Maryland Provider Portal Training – Submission of 3808 Retrospective Reviews March 2016

2  Introduction to Telligen  Security Registration  Security Administrator Training  Provider Portal User Training – 3808 Retrospective Reviews  Questions and Answers Agenda

3 Introduction to Telligen

4 Our mission is to improve quality and cost effectiveness of healthcare for consumers and providers Overview  Employee-owned: company founded in 1972 with headquarters in Iowa and offices in Maryland, Illinois, Oklahoma, Colorado, Minnesota, Massachusetts, Nebraska Clinical Expertise Technical Expertise Healthcare Intelligence Combining extensive clinical and technical expertise to solve complex healthcare challenges

5 Areas of Practice Healthcare solutions for state agencies that result in appropriate utilization, improved clinical outcomes & lower costs State Health Solutions Quality improvement, data analytics & IT solutions for national programs measuring quality & cost- effectiveness Federal Health Solutions Resources for employer & employees to better understand their healthcare options, reduce costs and obtain better outcomes Commercial Health Solutions Innovate data analytics & health IT solutions clients use to measure the value and effectiveness of care Federal Information Management Overview Currently managing Medicaid populations in Iowa, Oklahoma, Nebraska, Minnesota & Massachusetts Federally designated Quality Improvement Network for Iowa, Illinois & Colorado Developed & implemented the first pay-for-performance reporting system for CMS

6 Utilization Control Experience Utilization Control Telligen’s Health UM Programs: Continuous URAC accreditation since 1992 ExperienceIAOKMNNE Manage Medicaid costs and reduce the administrative burden on providers and payers Analyze healthcare data to identify opportunities for reducing inappropriate utilization Create, maintain and update web portal Work with partners to help providers adopt and implement new practices Perform prospective reviews and/or prior authorizations for medical necessity Medicaid participants556,147822,9301,025,464233,555

7 Engagement & Education  WebEx Trainings for 3808 Retrospective Reviews this week and next  WebEx Trainings in April for all other service levels  Follow up with providers on questions and on an individual as required Provider Partnership

8 Order of Events  Customization for Maryland medical community  Provider outreach and introductions  Transmittal from DHMH to providers for portal training and registration  Opening of public informational website  Webex training / distribution of education materials  Complete registration of Security Administrators and Users Facility designated “Security Administrator” Security Administrator manages user(s) for the facility  DHMH Announcement of portal opening  Submit Reviews. Acute Care Reviews

9 Security Registration

10  The Telligen Provider Portal is a web application that allows healthcare providers to submit review requests.  The Provider Portal utilizes a delegated security model – A delegated security model requires an organizational executive (Provider Executive) to “delegate” administrative rights to one or more individuals within their organization (Security Administrator)  The Security Administrator will: – There should be 1 Security Administrator per facility – Be the point of contact for the organization; – Add, remove or edit Provider Users accounts PLEASE NOTE - HIPAA and DHMH compliance requires all staff entering reviews or accessing the portal MUST have their own logon and password. Do not create generic logons Provider Portal Security

11  The registration packet can be downloaded from the website at:  Once downloaded, three sections will need to be completed. – Section 3: Executive Agreement – Section 4: Security Administrator Agreement – Section 5 – Security Administrator Registration Form Registration Process Overview

12 Protecting your security and in compliance with HIPAA  To comply with security requirements for the State of Maryland and with HIPAA hitech standards, we do require that page 5 of the request be notarized.  This can be done at the original submission OR be done within 30 days of electronic submission by sending a hard copy of the form to Telligen at the Telligen Maryland office. Provider Registration Requirements

13  Electronic – Please submit your completed form to Telligen at Telligen at  U.S. Mail – Telligen, Inc Meadowridge Road Elkridge, MD ATTN: Provider Services  Telligen will need a hard copy of your notarized form at the above address within 30 days of initial electronic submission  An will be sent with the security administrators login and temporary password within 3 business days of receipt. Methods of submission of Provider Registration

14 Provider Portal Training Retrospective Reviews

15 Information and timing – Portal submission equals quicker turnaround  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  When you access the portal, you can view the status of all requests and the authorization number  Save time and telephone calls by utilizing the Portal Telligen Portal – How the Provider Benefits

16 Assist us to assist you  Please only submit a single request once – you can check on your request using the Case ID  For the backlog for the period of February and March we would request that you submit 10% of your backlog each day beginning on 4/1/16 to allow for efficient processing of backlog requests as well as new requests.  Telligen will be staffed for the backlog and for peak activity periods to facilitate prompt processing  Turnaround times – Business Days 20 days for initial requests – 3 days for reconsiderations Tips for Submission and Prompt Response

17  To get started, navigate to the website:  Utilize the “Login” option in the top right hand corner to log-in to the Patient Portal.  Step 1: To start a new request, select “Add Authorization” button Provider Portal: Start a New Request

18  Step 2: Enter the member’s Medicaid ID and Date of Birth – The data entered MUST be an exact match to continue. Provider Portal: Patient Information

19  If the entered Member ID and Date of Birth is not found in the system, you will see the following screen. Provider Portal:  Click the “Try Again” button to reenter the information.  If member is still not found, confirm the information with the patient and/or contact the Help Desk for further assistance at

20  Step 3: Enter the Ordering Provider and Treating Facility Information. – Treating Facility is required. Provider Portal: Provider and Facility Information

21  Step 4: The following information will be entered on this screen. The ones with a red asterisk (*) are required. – Level of Care (Will be defaulted as shown) – Authorization Type (Will be defaulted as shown) – Principal Diagnosis* – Secondary Diagnosis (Up to 3 can be entered.) – Procedure (Up to 3 can be entered.) – Admit Date* – Discharge Date * – Discharge Status * – DRG Provider Portal: Service Request

22  Step 5: Attach supporting documentation. – This is where the medical record will be attached to the file along with any other supporting documentation. The medical record is required to be included for the review to be processed. Provider Portal: Supporting Documentation

23  Users have two options to add files: – Drag and drop files in to the box. – Select the “Choose Files” option, navigate to the file, and select it to be uploaded.  Once files are added, select the “Start Upload” button.  Multiple files can be added and uploaded at one time. Provider Portal: Supporting Documentation

24  The medical record can be attached in the following formats: Provider Portal: Supporting Documentation

25  Step 6: The user will review the information for accuracy, enter their Username to confirm that they agree to the terms, and click “Done”. Provider Portal: Summary and Attestation

26  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. Provider Portal: Summary and Attestation

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

28  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. Patient Portal: Case ID Once the case has been located, click on the Case ID field to select it.

29  Clicking on the Case ID opens the Case Details page. Patient Portal: Case Details Click the Reference ID to see a summary page and view correspondence

30  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. Patient Portal: Summary Page and Correspondence Clicking on the link(s) contained in the Letters section will open the correspondence for review.

31 Patient Portal: Attaching Additional Documentation and Requesting a Reconsideration Click the Attach Documentation button to upload additional information and attach it to the case. Click the Request Reconsideration button to request a reconsideration.

32  Security Administrator Training

33  Security Administrators will receive an once their Provider Portal account set-up is completed.  The will contain the link to the portal and the temporary password assigned to the account.  First time accessing the Portal, the Security Administrator will: – Change their password – Agree to the Terms of Use Security Administrator: Accessing the Portal

34  Step 1: Go to the User Management Tab Security Administrator: Adding a User  Step 2: Select “Add User” at the bottom of the page

35  It is very important that all information is completed, including name and address.  Required fields are marked with a red asterisk (*)  Check the Provider Group or Facility the User is associated with in the Group Membership section.  Select “Save”. Security Administrator: Adding a User

36  Once the User is created in the system, the Security Administrator will need to: – Communicate to the User that the account is established and provide the User with their User Name  All addresses and User Names must be unique in the system.  The system will not allow a User to be created if either the User Name or address is duplicated in another account. – Utilize the “Reset Password” functionality to send the User an with a temporary password. Once the User receives the , they will be able to log-in, change their password, and agree to the Terms of Use. Security Administrator: Adding a User

37  Click the User Management Tab  Search for the User that you wish to modify  Click the User’s name to navigate to the Details page  Click the “Edit” menu option on the upper right hand side Security Administrator: Modifying Information for a User

38  The Edit screen will display.  Update the values that need to be changed.  Click “Save” when finished with modifications. Security Administrator: Modifying Information for a User

39  Click the User Management tab  Search for the User  Select the User  Click “Reset Password” on the upper right hand side Security Administrator: Resetting a User Password

40  You will be prompted to continue. Click Yes Security Administrator: Resetting a User Password  The screen will provide notification of successfully resetting the password.

41 Telligen will become your partner in serving Medicaid clients Questions