Provider Website Overview

Transcription

1 Provider Website Overview Prepared for Physical Therapy Association of Washington May 11, 2017 Stephanie Cole Healthcare Implementation Manager

2 Agenda Introduction Quick Facts Live Demo Benefits Code checks Online resources Introduce evicore evicore Website Overview

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4 Website Overview

5 Quick Facts Accessing all of our secure tools requires registration through OneHealthPort (OHP) Our website is updated nightly Accumulators for physical therapy are available You can find the deductible, out-of-pocket and exclusions to the outof-pocket on our eligibility and benefits tool You can find two years of eligibility, claims and prior authorization info online If the Managed Care Coordinator message appears when you ve selected physical therapy or massage therapy from the benefits dropdown list, that indicates we require evicore review for that member s plan

6 Online Resources Provider orientation and online tool guides premera.com/wa/provider/learning-center Eligibility and Benefits: Verify member s eligibility and benefits, effective dates and accumulators online. Prospective Review Tool: Check a code to see if review is required. This provides a member specific response. Give feedback 24/7 with Premera Listens Provider News: Sign up for alerts to stay up to date

7 evicore Website Overview

8 Case Initiation 8

9 Initiating A Case Choose request a clinical certification/procedure to begin a new case request. 9

10 Select Program Select the Program for your certification. 10

11 Service Options Select Date Extension, Continuing Care, or Build a New Case. 11

12 Select Provider Select the Practitioner/Group for whom you want to build a case. 12

13 Select Health Plan Choose the appropriate Health Plan for the case request. 13

14 Select Address 14

15 Contact Information Enter the Provider name and appropriate information for the point of contact individual. 15

16 Member Information Enter the member information including the Patient ID number, date of birth, and patient s last name. Click Eligibility Lookup. 16

17 Clinical Details 17

18 Verify Service Selection ICD-10 Code ICD-10 Code 18

19 Site Selection Verify all information entered and make any needed changes prior to moving into the clinical collection phase of the prior authorization process. 19

20 Clinical Certification You will not have the opportunity to make changes after that point. 20

21 Finish Later/Save Option Once you have entered the clinical collection phase of the case process, you can save the information and return within (2) business days to complete. 21

22 Medical Review If additional information is required, you will have the option to either upload documentation, enter information into the text field, or contact us via phone. 22

23 Medical Review Acknowledge the Clinical Certification statements, and hit Submit Case. 23

24 Approval Once the clinical pathway questions are completed and if the answers have met the clinical criteria, an approval will be issued. Print the screen and store in the patient s file. 24

25 Building Additional Cases Once a case has been submitted for clinical certification, you can return to the Main Menu, resume an in-progress request, or start a new request. You can indicate if any of the previous case information will be needed for the new request. 25

26 Authorization look up Select Search by Authorization Number/NPI. Enter the provider s NPI and authorization or case number. Select Search. You can also search for an authorization by Member Information, and enter the health plan, Provider NPI, patient s ID number, and patient s 26

27 Authorization Status The authorization will then be accessible to review. To print authorization correspondence, select View Correspondence. 27

28 Eligibility Look Up 28

29 Provider Resources 29

30 Musculoskeletal Online Resources Clinical Guidelines, FAQ s, Online Forms, and other important resources can be accessed at Click Solutions from the menu bar, and select the specific program needed. 30

31 evicore Provider Blog Series The evicore blog series focuses on making processes more efficient and easier to understand by providing helpful tips on how to navigate prior authorizations, avoid peer-to-peer phone calls, and utilize our clinical guidelines. You can access the blog publications from the Media tab or via the direct link at 31

32 Web Portal Services-Assistance Call a Web Support Specialist at (800) (Option 2) Connect with us via Live Chat Web Portal Services-Available 24/7 32