Patient360 provider access and navigation guide

Transcription

1 Table of contents Section Page Registering for Patient360 2 Logging in to Patient360 3 Reading and using the Patient360 tool 5 Patient banner 5 Member care summary tab 6 Claims tab 7 Utilization tab 8 Pharmacy tab 9 Labs and lab reports tab 10 Care management tab 11 Episodic viewer tab 12 HealthKeepers, Inc. is a health plan that contracts with both Medicare and the Virginia Department of Medical Assistance Services to provide benefits of both programs to enrollees. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. AVADPEC

2 Page 2 of 12 Registering for Patient360 To access the Patient360 tool, providers must be registered users. To register, providers need to follow the steps outlined below. 1. Go to 2. On the Welcome page, choose Register. 3. On the next screen, choose Let s Get Started and complete the online form. If a provider experiences problems registering, please have them call the Web Support team at

3 Page 3 of 12 Logging in to Patient Go to 2. On the Welcome page, choose Login. 3. Enter your username and password on the Login screen.

4 Page 4 of Next, the secure Virginia Providers Welcome Page will open. 5. Under Member Information in the menu on the left, select Patient Information. 6. Complete the Member Last Name, Member ID and Date of Birth fields and select Lookup Member. 7. Review the attestation and disclaimer. 8. Choose Find Member. 9. To see a standard member record, choose Continue and skip the remaining steps. 10. To see sensitive services, choose Want to view sensitive information if available? 11. Review the sensitive services terms and conditions and check the box indicating I agree to the Sensitive Services Terms and Conditions.

5 Page 5 of 12 Reading and using the Patient360 tool Patient360 has seven tabs of data for each member record member care summary, claims, utilization, pharmacy, labs and lab reports, care management and episodic viewer. A screen shot and a key describing the items within each tab are presented below in the order shown in the tool. Use this information to help providers navigate the tool and find specific medical information about our members. Patient banner At the very top of the Patient360 tool is the patient banner. The banner displays all of the demographic information we have on file for that member. Traffic lights PCP Case manager The traffic lights are used to quickly determine key information about a member. Green signifies an okay status, while red requires provider attention. The member s primary care physician The case manager(s) coordinating the member s care

6 Page 6 of 12 Member care summary tab The first tab in Patient360 is the member care summary. This page summarizes important aspects of the member s care, such as active alerts for HEDIS * care gaps, immunization and lab records, emergency department visits, inpatient stay summaries and a history of office visits. Date range Active alerts Lab results Emergency department Expand grid icon Default range is six months, but up to two years of medical history data is available Care gaps that need immediate attention Lab results, with abnormal acuity identified in red The member s emergency department claims Select this to see an expanded view of the specified grid *HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

7 Page 7 of 12 Claims tab The next tab shows claim details for up to two years, including claim status, assigned diagnoses and services rendered. Status Claim detail Status of the specified claim Details of the selected claim, including the diagnoses assigned and the services rendered

8 Page 8 of 12 Utilization tab The utilization tab provides details about active and inactive authorizations on file for the member for up to two years. Active authorizations Inactive authorizations Authorization ID Status Assigned diagnoses Assigned services Authorizations for which the member is currently receiving care Authorizations that have expired or for which care has already been rendered The identification number of the selected authorization The current status of the selected authorization The diagnoses assigned to the selected authorization The services assigned to the selected authorization

9 Page 9 of 12 Pharmacy tab The pharmacy tab includes all the pharmacy information associated with claims we have received. Sensitive information is not displayed. Status Pharmacy detail Status of the specified pharmacy transaction Details of the selected pharmacy item, including the medication quantity, days supplied, prescribing physician and pharmacy location

10 Page 10 of 12 Labs and lab reports tab The lab tabs include all the lab information from Quest and LabCorp that we have received.

11 Page 11 of 12 Care management tab All care management activities are shown here, including assessments, care plan goals and initiatives. Care management summary Assessments Cases Tasks Provides a graphical view of the member s care management activities All assessment questions and answers recently completed by the member and the assigned care manager Notes on the member s care plan, including goals, milestones and outcomes Care management activities that will be beneficial to the member

12 Page 12 of 12 Episodic Viewer tab The final tab graphically shows the member s medical history over time. Legend Timeline Primary problems Grid Body system Describes the meaning of each icon The bottom bar represents the current time frame of member care being reviewed. The top bar lets you change the time period being viewed. The primary problems associated with the member s care along with the type and date of care A graphical view of the member s care over time, offering an at-aglance overview of the patient s medical history Primary problems categorized by the identified body system