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HP Provider Relations February 2011 Prior Authorization via Web interChange.

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Presentation on theme: "HP Provider Relations February 2011 Prior Authorization via Web interChange."— Presentation transcript:

1 HP Provider Relations February 2011 Prior Authorization via Web interChange

2 Prior Authorization via Web interChange February Agenda –Objectives –Valid provider types –Demonstration –Attachments –Prior authorization (PA) inquiry –PA status defined –Helpful tools –Questions

3 Prior Authorization via Web interChange February Objectives Following this session, providers will be able to: –Determine which provider types can submit a PA request via Web interChange –Complete the PA Submission screen in Web interChange –Look up PA requests that were previously submitted –Mail attachments related to a PA request

4 Describe Valid Provider Types

5 Prior Authorization via Web interChange February Valid Provider Types 405 IAC identifies the provider types that may submit a PA request via hard copy or electronically: –Doctor of medicine –Doctor of osteopathy –Dentist –Optometrist –Podiatrist –Chiropractor –Psychologist endorsed as a health service provider in psychology (HSPP) –Home health agency (authorized) –Hospital –Transportation provider –Any provider with prescriptive authority under Indiana law who prescribes drugs subject to PA

6 Demonstrate Prior Authorization

7 Prior Authorization via Web interChange February Prior Authorization via Web interChange

8 Prior Authorization via Web interChange February Prior Authorization via Web interChange

9 Prior Authorization via Web interChange February Certification Type Demonstration Listed below are definitions for the options available under "Certification Type": –Appeal – Immediate Informs the IHCP the request is for an administrative review –Appeal – Standard Informs the IHCP the request is for an administrative review –Extension - Indicates the request is for an update to a previously approved PA –Initial - Indicates a new request –Renewal – Indicates an update to a previously approved PA –Revised – Indicates a request for a change or update to a previously approved PA

10 Prior Authorization via Web interChange February Prior Authorization via Web interChange

11 Prior Authorization via Web interChange February Prior Authorization via Web interChange

12 Prior Authorization via Web interChange February Prior Authorization via Web interChange

13 Prior Authorization via Web interChange February Prior Authorization via Web interChange Type up to 264 characters

14 Prior Authorization via Web interChange February Prior Authorization via Web interChange

15 Prior Authorization via Web interChange February Submitting the PA Demonstration –After submitting the PA, a pop-up window will display the member name and a Confirmation Number –Web interChange will generate the PA number within 30 minutes after submitting the PA –Until the PA number is generated, use the Confirmation Number to view the PA using the PA Inquiry function

16 Explain Attachments

17 Prior Authorization via Web interChange February Attachments –Most PA requests require documentation to support medical necessity Exception: Non-emergency transportation services –To send required documentation for PA requests submitted via Web interChange, print the Prior Authorization System Update Request Form The form is available under the Forms link at Include the PA number – the PA number alerts CME staff that the documentation is related to a PA that has already been submitted and is in an Evaluation or Suspended status

18 Prior Authorization via Web interChange February Attachments Create Enter PA #

19 Prior Authorization via Web interChange February Attachments –Fax the Prior Authorization System Update Request Form and supporting documentation to ADVANTAGE Health Solutions for Traditional Medicaid Fee-for-Service and ADVANTAGE Care Select: FAX: –Fax the Prior Authorization System Update Request Form and supporting documentation to MDwise Care Select: FAX:

20 Describe Prior Authorization Inquiry

21 Prior Authorization via Web interChange February Prior Authorization Inquiry

22 Prior Authorization via Web interChange February Prior Authorization Inquiry

23 Define PA Status

24 Prior Authorization via Web interChange February PA Status – Defined Following are some of the statuses commonly assigned to PA requests: –Approved – medical necessity guidelines are met –Suspended – additional information requested from the member and/or the provider –Modified – the request is approved; however, the approval is not in accordance to the requested dates, units, or dollar amount found on the original request –Denied – the request is not approved –Rejected – the request could not be processed –Evaluation – request is awaiting a decision –No PA required – procedure/revenue code does not require PA

25 Find Help Resources Available

26 Prior Authorization via Web interChange February Helpful Tools –IHCP Web site at –IHCP Provider Manual, Chapter 6 –ADVANTAGE Health Solutions – Care Select Telephone: –MDwise – Care Select Telephone: –ADVANTAGE Health Solutions – Fee For Service Telephone: –Provider field consultant relations-field-consultants.aspx relations-field-consultants.aspx

27 Q&A


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