Clinical Form Tool Training Guide August 2016 900-1851-0716
Summary On July 16, 2016, Florida Blue enhanced the Clinical Form tool so multiple procedure codes can be included in an authorization request. Clinical Form is an electronic Certificate of Medical Necessity. It will display a Certificate of Medical Necessity button on the Authorization/Referral Results page in Availity. It allows providers to respond electronically to requests for clinical information for around 200 procedure codes for which Florida Blue would normally request medical records. Benefits of using the Clinical Form tool: Medical documentation can be submitted electronically for certain procedures. Faxing, emailing or mailing supporting documentation to Florida Blue is not required (some exceptions apply). It simplifies the Certificate of Medical Necessity process You can receive real-time referral/authorization decisions from Florida Blue. 2
Sign into Availity https://apps.availity.com/availity/web/public.elega nt.login Note: Please ensure you configure your web browser to allow pop-up windows from availity.com 3
Authorization/Referral Request 4
Authorization/Referral Request 5
Completing the Request 6
Completing the Request 7
Completing the Request Note: Enter the provider s Florida Blue proprietary number. Use the lookup button to access the provider directory for assistance if needed. 8
Submitting the Request 9
Authorization/Referral Results 10
Clinical Form Button Note: The new Clinical Form button appears when applicable procedure codes (based on the member s benefit plan) are entered. 11
Selecting the Organization 12
Clinical Form Attestation/Acknowledgment Note: The Attestation/ Acknowledgment dropdown field is required. 13
Clinical Form Completing the Form Note: If Florida Blue requests more information, it will be noted at bottom of the form with an email contact or fax number. 14
Clinical Form Response This concludes training for accessing and submitting a Clinical Form in Availity. Questions & Answers begin on the following slide. 15
Clinical Form Questions & Answers Q: How do I use the toolbar? Red X: Means more information is needed to complete the form (for example, the medical necessity review says information submitted doesn t meet medical necessity requirements and will pend for review.) Green Check: Means it meets medical necessity, and an approval will be received. Save Button: Saves all data entered in Clinical Form to complete at a later time. If the saved form is opened by a Florida Blue employee while in a saved status, the provider can no longer access the form. Notes: Currently not used. Complete: Once selected, the content of the form cannot be updated. Last Answer: Moves you to the last question. Cancel (coming soon): Cancels the form. It can be accessed again by running an Authorization/Referral Inquiry. Until it s available, please the click red x in right upper corner. Full Screen: Opens screen to a full view. Number Boxes: Non-functional Blue Clock: Non-functional 16
Clinical Form Questions & Answers Q: What does this icon do? A: The icons marked below are non-functional on the Clinical Form. 17
Clinical Form Questions & Answers Q: Do all procedures require completion of a Clinical Form? A: No. However, in the near future additional procedures will also have forms. Please note: If you use Clinical Form for a procedure, the information you include on the form(s) must be clearly documented in patients medical records, which may be subject to audit. Q: Is there an additional fee for using the Clinical Form? A: No. Q: Once Clinical Form is submitted, may I retrieve and edit or view it? A: No. Q: How can I send additional information (such as photos, medical records)? A: The bottom of the form will show if additional information is needed, and where to send it. Q: How do I exit the form? A: Close your browser tab/window once you see a successful submission message. Q: Why did a Clinical Form appear for the same service for one patient but not another? A: Different employer benefit plans have different requirements for medical review. Q: What if I want to cancel the form after starting one? A: Please select the red x in the upper right corner of the browser window/tab. A Cancel button at the top of the page will be available soon. 18
Clinical Form Questions & Answers Q: Why don t I get a Clinical Form for authorization requests that have more than one procedure? A: The capability allows providers to submit clinical information and receive real-time responses electronically for certain authorization requests that include multiple procedure codes. A Certificate of Medical Necessity button will display on the response screen in Availity only for certain procedures. Q: How will I be notified once a medical review is complete? A: An Availity inquiry can provide a status of the request. Florida Blue representatives will contact the provider s office according to the current process and timelines. Q: What if the form was never completed? What happens then? If a clinical form is not completed, the approval process for the request will follow the existing process. The form remains available for completion until a decision is made. Q: Where do I call to find out if my patient s plan requires a referral or authorization? A: You can use Availity s eligibility and benefits tool to determine benefits for specific services and refer to the provider manual for additional information; or the Availity authorization tool for requesting authorization for specific services. If the patient needs expedited or urgent care (the life or health of the patient may be jeopardized if care is not received right away), you can still make the request via the authorization tool. 19