Maryland Provider Portal Training – Submission of Durable Medical Equipment (DME) reviews August 2016

2  Introduction to Telligen  Security Registration  Provider Portal User Training – DME Reviews  Security Administrator Training  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 and & implemented the 1st pay- for-performance reporting for Centers for Medicaid and Medicare Services CMS

6 Utilization Control Experience Utilization Control – URAC Telligen’s Health UM Programs: Continuous URAC accreditation since 1992 ExperienceIAOKMDMNNE 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 participants - 556, , ,00 0 1,025, ,55 5

7 Engagement & Education  Advisory transmittals and updates from Department of Health and Mental Hygiene (DHMH) and Telligen  Telligen Web Training  Frequently Asked Questions (FAQ)documents on website  Refresher training and updates Provider Partnership

8 Telligen’s contract with DHMH covers multiple settings  Acute Hospital – 3808 Retrospective Payment Reviews – Prior Authorization – Elective Services – Concurrent Review – Inpatient Admissions  Long Term Care – Medical Eligibility Reviews – 3871 B – Adult Chronic Hospital Reviews – Special Pediatric Reviews  Home and Community Based Services – Prior Authorization – Waiver Services – In Home Assessments Telligen Scope of Work with DHMH

9 Security Registration

10 IMPORTANT REMINDERS FROM DHMH - Please make sure to refer to the Department’s memorandums, dated July 21 and August 12, 2016, and Transmittal No. 69 when preparing to submit these requests. August 26, 2016 is the last day providers will able to submit these preauthorization requests to the Department. Providers must hold all submissions after this date until they can be electronically submitted to Telligen on September 1, If the Department receives any requests after August 26, 2016, they will be returned to the provider for processing electronically via Telligen’s provider portal. Additional information regarding this transition can be found at:

11  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 – 2 or more for multi site locations – The security administrator will be the point of contact for the organization; – The security administrator will 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

12  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

13 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

14  Fax – Please submit your completed form to Telligen with a cover page titled: Maryland Provider Registration and send to  U.S. Mail – Telligen, Inc Meadowridge Road Elkridge, MD ATTN: Provider Services  Telligen must have 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 administrator’s login and temporary password within 3 business days of receipt. Methods of submission of Provider Registration

15 Provider Portal Training - DME Reviews

16 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 by using the Qualitrac Case ID number  Save time and telephone calls by utilizing the Portal Telligen Portal – How the Provider Benefits

17 Assist us to assist you  Please only submit a single request once – you can check on your request using the Case ID Tips for Submission and Prompt Response

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

19 Select the Type of Request Choose the review type that you are requesting a review for. Select Durable Medical Equipment Review from the drop down box

20  Select the Review Timing from the drop down box.  Prior Authorization is for a future request. Select the Review Timing

21  Enter the member’s Medicaid ID and Date of Birth – The data entered MUST be an exact match to continue. – Utilize the “Member does not have a Medicaid ID” link to enter patient information and receive a temporary ID Provider Portal: Patient Information

22 Group Selection Submitter will need to select the provider that this request is being submitted for.

23 Provider and Facility Search Submitter will enter the Ordering Provider and the Treating Facility. Both are required fields. Please use MA number to search.

24 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

25 Service Information Enter Principal Diagnosis Select Add Service to open pop up box for service information to be entered.

26 Submitter will need to enter:  Start Date  End Date  Treatment Requested  Treatment Description (For NOS codes only)  Quantity Add Service

27 Service Information Select if this will be a Rental or a Purchase

28 Rental For Rental: Enter required fields: - Rental Cost - Frequency -How long does the member need this?

29 Purchase For a purchase: Enter required fields: - Purchase cost

30 Procedure Code Once all fields in the Requested Services pop up box are completed, the information will be displayed for your refernce. At this time, the submitter may select Add Service and add a second line to this submission. As many lines can be added as needed.

31  Attach supporting documentation. – This is where the medical record will be attached to the file along with any other supporting documentation. Provider Portal: Supporting Documentation

32  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. Tips For Eliminating Errors When Uploading Documents

33 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

34  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

35 Patient Portal: Landing Page Use buttons to filter the cases in your queue. Use search boxes to find specific information. Use column headings to sort 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.

36  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.

37  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

38  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.

39  Security Administrator Training

40  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

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

42  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

43  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

44 Let’s make sure we are compliant  Please do not share a user ID with someone who isn’t with your organization.  Please do not create a user ID for a referring provider or entity  All user ID’s created should tie back to your organization’s address  The Qualitrac system is routinely monitored for utilization and security to ensure the integrity of the system and the review process. Security and Privacy

45  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

46  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

47  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

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

49 We are here to help  For assistance with registration or getting started, please contact  Cori Bondon –  Michael Mercado –  Or please contact our Provider Help Desk at by telephone at  When inquiring on a review request –please use your Qualitrac Case ID number – please do not send PHI or PII in your . For Assistance with DME submissions

50 Telligen will become your partner in serving Medicaid clients Questions