1. Autism (CMDE/ EDIBI) Atrezzo Provider Portal Submission Requirements INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT

2. Accessing Atrezzo Provider Portal Website Address: https://mhcp.kepro.comhttps://mhcp.kepro.com Select “ Atrezzo Login” To Register for Atrezzo Provider Portal : Enter your 10 digit National Provider Identifier (NPI) number and Provider Registration Code (DHS PA# located in MN-ITS mailbox) Registered Provider- Enter your unique user name and password 2

3. Atrezzo Provider Portal Atrezzo Provider Portal allows for: –Secure access to Atrezzo Connect (Provider Portal) –Provider will be able to access letters by Case/Request, Respond/Send messages To/From KEPRO 3

4. Atrezzo Provider Portal Successful Completion of setup/login, takes you to the Home Page Click “New Request” to start your case creation 4

5. Atrezzo Provider Portal Complete member search utilizing the Members Minnesota Medicaid ID # or Last name and Birthdate 5

6. Atrezzo Provider Portal Upon verification of the members First Name, Last name and Date of Birth Click “ Select” under the actions column 6

7. Atrezzo Provider Portal

9. Member Detail information will display. Ensure accuracy of the members name an Medicaid id prior to proceeding. Once verification is complete click “ Next” to continue.

10. Atrezzo Provider Portal Requesting Provider information will automatically default the provider listed in the change context section ( Top center of your screen). Requesting provider information can only be changed if you have if you have more than 1 NPI number registered to your Atrezzo Provider portal account. To change the requesting provider you must cancel your existing case creation an select the applicable provider from the change context section. Note: Enter in the FAX # where official communication about this service authorization should be sent.

11. Atrezzo Provider Portal The servicing provider information will automatically default to reflect the providers name listed in the change context section ( Top Center of your screen ). If the listed provider is not applicable to the requested authorization click “Find” to complete a provider search.

12. Atrezzo Provider Portal **Attending Physician Section is optional**

13. Atrezzo Provider Portal Select the applicable service type from the drop down listing(Selection of the incorrect service type will delay case processing time) EIDBI= 048-EIDBI Request Type= Prior Auth FIPS Code= Does not apply (Leave option blank)

14. Atrezzo Provider Portal Select the applicable service type from the drop down listing(Selection of the incorrect service type will delay case processing time) EIDBI= 048a-CMDE Request Type= Prior Auth FIPS Code= Does not apply (Leave option blank)

15. Atrezzo Provider Portal Click “ Find” to complete CPT code search.

16. Atrezzo Provider Portal Example of 0368T EIDBI and 0359T CMDE procedure code search. Click “Select” under the Actions column to place the selected code on case entry *Recommendation: Complete search utilizing cpt code versus description to minimize search results

17. Atrezzo Provider Portal Enter requested date span utilizing the calendar dropdowns Enter the quantity ( Units) Select the applicable modifier from the drop down listing More than 1 procedure code repeat steps

18. Atrezzo Provider Portal Enter Diagnosis code by clicking “ Find” ***Recommendation: Complete search utilizing Diagnosis code versus description to minimize search results

19. Atrezzo Provider Portal First diagnosis code entered is automatically deemed as primary diagnosis. More than one diagnosis code repeat same steps.

20. Atrezzo Provider Portal Optional- Enter Clinical documentation to support the requested services Enter Contact name and Telephone number

21. Upload required documentation- Click “Browse” locate the file and click open to attach. File Name will appear when it is successfully uploaded ( refer to slide 22 for steps 2-4 ) Step 1 Atrezzo Provider Portal

22. Step 2 Step 3 Step 4 Atrezzo Provider Portal

23. Review requires completion of questionnaire. Click questionnaire link to begin. Once completed click “Save Changes” and “Mark as Complete”. Upon completion of questionnaire click the “Return to Request” link ( Located upper right corner ) Link will be displayed here

24. Atrezzo Provider Portal Click the check box of the of the case entry page acknowledging the below statement. Successful case entries requires selection of “ Submit”. Request overview page will now display your case entry and KEPRO case id number. Selecting “Save for Later” Saves the case entry upto the current point. Case will reflect on the provider Atrezzo Provider Portal home page awaiting final submission. ***Note: Case is not received by KEPRO until receipt of KEPRO case id on the Request over view page.***

25. Atrezzo Provider Portal Once a request is successfully submitted the following page will display. KEPRO case id number is located to the upper left

26. Atrezzo Provider Portal For additional assistance contact KEPRO Customer Service Department at 1-866-433-3658