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April, 2014 Telligen: Introduction and Getting Started!

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Presentation on theme: "April, 2014 Telligen: Introduction and Getting Started!"— Presentation transcript:

1 April, 2014 Telligen: Introduction and Getting Started!

2 2  Telligen is a Healthcare Intelligence company providing many services including: health Informatics services, utilization management, consulting, population health management  URAC accredited  Founded in 1972, as Iowa Foundation for Medical Care (IFMC)  2011 name changed to Telligen- to better reflect our line of business across many states  Headquarters in West Des Moines with offices in Lincoln, Illinois, Maryland, Minnesota and Oklahoma Telligen, Who Are We? Our Mission: We improve the quality and cost-effectiveness of healthcare for consumers and providers

3 3  Telligen awarded State of Nebraska Medicaid Utilization and Quality Management Program  Telligen review start date: May 1, 2014  Core Components of the Program include  Utilization review function for non-managed Medicaid members  Provider education  Consult with DHHS for recommendations on program enhancements and other strategies to improved care delivered  Local Telligen office in Lincoln Nebraska Medicaid Contract

4 4 Who’s on our Team? Telligen, Who Are We?

5 5 Medical Director: Dr. Stuart Schlanger  Board certified in Internal Medicine  Active practice in Nebraska  Part of academia staff at Creighton University  Experience in Medicaid, Medicare and commercial physician reviews Peer Reviewer  Contract with Nebraska licensed Providers  Selected throughout State of Nebraska-Urban and Rural  Specialty and Practices selected based on review requirements Telligen, Who Are We?

6 6 Contract Manager: Loretta Olsen RN, MSN, ACM  Practicing nurse for over 30 years  Master’s of Science in Nursing  Certified case manager  Experience in utilization review and management of Medicaid, Medicare, and commercial medical necessity reviews Telligen, Who Are We?

7 7 Senior Review Coordinators  Registered nurses  Clinical expertise in varied specialties in healthcare  Experience in InterQual criteria  Experience in utilization review and utilization management Telligen, Who Are We?

8 8 Coding Analyst  MA, RHIA  Extensive knowledge of DRG reimbursement system  Experience as director of health information in an acute care hospital  Coding experience for inpatient and outpatient medical records Telligen, Who Are We?

9 9 Project Assistant  Expertise in customer service and problem solving  Experience and proficient in developing reports  Expertise in planning and coordinating events Telligen, Who Are We?

10 10 Electronic Request Submission Getting Started: Telligen Web Portal

11 11  Qualitrac—Telligen’s web-based health management system  Secure Internet Connection, for protected health information  Provider portal:  Allows for electronic submission of utilization review requests  Allows electronic uploads of medical records  Allows providers to track the progress of their submitted request  Sends real-time email of the outcome of the review with links to the specific review  Provider can access the portal 24/7  To access the website, go to: http:// telligen.nemedicalauth.com Telligen Web Portal

12 12  Provider portal (continued)  Provider is able to review past review requests and outcomes  Eliminates time spent faxing and wondering if all the documents were received  Improves provider’s staff satisfaction  Reduces the wait times for review determinations  User Friendly Telligen Web Portal

13 13  Registration is required to provide access to Qualitrac  Important to register as soon as possible  Once registration is complete, allow 5-7 business days for upload of information  Providers who are successfully registered by April 21, 2014 will be able to access the portal on May 1, 2014 Telligen Web Portal

14 14 How To Register

15 15  First Steps:  Organization will designate a Provider Executive  Provider Executive will designate a Security Administrator  Provider Executive signs registration agreement on behalf of their organization  Read, complete, sign and notarize required documents Telligen Web Portal

16 16 Telligen Web Portal The Provider Executive Agreement must be completed and signed by a duly authorized representative of your organization permitted to bind your organization to the terms and conditions of this agreement to approve registration of users for the Telligen Provider Portal, including Provider Security Administrator(s) and Provider Users for submission of Prior Authorization requests. I __________________________________________________________________ authorize ________________________________________________to be the Provider Portal Security Administrator for Telligen, Inc. (“Telligen”)’s Provider Portal on behalf of _______________________________(Provider Organization Name (“Provider”)), located at ______________________________________________________. The following providers are associated with this Provider Organization and are included in this authorization (list all individual NPIs and/ Medicaid IDs associated with this provider organization). Section 3: Provider Executive Agreement

17 17 Telligen Web Portal Section 3 continued Provider Name(s) Provider NPI (s) Provider Medicaid ID(s) __________________ __________________ ____________________ _________________ __________________ ____________________ I understand that the Provider Portal Security Administrator designated will be responsible for the following: Setting up and managing Provider user accounts for individual users in the system. Verifying the identity of individual physicians and users in Provider’s facility. Monitoring Provider’s Telligen Provider Portal usage to ensure that users maintain proper security and confidentiality procedures and resetting user passwords when needed. Serving as Provider’s primary point of contact for information regarding the Telligen Provider Portal.

18 18 Telligen, Inc. - Provider Portal Registration Page 6 | I agree to abide by the Provider Portal Terms of Use. I understand that as a security measure I may be contacted in the future by Telligen to verify my position and the designated Provider Staff Users and Security Administrator(s) for my organization. I may also be asked to verify those individuals who have been given access to the Telligen Provider Portal. I agree to respond in a prompt manner to all inquiries. Any violation of the above may be grounds for immediate termination of this agreement and/or access.. Signature of Provider: Name: (Please print)_________________________________ Signature: _________________________________________ Title: ___________________________________________ Date: ___________________________________________ Telligen Web Portal Section 3 continued

19 19  Security Administrator Role:  Point of contact for their organization  Submit a notarized registration form approved by the executive leader  Must agree to the responsibilities associate with the role of Security Administrator  Provide signature agreeing to the terms and conditions of using the Telligen Provider Portal  Responsible for managing Provider User Accounts  Adding or removing Provider Users required to support your organization Telligen Web Portal

20 20 Section 4: Provider Security Administrator Agreement  The Provider Security Administrator Agreement (“Agreement”) must be completed and signed by each security administrator (“Security Administrator”) designated by Provider.  The Telligen Provider Portal is intended to enable users to enter and store confidential patient information and to transmit such patient information to Telligen. In order to ensure the integrity, security and confidentiality of information maintained by the Telligen Provider Portal and Telligen, Inc. (“Telligen”), and to permit appropriate disclosure and use of data permitted by law, The Security Administrator agrees, represents and certifies:  This is a non-transferable, non-exclusive limited right to use Telligen Provider Portal to maintain, update and support the use of Provider User (“User”) IDs on behalf of Provider.  To comply with the Provider Portal Terms of Use at all times.  To ensure Users comply with the Provider Portal Terms of Use at all times.  To determine Users and type of access to the Telligen Provider Portal.  To authorize, control, monitor, access and use of the Telligen Provider Portal by Users.  To not disclose, release, reveal, show, sell, rent, lease, loan or grant access to Security Administrator’s Telligen Provider Portal User ID and/or password to any individual(s) for any reason.  To instruct Users to not allow another person to use their User IDs to access the system. Telligen Web Portal

21 21  To notify Telligen immediately of any potential security breaches.  To notify Telligen in a timely manner (not to exceed 5 business days) to terminate users who leave the organization or who no longer require access to the Telligen Provider Portal.  To notify Telligen should they believe that their User ID and password have been compromised, to ensure their User ID be inactivated and a new User ID and password be created.  To establish appropriate administrative, technical and physical safeguards to protect the confidentiality of the information accessed through the Telligen Provider Portal  To establish user access at the “minimum necessary use” level for the User to accomplish their role and/or responsibility.  To prohibit the unauthorized disclosure of files or information derived from the use of the Telligen Provider Portal.  To comply with all laws at all times during the term of this Agreement.  This agreement is subject to change at any time. Telligen Web Portal Section 4 continued

22 22 By accepting this agreement the Provider Security Administrator agrees to abide by all provisions set out in this Agreement for protection of the data and acknowledges having received notice of the potential criminal, administrative or civil penalties for violation of the terms of this agreement. Any violation of the above may be grounds for immediate termination of this agreement and/or access pursuant to the Provider Portal Terms of Use. Provider Security Administrator Signature: Name: (Please print)_________________________________ Signature: _________________________________________ Title: ___________________________________________ Date: __________________________________________ Telligen Web Portal Section 4 continued

23 23 * NOTE: All fields marked with an asterisk are required and must be completed to obtain approval. Access Request *Request Date: *First Name: Middle Initial: *Last Name: *Business E-Mail Address: *Job Title: *Business Name: *Facility Medicaid ID: *National Provider Identifier (Facility NPI): *Business Address: Street City State ZIP *Work Phone: ( ) Extension: Fax: ( ) Signatures Required *Applicant: *Date: *As The Assigned Notary Public I have used the following ID as verification  Driver's License  Passport  Other: _________________________________ *Notarized Date: _____________________________ Notary Expiration Date: ____________________ *Notary Public (seal or stamp): *Notary Signature: _________________________________________ Telligen Web Portal Section 5: Provider Security Administrator Registration Form

24 24 Final Registration Steps:  Review All forms for completion  Notarized Provider Security Administrator Registration Form  Mail All forms together to: Telligen 206 S. 13 th Street, Suite 100 Lincoln, Nebraska 68508 Return as soon as possible to ensure you have portal access beginning May 1, 2014 Telligen Web Portal

25 25  Telligen-Nebraska Medicaid Website: http://telligen.nemedicalauth.com http://telligen.nemedicalauth.com  For questions concerning completion of the registration forms:  Call 1-855-638-7949  Email: Telligen-NEMedicaid@telligen.comTelligen-NEMedicaid@telligen.com Telligen Web Portal

26 26 Mark Your Calendars:  New Webex on Accessing and Completing a Portal request  April 23rd and April 29 th  Will send out email notification to register Webex will:  Guide you through login to the Provider Portal  Completing an electronic request  Uploading documents  Electronic notification of review results  Accessing your submitted requests Follow Up Training-Webex

27 27 Telligen Questions?


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