Idaho Medicaid: Telligen Provider Portal October 27, 2016 and November 3, 2016

Provider Portal Training

Key points for Review Submission Prior Authorization Review – to be submitted in advance of the admission to receive medical necessity approval for the admission when required by the Idaho Medicaid program Concurrent (Continued Stay) Review – submitted when: A hospital stay exceeds prior authorization approval, Any hospital admission exceeds three days, or A cesarean section stay exceeds four days Retrospective Review – submitted for retroactive eligibility and service has been provided Telligen utilizes Milliman Care Guidelines for all reviews.

Telligen Portal – Concurrent Review Submission Update Telligen has added additional questions around concurrent review submission to confirm that authorization numbers are maintained from prior authorization to concurrent and across concurrent reviews submitted for the same stay. Log in to the Telligen Provider Portal at idmedicaid.telligen.com Use the Sign In link on the top right corner of the page.

Select the Request Type Select one of the options from the drop down box: Inpatient Psychiatric Inpatient Medical/Surgical Inpatient Rehabilitation Services Outpatient Medical/Surgical Choose the review type that you are requesting a review for.

Select the appropriate review timing When you select "Concurrent" the page will update and display another question. If this review is related to a previously submitted case, select Yes. The system will then ask you to enter the authorization number for the previously submitted review(s). Submit the Authorization number from the previous reviews(s) and select next to continue the submission. If this is the initial review for a stay, and no previous reviews related to this stay have been submitted, select No. Then select next to continue the submission.

Provider Portal: Retrospective Review Submission Retrospective reviews need to have the actual admission date and discharge date entered for the review. If you are submitting a Retrospective Review to Telligen and the dates of service are prior to February 1, 2016, please fax your review to Telligen. Reviews can be faxed to Telligen using: (866) 539-0365

Telligen Provider Portal: Landing Page Use buttons to filter the cases in your queue. Use column headings to reorder the data. Use search boxes to find specific information. Click on Case ID to get more details. Use to navigate through the pages Use this button to begin entering a new case.

Patient Portal: Case ID After a case has been submitted, Users can look up the case and perform additional actions or view details. A User can search for a case using the search fields or by navigating through the pages. Once the case has been located, click on the Case ID field to select it.

Patient Portal: Case Details Clicking on the Case ID opens the Case Details page. Click the Reference ID to see a summary page and view correspondence Use the “Attach Documentation” button to add additional information to the case Click the Request Reconsideration button to request a reconsideration.

Patient Portal: Summary Page and Correspondence When the User clicks on the Reference ID, a summary page opens where the case information, supporting documentation, and status can be reviewed. This page contains any correspondence attached to the case. Clicking on the link(s) contained in the Letters section will open the correspondence for review.

Important Numbers Website: IDMedicaid.Telligen.com Call Center: (866) 538-9510 Help Desk email address: IDMedicaidsupport@telligen.com Phone number of Boise office: (866) 538-9510 Utilization Review Fax number: (866) 539-0365 Case Management Fax Number: (888) 897-9003

Implementation Information Questions