Maryland Provider Portal Training – Prior Authorization, Concurrent, and 3871B Reviews April 2016

2  Telligen Patient Portal Update  3808 Prior Authorization and Concurrent  3871B Long Term Care  Questions and Answers Agenda

3 Update

4  The Telligen Provider Portal went live on April 1, 2016  As of April 15 th : – Over 70 facilities have set up Security Administrators – Over 3,300 cases have been submitted for retrospective reviews  The Security Admin registration packet can be downloaded from the website at:  Once downloaded, three sections will need to be completed. – Section 3: Executive Agreement – Section 4: Security Administrator Agreement – Section 5: Security Administrator Registration Form Telligen Provider Portal Update

5  Fax – Please submit your completed form to Telligen with a cover page titled: Maryland Provider Registration and send to U.S. Mail – Telligen, Inc Meadowridge Road Elkridge, MD ATTN: Provider Services  Telligen will need a hard copy of your notarized form at the above address within 30 days of initial electronic submission  An will be sent with the security administrators login and temporary password within 3 business days of receipt. Methods of Submission of Provider Registration

6 Provider Portal Training Prior Authorization and Concurrent Reviews

7 Information and timing – Portal submission equals quicker turnaround  When you upload a document to the Portal you will receive an confirmation  When a determination is made on your request, you will receive an notification  When you access the portal, you can view the status of all requests and the authorization number  Save time and telephone calls by utilizing the Portal Telligen Portal – How the Provider Benefits

8  Elective Admission Reviews: – A hospital is required to submit a Prior Authorization Request in advance of the admission to receive medical necessity approval for the admission – If Member needs to stay in the hospital for extended days longer than originally expected, the Hospital is required to submit a concurrent review request for that elective admission to receive guidance on whether those additional days would likely be approved – If admit day changes, a new prior auth needs to be submitted.  Emergency Admission Reviews: – Submit Concurrent Review within 48 hours of admission and any additional concurrent reviews that may be required. Key points for Elective and Emergency Reviews

9  Do not upload documents that are password protected.  Do not upload documents directly from a secure drive.  If documents are larger than 300 Mb, split the document in to smaller files making them easier to process.  Please submit all documentation required to make an accurate determination, complete medical record.  Speed does affect the upload time of the document. Slower internet connections will result in extended upload times. Tips For Eliminating Errors When Uploading Documents

10  To get started, navigate to the website:  Utilize the “Login” option in the top right hand corner to log-in to the Patient Portal.  To start a new request, select “Add Authorization” button Provider Portal: Start a New Request

11 Select the Request Type  Select one of the options from the drop down box: – Acute Hospital Review – Adult Chronic Hospital Review – Home and Community Based Review – Nursing Facility Review – Special Pediatric Hospital Review  Choose the review type that you are requesting a review for.

12  Enter the member’s Medicaid ID and Date of Birth – The data entered MUST be an exact match to continue. Provider Portal: Patient Information

13  Enter the Ordering Provider and Treating Facility Information. – Treating Facility is required. Provider Portal: Provider and Facility Information

14  Admission Type has three options: – Elective – Emergency – Retroactive  Admit date is required. Admit Date determines if review will be Prior Authorization or Concurrent. – Future Admit date says that this is a Prior Authorization review and the discharge date field will not show. – A current or past Admit date tells the system that this is a Concurrent review. The Discharge Date box will show and a future expected Discharge date should be entered. Provider Portal: Service Request

15  When a subsequent review is entered that has the same member, treating facility, and Admission date, the system will provide a message.  At this time, additional documentation that is necessary to support the request for additional days will need to be uploaded. Continuation of Services/Concurrent Review

16  The user will review the information for accuracy, enter their Username to confirm that they agree to the terms, and click “Done”. Provider Portal: Summary and Attestation

17  Clicking the “Done” button is necessary to submit the case through the system for review.  An will be sent to the User with the case number. This confirms that the case has been submitted.  The User will also receive an when case review is complete.  A User may log in at any time to determine case status, view applicable correspondence, and attach additional information. Provider Portal: Summary and Attestation

18 Patient Portal: Requesting a Reconsideration Click the Request Reconsideration button to request a reconsideration.

19 Provider Portal Training – 3871B Submission

20  To get started, navigate to the website:  Utilize the “Login” option in the top right hand corner to log-in to the Patient Portal.  To start a new request, select “Add Authorization” button Provider Portal: Start a New Request

21 Select the care facility  Select one of the options from the drop down box: – Acute Hospital Review – Adult Chronic Hospital Review – Home or Community Based Review – Nursing Facility Review – Special Pediatric Hospital Review  Choose the review type that you are requesting a review for.

22  Enter the member’s Medicaid ID and Date of Birth – The data entered MUST be an exact match to continue. – If the member does not have a Medicaid ID, select the link above the Member ID box to enter patient information. Provider Portal: Patient Information

23 Member Information  The submitter will need to answer questions related to the member including: –Is the member currently in the facility that the request is for? –The submitter will be able to enter information for a Personal Representative if the member has one. –Attending Physician is not required but should be entered if available

24  Submitter is required to enter the: – Requested Eligibility Date – Admission Date – Reason for Request – Principal Diagnosis  Secondary Diagnosis is not required but up to 18 can be entered if needed. Request and Diagnosis Information

25  The submitter will move in to the Medical Eligibility Questionnaire.  All questions must have answers to proceed Medical Eligibility Questionnaire

26  Attach supporting documentation. – This is where supporting documentation for the requested level of care will be uploaded as well as any other required forms. Examples include ventilator questionnaire and PASRR (if applicable). – The system will provide notification for applicable forms. Provider Portal: Supporting Documentation

27 Summary and Attestation  The submitter will have the opportunity to review all information that was entered including support documentation that was uploaded.  Once everything is correct, utilize the electronic signature and select done to submit the case.

28  Clicking the “Done” button is necessary to submit the case through the system for review.  An will be sent to the User with the case number. This confirms that the case has been submitted.  The User will also receive an when case review is complete.  A User may log in at any time to determine case status, view applicable correspondence, and attach additional information. Provider Portal: Summary and Attestation

29 We are here to help – local resources  For questions regarding acute submissions – please contact Jada Scarborough -  For questions regarding 3871B submissions in Qualitrac, please contact Ed Mitchell  For general operational questions, please contact Michael Mercado – Resources for Questions and Assistance

30 Telligen will become your partner in serving Medicaid clients Questions