1. Maryland Durable Medical Equipment (DME) Updates and Review
January 2017
Hi everyone. Thank you for joining us today. The presentation today will cover Durable Medical Equipment updates and review.

2. We utilize the web application Qualitrac for our DME reviews
Who Is Telligen
We are the Utilization Control Agent for Department of Health and Mental Hygiene (DHMH). We provide medical necessity Pre-authorization reviews for select Durable Medical Equipment.
We utilize the web application Qualitrac for our DME reviews
As many of you know Telligen is the Utilization Control Agent for the Department of Health and Mental Hygeine. We began reviewing select Durable Medical Equipment in September Telligen utilizes the web application Qualitrac for our DME pre-authorizarion reviews.

3. New Features – Reconsideration Option!!!!
Agenda
Updates on Letters!!!!
New Features – Reconsideration Option!!!!
Review of DME request process via Qualitrac portal
Common Errors – Troubleshooting
Questions and Answer Period
Today we are very excited to provide you with updates to Provider letters through our Qualitrac Portal; New Features that are available —the option for reconsiderations; Review of submitting a request through the Qualitrac Portal and Common Errors seen when submitting requests. We will conclude today with a Question and Answer period. So lets dive in to new changes in Qualitrac!

4. Important Procedural Changes
Effective February 1, 2017, The pre- authorization number generated in Qualitrac will be used for billing to DHMH
This will replace the DHMH Authorization Number
Approval letters will not be generated any longer by DHMH
Providers can print out approval information in Qualitrac for their records
Effective February 1, 2017 the pre-authorization number generated in Qualitrac will be the Authorization number providers will use to bill for approved services. DHMH will no longer be issuing provider letters with an authorization number. This will replace the DHMH Authorization number.
Approval letters will not be generated by DHMH. Providers will be able to print approval information in Qualitrac for their records. Telligen will not be issuing approval letters to providers.

5. Provider Letters In Qualitrac
Denial letters-**NEW**
Effective February 1, 2017 Telligen will be issuing denial letters through Qualitrac
Additional Information
Letter attached in portal asking for additional documentation to evaluate medical necessity for the request.
No Review Required
Duplicate request
New request is needed(incorrect information entered)
HCPCS Codes not reviewed by Telligen
Another big change beginning Februrary 1, denial letters will not be issued by DHMH. Telligen will be attaching denial letters to the case in Qualitrac. Providers will be able to see and print denial letters from the Qualitrac Portal.
Telligen also has 2 other types of letters providers may see attached to a case: Additional Information and No Review Required.
Additional information letters are used when Telligen requests more information or documentation for a request. Examples of this includes: face to face evaluation, Therapy notes, doctors orders, etc.
A request may be given the status of No Review Required. This could be because of a duplicate request, incorrect information entered for a request, or Requests Telligen is currently not reviewing. In these situations a letter will be attached to the case explaining the reason for the decision.

6. NEW FEATURES
When a case is denied providers now can request reconsideration with the push of a button!!!
Search for the request using the reference ID. If denied you will now see an option to REQUEST RECONSIDERATION.
Qualitrac now has a new feature for DME providers…the option to ask for reconsideration. Lets go through the process of how to ask for reconsideration.

7. Request Reconsideration
Your request has been denied or partially approved
You have 20 days to request a reconsideration on a case
Find the case
You have the opportunity to ask for reconsideration if your case has been denied or partially approved; meaning part of the request has been denied. After the decision has been rendered you will have 20 days to ask for reconsideration of a request.
To ask for reconsideration log into the Qualitrac Portal, search for the reference ID, click on the reference ID to open the case. In the lower left hand corner you will see a button that says “Request Reconsideration”

8. Press button
After you press the Reconsideration Button your Qualitrc screen will show the recipients name, Member ID, birth date and case ID. You will then click on the next button to continue your request.

9. Attach additional information
You have the opportunity to upload additional information to the case to be reviewed for reconsideration. There is also an additional information box where Providers can provide a comment for the request. Hit the next button

10. Attest and electronically sign
You then will attest all information is correct and true to the best of your ability and electronically sign the case by providing your username. Hit the next button

11. Search for case again
To go back and verify you have requested reconsideration, search for the case again in the Qualitrac Portal. You can see on this scrren shot the case will show up with 2 reference IDs that are the same.The bottom one is the original case and the top is the reconsideration case.

12. Select case
Select the case and you will see in the column on the far right a date for reconsideration. Telligen has 10 business days to complete a reconsideration.

13. Provider Portal Training Refresher
Now that we have reviewed the updates and new features in qualitrac lets review entering a request. Also, we will review common errors seen when submitting cases as well as tips and tricks.

14. Telligen follows criteria established by DHMH for DME reviews and/or Medicare Local Care Determinations (LCD’S).
COMAR and
In the event medical necessity cannot be established by the nurse reviewer; it will be referred to a physician for review.
Please ensure all supporting clinical documentation is provided so as not to delay the review process.
Telligen conducts pre-authorization reviews for Durable Medical Equipment. We use criteria established by DHMH, Medicare Local Coverage Determinations and Comarr and
In the event the nurse reviewer is unable to determine medical necessity the request is referred to the physician for review and determination.
It is imperative to have all supporting clinincal documentation provided when the request is submitted so the review process will not be delayed.

15. Our Website http://www.telligenmd.qualitrac.com Consists of :
Home page
Document Library- contains the Provider Portal application
Education and Training-recorded trainings/slides
Provider News
FAQs—this is a very big resource for DME
Contact Information
There is also a link that will take you to the Qualitrac Portal Log in page
Telligen’s website is We use this website as a means to communicate to providers.
It consists of a home page. The website opens to this page. This section consists of the Bulletin Board which provides updated information and tips to providers.
Under the Document Library providers have access to the Qualitrac User Guide and Security Admin Registration Form.
The Education and Training tab contains recorded trainings and slides. We will have this power point added to the website for your review. It will also post any upcoming trainings.
There is a Provider News page and Frequently asked questions. The provider news page provides policy changes and other issues related to services provided to Maryland Medicaid Members. The FAQ page contains commonly asked questions related to Telligen or submitting requests.
Our website also has a link in the upper right corner that will take you to the Qualitrac Portal Log in page. Getting in the habit of going to the portal via our website will assist to keep you up to date with current DME news. Telligen will be reviewing and updating the website monthly.

16. REMINDERS
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
**Please note** - the person who enters the case receives the
When you access the portal, you can view the status of all requests by using the Qualitrac Reference ID number
Before we review submitting a request lets first go over a few reminders and tips regarding our portal and submitting DME requests.
When you upload a document to the portal you will receive an confirmation.
When a determination is made on your request or additional information is needed you will receive an notification. It is important to note that the person who inputs the request will be the person that receives the s.
When you accesss the portal you can view the status of all your requests by using the Qualitrac Reference ID number.

17. Purchase vs Rental
The Maryland Medical Assistance fee schedule indicates whether an item can be rented or purchased.
It is at the discretion of the DME reviewer to approve a request for a rental or purchase
The reviewer may modify the request from a purchase to a rental
Examples include:
Osteogenesis bone stimulators cough assist
bipap
Telligen uses the Maryland Medical Assistance fee schedule to determine pricing for requests. There are some items on the fee schedule that can be purchased or rented.
It is the discreation of the telligen reviewer to approve a request for a rental or purchase. Telligen may modify a request from a purchase to a rental. If the recipient requires the equipment after the authorization period a new request can be entered into Qualitrac with supporting documentation for review.
Some examples include: osteogenesis bone stimulators, bi-pap, cpap and cough assist devices.

18. Tips for Submission and Prompt Response
Assist us to assist you
Do not group multiple equipment requests in one requisition.
Each piece of equipment AND its accompanying accessories warrant an individual request.
You can always check on the status of your request by returning to the portal and search using the Qualitrac Reference ID
When a request is entered please do not group multiple equipment requests in one requisition.
Each piece of equipment and its accompanying accessories warrant an individual request.
You can always check on the the status of your request by returning to the portal and search using the Qualitrac Refernce ID.

19. Provider Portal: Start a New Request
To get started, navigate to the website:
Utilize the “sign in” option in the top right hand corner to log-in to the Patient Portal.
To start a new request, select “Add Authorization” button
To start a new request in the provider portal
Navigate to the website
Utilize the “sign in” option in the top right hand corner to log in to the patient portal
Select the “Add Authorization” button to start a new request.

20. Select the Type of Request
Choose the type of review that you are requesting.
Select Durable Medical Equipment Review from the drop down box
Choose the type of review you are requesting. For our purposes you will select Durable Medical Equipment review from the drop down box

21. Select the Review Timing
Select the Review Timing from the drop down box.
Prior Authorization is for a future request.
You will be asked to select the timing of the review. For DME please select Prior Authorization. This indicates a future request.

22. Provider Portal: Patient Information
Enter the member’s Medicaid ID and Date of Birth
The data entered MUST be an exact match to continue.
You will then be asked to enter information for the patient.
Enter the members Medicaid ID and date of birth
Then hit the next button.

23. Group Selection
Submitter will need to select the provider that this request is being submitted for.
The submitter will need to select the provider that request is being submitted for ie Durable Medical Equipment reviews
Select next

24. Provider and Facility Search
Submitter will enter the Ordering Provider and the Treating Facility. Both are required fields.
Please use name, NPI and/or zip code to search
You will then be asked to enter an “Ordering Provider” and a “Treating Facility”. Both fields are required before you can continue the request. Please use the Name, NPI number, or zip code to search in each field.
Select Next

25. **Ordering provider**
This is the physician who wrote the prescription for the equipment
**Treating Facility**—This is the DME provider
In the event this is not entered correctly the request will be returned to the provider and a new request will be needed.
This will delay the processing of the request.
The terminology Ordering Provider and Treating Facility has been a bit confusing. Unfortunately Telligen is unable to modify this verbage.
The ordering provider is the physician who wrote the prescription
The treating facility is the DME provider. It is imperative the DME provider be listed here since Qualitrac will now be communicating with the state system. This is the only way of knowing the DME provider and ensure payment of approvals.
In the event the Treating Facility is not entered correctly the request will be returned to the provider and a new request will need to be entered. This in turn will delay the processing of the request.

26. Service Information Click on the blue edit box under equipment type.
Equipment type pop up box appears and submitter selects the type of equipment that this review is being submitted for.
Select edit box icon to open equipment type selection box
You will be asked to enter the service information
Click on the blue edit box under the equipment type
The box will appear and the submitter selects the type of equipment this review is being submitted for

27. Items that don’t meet a category
Equipment Type
Items that don’t meet a category
Wound Vac-at this time please enter as “specialty mattress”
Osteogenesis bone stimulator- at this time enter dynamic splint systems
We have identified 2 equipment requests that do not fit info a specific category. At this time we have asked providers to classify a wound vac as a “specialty mattress” and an osteogenesis bone stimulator as a dynamic splint system

28. Service Information Enter Principal Diagnosis
You will then be asked to enter the principal diagnosis for the request
Then the submitter needs to select the requested services. Select add service to open a pop up box for the service information to be entered
Select Add Service to open pop up box for service information to be entered.

29. Submitter will need to enter:
Add Service
Submitter will need to enter:
Start Date
End Date
These are your requested dates of service
The submitter will need to enter the start date and end date. Please remember these are your requested dates of service.

30. Treatment Description
Add Service
Treatment Requested
This is the HCPCS Code
Treatment Description
Can be used if it is a recertification
For NOS codes
You will then enter the treatment requested. This should be the HCPCS Code requested. The treatment description box is mandatory for all NOS codes. It can also be used to communicated the request is a recertification or the name of the equipment.

31. Add Service
Quantity
This is the number of items being requested for this particular HCPCS
You will need to enter the quantity. Please note the quantity is the number of items you are requesting. The majority of the time this should be 1. This can be a little confusing since the quantity in the Qualitrac system equivalates to the number of units.

32. Service Information Select if this will be a Rental or a Purchase
Please select if the request is for a rental or purchase

33. Rental For Rental: Enter required fields: -Quantity - Rental Cost
- Frequency
-How long does the member need this?
When requesting a rental enter the Quantity(number of items you are requesting) Rental cost(amount requested) and how long the member needs this item(this should be the number of months you are requesting the rental).

34. Purchase For a purchase: Enter required fields: - Quantity
- Purchase cost
If the request is for a purchase you will need to enter the quantity(number of items you are requesting) and the purchase cost(amount you are requesting)

35. Procedure Code
Once all fields in the Requested Services pop up box are completed, the information will be displayed for your reference.
At this time, the submitter may select Add Service and add a second line to this submission.
24 lines can be entered per request. If you need to request more items for a request a new case will need to be entered
Please note in the new request the Reference ID from the original request
Once all the fields in the Requested Services pop up box are completed the information will be displayed for your reference.
At this time the submitter may select Add Service and add a second line to this submission.
There can only be 24 lines entered per reference ID. If you need more lines for a request a new case will need to be entered. This will allow all information of the request be transmitted to the state.
Qualitrac will not limit the number of 24 lines to be entered. It will be the providers responsibility to enter only 24 lines in a request. If more then 24 lines are entered the reviewer will return the request to the provider and you will need to submit a new case.
In the event you need to enter a second request for an item please include the reference ID of the original case in the comments to assist Telligen in processing the whole request.

36. These can delay reviews
Common Errors with Procedure Codes
These can delay reviews
Entering HCPCS codes Telligen is not reviewing
Entering codes that do not require preauthorization
Entering an ICD-10 instead of a HCPCS code
Entering the wrong HCPCS for the request
Some common errors we have seen with requests include:
Entering HCPCS codes Telligen is not reviewing
Entering codes that do not require preauthorizatrion
Entering an ICD 10 instead of a HCPCS code or
Entering the wrong HCPCs for the request.
These items can delay the processing of reviews.

37. Multiple Component Requests
Equipment with accessories
Must request each accessory separate from the main item
Each component is reviewed individually and will have its own outcome.
Denial Letters will follow for those components not approved .
Examples include:
Gait trainers custom seat
Standers custom back
Entering these items as one request will be returned to the provider and a new request will need to be entered. This can delay the review decision
Some requests may have more than one component to the request. These are usually equipment that have added accessories.
Each accessory must be listed separately from the main item. This is done so that each component can be reviewed individually and have its own outcome.
Denial letters will follow for those components not approved.
Some examples of multiple component requests are gait trainers, standers, custom seat or custom back.
Teligen has been very flexible when providers have entered requests that included the accessories as one request. Since Telligen will be issuing all letters beginning February 1 requests that have been entered incorrectly will be returned to the provider and a new request will need to be entered.

38. Provider Portal: Supporting Documentation
Attach supporting documentation.
This is where the medical record will be attached to the file along with any other supporting documentation.
Supporting documentation needs to be uploaded to the request. This is where the medical record will be attached along with any other supporting documentation.

39. How to Minimize Errors When Uploading Documents
Trouble Shooting
How to Minimize Errors When Uploading Documents
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.
Here are some trouble shooting tips when uploading documents
Do not upload documents that are password protected
Do not upload documents directly from a secure drive
If documents are larger that 300 Mb, split the document in to smaller files making them easier to process.
Please submit all documentation required to make an accurate determination.
And Speed does affect the upload time of the document. The slower the internet connection will result in extend upload times.

40. Summary and Attestation
The submitter will have the opportunity to review all information that was entered including support documentation that was uploaded. If there are any errors or items omitted, please hit the back button to correct the request
Once everything is correct, utilize the electronic signature and select done to submit the case.
Under Review
You will then be provided a summary and attest the information is correct and true. You will need to enter your user name as your electronic signature.
Under Review

41. Provider Portal: Summary and Attestation
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.
The request is not complete until the submitter clicks the “done” button. 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 the case has been submitted
As stated earlier the user will receive an when the request is complete and at any time the user may long in to review and check the case status.

42. Patient Portal: Landing Page
Use buttons to filter the cases in your queue.
Use column headings to sort the data.
Use search boxes to find specific information.
Click on Case ID to get more details.
If we go back to the Qualtrac portal, the Landing page is the page the portal opens to when you log in.
You can use the column heading to sort the data
You can use bottons to filter the cases in your queue
You can search the boxes to find specific information
Clicking on the case id can yield more information on a particular case
The button in the lower lt corner is to enter a new case and on the rt hand side you can navigate to the pages of requests.
Use to navigate through the pages
Use this button to begin entering a new case.

43. 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.
After the 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

44. 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
This will show the case details. By clicking on the reference ID you will see a summary page and view attached documents.

45. 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.
Here is a screen shot of the summary page and correspondence. When the user clicks on the reference ID a summary page opens where case information, supporting documentation and status can be reviewed. This page contains any letters or documents attached to the case.
Clicking on the link(s) contained in the Letters section will open the correspondence for review.

46. or email marylanducsupport@telligen.com
For DME Questions
We are here to help
please contact our Provider Help Desk by telephone at pressing option number 2 will connect you with the DME Line. or
When inquiring on a review request –please use your Qualitrac Case ID number(Reference ID) – please do not send PHI or PII in your .
Telligen has several ways providers can have questions answered. We have a Provider Help Desk that may be contacted by phone at (pressing option number 2 will connect you with the DME line or you can
When inquiring about a request please use your Qualitrac Case ID or also known as the Reference ID
Please remember to not send PHI or PII in your .
Thanks so much for taking time out of your busy day to join us. We will now answer questions you may have.

47. Questions
Telligen will become your partner in serving Medicaid clients