HELP - MMH Plus (WellPoint Member Medical History Plus System) 04/12/2014

Transcription

1 MMH Plus Help Topics Home/Communications Eligibility Facility Report Lab Results Report Care Alerts Report Search Professional Report Pharmacy Report Medical Management Report Patient Summary Report Basics (Sort, Move, Lock Columns) Special Functions (Print, Export to Excel, Filter, Search) HOME/ COMMUNICATIONS Home Tab After logging in to MMH Plus, the Home tab displays. -Communications Review the Communications panel to stay current on updates or information about the MMH Plus system. -Quick Links Request IT (WellPoint employees only) Links to Request IT. This is useful if you need to request access to MMH Plus. Change Password Links to PASS, WellPoint s Password Account Service System. MMH+ User Community (WellPoint employees only) links to MMH Plus SharePoint site. -Help/HMC/Logout Use the buttons in the upper right corner to: HELP - Access the online Help HMC (WellPoint employees only) - Access the AccessHMC Logout Exit the MMH Plus system -Search To locate a member, click the Search tab.

2 SEARCH SEARCH TIPS: 1. To perform a wild card search, enter part of the member name (i.e, charm, prin) and the system automatically conducts a wild card search at the ends of the last name and first name. Do not use the * (asterisk) in this search. Search Tab The Search tab has two main sections, the Search Form and Search Results. -Search Form To search for a member, enter an ID, an ID and date or birth, or name and date of birth, then click Submit. ID Enter any of the following: member HCID, subscriber ID, Social Security Number, Medicare or Medicaid Number. Name Enter all or part of the member name in last name, first name format. Date of Birth enter the date of birth in the MM/DD/YYYY format or click the calendar icon to select a date. Date Range By default, the system searches one year of history. You can select two years, five years or a custom range of dates. Lengthening the date range increases the search time. Submit After entering member information, click Submit to search. Submit does not become active until sufficient search information is entered. Reset Clears all information in the search form so you can begin another search. -Search Results Members matching the search criteria display. If multiple members display, this information can help identify the correct member. Member Name Address Gender Age Date of Birth Subscriber ID Eligibility Start Date Eligibility End Date Use the scroll bar at the bottom to display additional fields. Double-click on a name to access the member

3 MEMBER DEMOGRAPHIC INFORMATION -Member Tab The name of the member displays on a tab at the top. -Member Information The Member Demographic Information section displays at the top of the screen and remains displayed whatever report is displayed at the bottom of the screen. Information includes: - HCID - Name - Gender - DOB (Date of Birth) - Address, city, state, zip, phone - Alternate IDs - Group/Subgroup info TIPS: 1. You can access multiple members at the same time. Each member displays a tab at the top. Click a tab to switch to that member. Click the x in the corner of a tab to close that member. 2. Click the to collapse the Member Demographic Information section. This allows more data to display in the reports the bottom of the screen. -MMH Reports The member s medical history displays on a series of reports. - Eligibility (Benefit Coverage) - Professional services - Facility services - Pharmacy (Prescriptions) - Lab Results - Medical Management (Utilization, Case and Disease Management services) - Care Alerts - Patient Summary

4 ELIGIBILITY Report Eligibility Report The Eligibility Report displays by default when the member record is accessed. The report displays: - Current and/or previous coverage information. Information that displays includes: - Start/End Date - Company - Subscriber ID - HCID - Codes - Product Description - SBU - MBU - Funding TIPS: 1. Lock the Start Date and End Date columns to keep the dates visible as you scroll to the right to review additional fields. 2. Learn about MMH Report Options and Special Functions.

5 PROFESSIONAL Report Professional Report The Professional Report displays services for: - Office Visits - Radiology - Home Health Care - Durable Medical Equipment TIP: Learn about MMH Report Options and Special Functions. Report Information includes: - Date: Service Start Date - ER Visit: Y indicates an emergency visit - Inpatient: Y indicates an inpatient service - ICD Vrsn: Identifies whether ICD-9 or ICD- 10 diagnosis codes/descriptions are used in that specific record - Primary and Secondary Diagnosis Code/Description - Health Service Code/Description - Place of Service - Provider/ Provider Specialty - Subscriber ID - Claim Number/Claim Line Number - Claim Payment Info (WellPoint Employees Only): Billed Charge Amount, Amount Allowed, Amount Paid, Copay Amount, Co-Insurance Amount

6 FACILITY Report Facility Report The Facility Report displays services for: - Inpatient Surgeries - Outpatient Surgeries TIP: Learn about MMH Report Options and Special Functions. Information that displays includes: - ER Visit: Y indicates an emergency visit - Inpatient: Y indicates an inpatient service - Admit/Discharge Date: - ICD Vrsn: Identifies whether ICD-9 or ICD- 10 diagnosis code/descriptions display - Primary and Secondary Diagnosis Code/Description - Health Service Code/Description - Primary/Secondary ICD Procedure Code/Description - Revenue Code/Name - Facility Type - Provider and Specialty - Subscriber ID - Claim Number/Claim Line Number - Claim Payment Info (WellPoint Employees Only): Billed Charge Amount. Amount Allowed, Amount Paid, Copay Amount, Co-Insurance Amount

7 PHARMACY Report Pharmacy Report The Pharmacy Report displays: - Pharmacy Prescriptions TIP: Learn about MMH Report Options and Special Functions. Report information includes: - Fill Date - Claim Line Number - Drug Name/Dosage - Days Supplied - Dispensed Quantity - Prescribed By: The name of the person who wrote the prescription - Filled By: The name of the pharmacy that filled the prescription. - Refilled Authorized Number: The number of remaining authorized refills - Refill Indicator: NEW indicates the first fill of a new prescription - AWP: Average Wholesale Price (As determined by the manufacturer.) - DAW: Dispense As Written (To be filled with the brand drug. Member is responsible for the higher copay.) - Subscriber ID - Claim Number - RX Number - DEA Class Code - Hierarchical Specific therapeutic Class - Claim Payment Info (WellPoint Employees Only): Billed Charge Amount. Amount Allowed, Amount Paid, Copay Amount, Co-Insurance Amount

8 LAB RESULTS Report TIP: Lab notes can be very long. When a lab note is too long to display in the Notes field, the first several characters of the note display followed by an ellipsis ( ). When this occurs, double-click on the cell of the lab note and a pop-up displays the full text of the lab note. Lab Results Report The Lab Results Report displays services for: - Tests and evaluations Report Information includes: - Order Date - Result Date - Observation End Date - LOINC or Alt Code/Description - Ref Range: Range of normal values - Result - Abnormal Code: Abnormal results are identified in red. Common abnormal codes are L and H. - L - lower than normal results - H higher than normal - Notes * (see TIP) - Lab Vendor Records with abnormal results display at the top of the report.

9 MEDICAL MANAGEMENT Report Medical Management Report Medical Management includes 3 separate reports of services for: - Utilization Management (UM) - Case Management (CM) - Disease Management (DM) TIP: Only one report can be opened at a time. Click on a report, i.e., Case Management to open that report. The other reports close. UM Report Information includes: - Case Creation Date - Reference Number - Admit and Discharge Dates - Beginning and Ending Date of Service - Case Type - Place of Service - Service - Additional Services Indicator: Y - Facility Name - Provider Name - ICD Vrsn/Primary Diagnosis Code/Description - Procedure ICD Vrsn/Primary Procedure Code/Description - Requested Days - Approved Days and Denied Days - Case Owner ID and Name - Outcome Reason - Case Status - HCID - Subscriber ID - Clinical Source System Learn what information is included in CM and DM Reports.

10 MEDICAL MANAGEMENT Report, continued Medical Management Report, continued CM Report Information includes: - Case Management Begin/End Dates - Referral Source - Program Description - Case Manager ID, Name and Contact Number - Case Status: i.e., Active or Closed - HCID and Subscriber ID - Clinical Source System: Such as WMDS DM Report Information includes: - Referral Date - Referral Source and Reason - Program - Case Number - Case Open and Close Dates - Conditions and Intensity (Risk Levels) - Case Status and Reason - Assigned Nurse or Team - Name of Nurse With Last Interaction

11 CARE ALERTS Report Care Alerts Report Care Alerts are claims-based rules that identify members who may have a gap in care. Types of Care Alerts include: - Follow-up Visit Alerts - Lack of Child Vaccinations - Medications Alerts - Preventative Screenings Report Information includes: - Rule Name - Provider Message The Analysis As of Date identifies the date the rules were run that generated the alerts.

12 PATIENT SUMMARY Patient Summary The Patient Summary consolidates member information in a single display that opens in in a separate window. The Patient Summary includes the following reports: - Top Problem List - ER Visits - Inpatient information - Abnormal Lab Results - Rx (Pharmacy) - Provider Care Alerts - Utilization Management - Case Management - Disease Management TIP: Click the icon to access the Patient Summary in a PDF format. When prompted, click Open to display the Patient Summary PDF. Click Save to place the Patient Summary PDF to a specific location on a computer.

13 REPORT BASICS Sort, Move, Resize, Lock Columns You can sort columns, move columns, lock columns, and choose what columns display on a report. Hover your mouse over a column heading to access your options. Changes remain only until that member is closed. ACCESS OPTIONS DROP DOWN MENU To access report options, hover the mouse over a column heading until an arrow displays, then click the arrow. Use the popup menu to select options. SORT COLUMNS From the popup menu, select the option to sort the information in that column by ascending or descending. On text fields ascending sorts information from A-Z. On date fields ascending sorts oldest to newest. Date Column Ascending Sort MOVE COLUMNS Click and drag any header report to move the column and arrange the order of the columns RESIZE COLUMNS Hover the mouse over a column boundary until the crosshairs symbol appears. Then click and drag the boundary line to resize the column to narrow or widen it. LOCK A COLUMN Lock columns to keep the information in those columns visual as you scroll to the right. The blue line identifies a locked column. The first column is locked by default, but can be unlocked. CHOOSE WHICH COLUMNS DISPLAY To choose which information display on a report, access the options drop down menu and select Columns. Uncheck to remove the specific type of information from the report. Check to include the information.

14 SPECIAL FUNTIONS Print, Export to Excel, Filter, Search PRINT and EXPORT Information Member information in the Search Results panel as well as information on each report can be printed or exported to an Excel spreadsheet. Click the icon and on the Export & Print Options window, click either Export to Excel or View Printer Friendly. FILTER /SEARCH The ability to filter report information is available on reports. To filter records that contain a specific word or phrase, click in the Filter field and type the word/phrase. (On the Medical Management Report the field is labeled Search.) As you type, the report displays only those records that include that word/phrase somewhere in the record (except Date fields). To return to displaying all records, clear the text from the field.