ACCESSING AND UTILIZING THE PROVIDER PORTAL MEDICAL AUTHORIZATION UNIT 1

AGENDA Accessing SoonerCare Provider Portal Welcome Screen Search Fee Schedule Create Authorization View Authorization Status Authorization Notice 2

ACCESSING PROVIDER PORTAL Provider Secure Sites 3

ACCESSING PROVIDER PORTAL SoonerCare Provider Portal 4

LOGGING IN 5 Use your current username for initial log on. If you DO NOT have a User ID you will need to contact the Internet Helpdesk at Option 2

WELCOME SCREEN 6

SEARCH FEE SCHEDULE 7 Click on Resources

SEARCH FEE SCHEDULE…..CONT. 8 Click on Search Fee Schedule

SEARCH FEE SCHEDULE …..CONT. 9 You will need to select the correct Benefit Package for the member you are servicing. Enter the Procedure Code you will be providing, Date of Service and age of member you are servicing. If you will be using a modifier please make sure you enter it. Once you have entered the information hit the search button.

SEARCH FEE SCHEDULE…..CONT. 10 Once you have hit the search button, the following coverage information will populate.

PRIOR AUTHORIZATION Utilizing the Provider Portal to submit a Prior Authorization Request (PAR) is a great tool for providers to be able to get an immediate tracking number to track the progress of their request. ALL Prior Authorization Requests, no matter how they are submitted, requires the submitting provider to send in supporting medical documentation and necessary forms for the Medical Authorization Unit (MAU) to perform a comprehensive review to determine the medical necessity of the service being requested. Submitting a request thru the Provider Portal allows the provider to select how to submit the necessary medical documentation and forms via 3 different methods; see below: 1.Upload thru Provider Portal – Jpeg, PDF, TIF are the ONLY formats accepted 2.Fax documentation – Mail documentation – HP Attn: Prior Authorization 2401 NW 23 rd, Suite 11 Oklahoma City, OK

HOW TO CREATE PRIOR AUTHORIZATION 12 Hover over Prior Authorization and then click on Create Authorization

CREATING AUTHORIZATION 13 Complete PA Form

CREATING AUTHORIZATION…..CONT. 14 Click on Medical

CREATING AUTHORIZATION…..CONT. 15 Provider Name Provider Number This information will Auto Populate based on how you are logged into the system.

CREATING AUTHORIZATION…..CONT. 16 Enter Members RID and press tab, the Name and Birthdate will Auto Populate which allows you to verify you have entered the correct Member RID.

CREATING AUTHORIZATION…..CONT. 17

CREATING AUTHORIZATION…..CONT. 18 Select the correct Assignment Code from the drop down box. Do not place anything in the Managed Care, Fund or Letter boxes

CREATING AUTHORIZATION…..CONT. 19 Select the correct ICD Version you are using, then enter the correct Diagnosis Code (no decimals). Once you have entered the diagnosis hit the Add button to add the diagnosis to the PA.

CREATING AUTHORIZATION…..CONT. 20 Enter the date range for the service you are providing. For Surgeries give yourself a 3 month time span Leave Code Type as Procedure Code. Enter Code you will be providing Use Appropriate modifiers if applicable. You can enter up to 4 Leave Payment Method Blank Enter units for time span requested Click on + sign to designated how documentation will be submitted

CREATING AUTHORIZATION…..CONT. 21 Choose from the drop down either BM – By Mail, EL – Electronic Only or FX – By fax.

CREATING AUTHORIZATION…..CONT. 22 If you have chosen EL – Electronic Only you will then need to upload the file from you computer by clicking on the browse button (file types accepted are PDF, JPEG or tif )(you do not have to add documents with every line item you can add the documents all to 1 line item). You will then need to put a description of the file. Once you have completed this hit the “Add” button. This will refresh the page and take you back to the top. Scroll back down and hit the “Add Service” button to add the line item you entered to the PA. If you have more than one line item enter the next line item and continue with the same steps as above

CREATING AUTHORIZATION…..CONT. 23 Once you have entered all your line items and are ready to submit the PA, first verify that the line items you are needing are listed (the arrow shows you where the attachment is at), then hit the submit button. For items listed as a misc. code such as E1399 or K0108 please enter the Line Item it is entered on along with a short description If uploading documents thru Provider Portal please enter a contact name and phone # in the Remarks section.

CREATING AUTHORIZATION…..CONT. 24 The system will then ask you to Confirm your entry. Review the information you entered again and then hit the Confirm button

CREATING AUTHORIZATION…..CONT. 25 You can now click on Print Preview which will populate another screen that will allow you to print a copy of what you submitted The system will then let you know the PA was successfully submitted and give you a Prior Authorization Number. This DOES NOT mean you have an Approval. At this point the PA number is used strictly as a Tracking number for you to use to look up the status of the PA. Attachment Coversheet button will only show if you have selected under attachment BM - By Mail or FX – By Fax.

CREATING AUTHORIZATION…..CONT. 26 If you have chosen BM – By Mail or FX – By Fax as your submission method for your documentation hit the Attachment Coversheet button. This will open up another screen and will have an Auto Populated HCA-13A Cover Sheet. You will need to place this on top of the documents you are submitting.. DO NOT place another cover sheet on top of the HCA-13A. The system will not accept documents being faxed in or mailed in if the HCA-13A is not the top sheet.

SEARCH AUTHORIZATIONS 27 To view authorization status hover over Prior Authorizations and click on View Authorization Status. You will then need to select one of the field for searching for the PA. If searching by Assignment Code or Code you will need to enter the Authorized Day Range or Authorized Service Date.

SEARCH AUTHORIZATIONS 28 This search example is by Member ID. It populated the PAs requested by the particular provider signed in for this. Click on the Prior Authorization Number.

SEARCHING AUTHORIZATIONS 29 Once you have selected the Prior Authorization you are looking for you will get this screen. The greyed out bars you can select the + sign and get the full details of what was entered for that section. The Status will tell where the PA is at in the review Process. This particular PA is in Pending Documents status which means we need additional information to complete the review of the PA. Under Remarks it will state View. Click on that to pull up the Remarks. The remarks will give you information as to why a service was Denied, Cancelled or what additional documentation is needed.

AUTHORIZATION NOTICES 30 To view the Authorization Notice you will need to enter a search criteria. If you are searching by Code you will need to enter a Code Type. Once you have entered your search criteria hit the search button, this will populate the search results. Notice that the Status is Unread – this indicates you have not viewed this Prior Authorization Notice. (If you click on the Prior Authorization Number to view the notice the status will stay as Unread. If you click on the Date Sent the Status will show as Read.) This will give you the same view of the Authorization as notated on slide 29.