HPHConnect for Providers. Referral/Authorization Transaction Status User Guide

Transcription

1 HPHConnect for Providers Referral/Authorization Transaction Status User Guide November 2015

2

3 User Guide Table of Contents A. PATIENT MANAGEMENT Introduction to Patient Management Service Request Search Results Transaction Detail B. OFFICE MANAGEMENT Introduction to Office Management Status Search Form Search Example Search by NPI Harvard Pilgrim Health Care HPHConnect iii November 2015

4 Referral/Authorization Transaction Status Patient Managment Introduction to Patient Managment The Patient Management Referrals/Auths (RA) link lets you access the most recent 12 months of RA transaction history for providers on your access list for a member on the Current Patient list. When the patient s name has been selected from the list and is showing in the Current Patient field, click the Referrals/Auths link. If the patient s name is not on the Current Patient list, follow the steps in the Eligibility Verification section to add it. Service Request Search Results The Service Request Search Results screen will list the member s existing referrals and authorizations for which you are the servicing provider or the requesting provider. To access the detail of the record, click on the Service Request Number link. Susan Blacke 15 Mar 1962 MAURY JONES NPI SUSAN BLACKE JONES, MAURY, PEMBROKE SMITH, MARSHA WILSON REHABILITATION SMITH, MARSHA JONES, MAURY SOUTH BAY HOSPITAL (continued) Harvard Pilgrim Health Care HPHConnect 1 November 2015

5 Patient Management, continued Transaction Detail The transaction detail displays. Approved, Modified, and Pended records can be edited to revise, renew, or extend the requested service. Refer to the guidelines for the specific service for directions. Susan Blacke HP Susan Blacke ACUTE ON CHRONIC DIASTOL- IC (CONGESTIVE) HEART FAILURE JONES, MAURY (continued) Harvard Pilgrim Health Care HPHConnect 2 November 2015

6 Office Management Introduction Office Management When you click on the Referrals/Auths link in the Office Management section, the Status search screen displays. Here, you can search for RA transactions by any of the following categories: Patient Requesting Provider Servicing Provider Request Number Date(s) of Service Status Providers can only view RA transactions when they are the: Requesting Provider Servicing Provider, or Member s PCP Status Search Form Flexible search criteria allow the user to define which transactions to view. A Start Date and End Date are required on all requests, even when searching by specific Request Number. (continued) Harvard Pilgrim Health Care HPHConnect 3 November 2015

7 Office Management, continued Search Example To search for the authorizations requested by ABC Hospital for services between the dates of July 2, 2014 and July 3, 2014: 1. In the Requesting Provider section, select Last Name or Provider NPI. 2. Enter the provider name (ABC Hospital) or provider NPI ( ). 3. Select the Start Date : July 2, Select the End Date : July 3, (Optional) You can select to sort the records by any of the following categories: Patient Requesting Provider Servicing Provider Service Request Number Service Type Status Start Date End Date 6. Click on Search. The Service Request Search Results for ABC Hospital displays: Smith, John HP Blacke, Susan HP Brown, Sally HP TYLER, MAURY HARVEY, MATTHEW JONES, NANCY VISITING NURSE STOUGHTON SMITH, JOY VNA SERVICES SOUTH HOSPITAL, NORTON Blu, Suzanne HP , PEMBROKE, PEMBROKE Smyth, Jon HP BROWN, MARSHA BROWN, MARSHA Boyd, Bette HP WILSON REHAB SMITH, MARSHA REHAB HOSPITAL WILSON Search by NPI Users may search for referrals and authorizations by the requesting or servicing provider s National Provider Identifier (NPI). For organizations or facilities that have subparted: To search for referrals and authorizations submitted prior to May 23, 2014 use your main NPI number. It will be linked to all historical transactions based on your legacy provider ID. To search for referrals and authorizations created after May 23, 2014, use the NPI that the referral or authorization was created with; either main NPI or subparted NPI will be accepted. Harvard Pilgrim Health Care HPHConnect 4 November 2015