION CIP Providers may submit the following types of requests and supporting documentation: Request Type Appeal Reconsideration Pre-service Required Supporting Documents At least one of the following must be attached: Assignment of responsibility (AOR) Waiver of liability form (WOL) 1-5 additional documents 1-5 additional documents (at least one document required) At least one of the following must be attached: Assignment of responsibility (AOR) Waiver of liability form (WOL) 1-5 additional documents 1. Begin by logging in to the CIP Provider Portal and click the Document Upload link at the top of the page. You will see options for Medical Record Upload and Appeal/Reconsideration Request. Medical Records Electronic Submission Guide 6
2. Select Appeal/Reconsideration Request. Note: The provider/ facility name, provider name, and provider email associated with the account are displayed by default. 3. Provider Tax ID or NPI Select the provider tax ID or NPI if there is more than one associated with the account. Note: The provider tax ID or provider NPI selection will be displayed based on the account. If there is only one Tax ID or NPI associated with the account, it will be selected by default. 4. Confirmation Email Address If you wish to receive confirmation emails at an address other than the one displayed, enter it in the Confirmation Email Address field. 5. Document ID Enter the document ID in the Medical Record Request Letter section and click Submit. Note: If you need to look up the Document ID using other information about the member and visit, click the Help/Document ID Lookup or I don t have a document ID link. Medical Records Electronic Submission Guide 7
The document ID can be found on the bottom right corner of the decision letter. If you don t have the decision letter and and need to look up the document ID, click I don t have a document ID. You can look up the document ID with the date of service plus one of the following: 1. HICN 2. Member name and date of birth 3. Subscriber ID NOTE: If you are unable to locate or look up the document ID number using other information, you can submit a manual routing request. For more information, see the Submit a Manual Routing Request section of this guide. 6. Member section The member information is displayed automatically based on the selected document ID. Verify that the member information is correct. Medical Records Electronic Submission Guide 8
7. The request type will be determined based on the document ID entered and the required supporting documents will be listed. The example below is an appeal request. 8. Select the files to upload by clicking the Choose File buttons. When all the required files are attached, click Confirm and Submit Appeal. Note: - At least one supporting document must be uploaded - File format must be PDF, JPEG, TIFF, or XML - Maximum file size allowed is 60 MB If the upload is successful, the following confirmation message is displayed and the last upload will be reflected in the Appeal/Reconsideration History section: Medical Records Electronic Submission Guide 9
SUBMIT A MANUAL ROUTING REQUEST 1. If your request was not found when you entered the document ID after two attempts, an option to submit a manual routing request will appear at the bottom of the page. Click on Submit Manual Routing Request to begin. 2. Click the Submit Manual Routing request button. 3. Enter the information about the request type, member, and date of service, then click Proceed to upload documentation. 4. Upload documentation and submit. For more information, see the Submit a Request & Upload Supporting Documentation section of this guide. 5. Pre-service Expedited requests will only be accepted via fax only. Medical Records Electronic Submission Guide 10
VIEW YOUR REQUEST HISTORY 1. In the Appeal/Reconsideration history section, click the Appeal/Reconsideration History button. 2. Filter the list by entering the upload From and To dates, then click Search : Note: Use the Clear Search button to clear the date filters and show the complete request history. UPDATE REQUEST DOCUMENTATION 1. Start in the appeal/reconsideration history section (for more information see the View Your Request History section of this guide). 2. Click the Update button next to the request to be updated. Note: When you update documents, they will replace any previous documents submitted. 3. The document upload page is displayed. Verify the document ID and the member information. 4. Upload documentation and submit. For more information, see the Submit a Request & Upload Supporting Documentation section of this guide. Medical Records Electronic Submission Guide 11
EXPORT REQUEST HISTORY TO EXCEL 1. Start in the appeal/reconsideration history section (see the View Your Request History section of this guide). 2. Click the Export to Excel button to export the request history. 3. Accept the Internet Browser prompt (if displayed) to allow the download. 4. The medical record history will appear as follows: Medical Records Electronic Submission Guide 12