Maryland Provider Portal Training – Prior Authorization, Concurrent, and 3871B Reviews April 2016

1. Maryland Provider Portal Training – Prior Authorization, Concurrent, and 3871B Reviews April 2016

2. Agenda • Telligen Patient Portal Update • 3808 Prior Authorization and Concurrent • 3871B Long Term Care • Questions and Answers

3. Update

4. Telligen Provider Portal Update • The Telligen Provider Portal went live on April 1, 2016 • As of April 15th: • Over 70 facilities have set up Security Administrators • Over 3,300 cases have been submitted for retrospective reviews • The Security Admin registration packet can be downloaded from the website at: http://telligenmd.qualitrac.com • Once downloaded, three sections will need to be completed. • Section 3: Executive Agreement • Section 4: Security Administrator Agreement • Section 5: Security Administrator Registration Form

5. Methods of Submission of Provider Registration • Fax – Please submit your completed form to Telligen with a cover page titled: Maryland Provider Registration and send to 1-888-297-4276 U.S. Mail – Telligen, Inc. • 6518 Meadowridge Road • Elkridge, MD 21075 • ATTN: Provider Services • Telligen will need a hard copy of your notarized form at the above address within 30 days of initial electronic submission • An email will be sent with the security administrators login and temporary password within 3 business days of receipt.

6. Provider Portal Training- 3808 Prior Authorization and Concurrent Reviews

7. Telligen Portal – How the Provider Benefits Information and timing – Portal submission equals quicker turnaround • When you upload a document to the Portal you will receive an email confirmation • When a determination is made on your request, you will receive an email notification • When you access the portal, you can view the status of all requests and the authorization number • Save time and telephone calls by utilizing the Portal

8. Key points for Elective and Emergency Reviews • Elective Admission Reviews: • A hospital is required to submit a Prior Authorization Request in advance of the admission to receive medical necessity approval for the admission • If Member needs to stay in the hospital for extended days longer than originally expected, the Hospital is required to submit a concurrent review request for that elective admission to receive guidance on whether those additional days would likely be approved • If admit day changes, a new prior auth needs to be submitted. • Emergency Admission Reviews: • Submit Concurrent Review within 48 hours of admission and any additional concurrent reviews that may be required.

9. Tips For Eliminating Errors When Uploading Documents • Do not upload documents that are password protected. • Do not upload documents directly from a secure drive. • If documents are larger than 300 Mb, split the document in to smaller files making them easier to process. • Please submit all documentation required to make an accurate determination, complete medical record. • Speed does affect the upload time of the document. Slower internet connections will result in extended upload times.

10. Provider Portal: Start a New Request • To get started, navigate to the website: http://telligenmd.qualitrac.com • Utilize the “Login” option in the top right hand corner to log-in to the Patient Portal. • To start a new request, select “Add Authorization” button

11. Select the Request Type • Select one of the options from the drop down box: • Acute Hospital Review • Adult Chronic Hospital Review • Home and Community Based Review • Nursing Facility Review • Special Pediatric Hospital Review • Choose the review type that you are requesting a review for.

12. Provider Portal: Patient Information • Enter the member’s Medicaid ID and Date of Birth • The data entered MUST be an exact match to continue.

13. Provider Portal: Provider and Facility Information • Enter the Ordering Provider and Treating Facility Information. • Treating Facility is required.

14. Provider Portal: Service Request • Admission Type has three options: • Elective • Emergency • Retroactive • Admit date is required. Admit Date determines if review will be Prior Authorization or Concurrent. • Future Admit date says that this is a Prior Authorization review and the discharge date field will not show. • A current or past Admit date tells the system that this is a Concurrent review. The Discharge Date box will show and a future expected Discharge date should be entered.

15. Continuation of Services/Concurrent Review When a subsequent review is entered that has the same member, treating facility, and Admission date, the system will provide a message. At this time, additional documentation that is necessary to support the request for additional days will need to be uploaded.

16. Provider Portal: Summary and Attestation • The user will review the information for accuracy, enter their Username to confirm that they agree to the terms, and click “Done”.

17. Provider Portal: Summary and Attestation • Clicking the “Done” button is necessary to submit the case through the system for review. • An email will be sent to the User with the case number. This confirms that the case has been submitted. • The User will also receive an email when case review is complete. • A User may log in at any time to determine case status, view applicable correspondence, and attach additional information.

18. Patient Portal: Requesting a Reconsideration Click the Request Reconsideration button to request a reconsideration.

19. Provider Portal Training – 3871B Submission

20. Provider Portal: Start a New Request • To get started, navigate to the website: http://telligenmd.qualitrac.com • Utilize the “Login” option in the top right hand corner to log-in to the Patient Portal. • To start a new request, select “Add Authorization” button

21. Select the care facility • Select one of the options from the drop down box: • Acute Hospital Review • Adult Chronic Hospital Review • Home or Community Based Review • Nursing Facility Review • Special Pediatric Hospital Review • Choose the review type that you are requesting a review for.

22. Provider Portal: Patient Information • Enter the member’s Medicaid ID and Date of Birth • The data entered MUST be an exact match to continue. • If the member does not have a Medicaid ID, select the link above the Member ID box to enter patient information.

23. Member Information • The submitter will need to answer questions related to the member including: • Is the member currently in the facility that the request is for? • The submitter will be able to enter information for a Personal Representative if the member has one. • Attending Physician is not required but should be entered if available

24. Request and Diagnosis Information • Submitter is required to enter the: • Requested Eligibility Date • Admission Date • Reason for Request • Principal Diagnosis • Secondary Diagnosis is not required but up to 18 can be entered if needed.

25. Medical Eligibility Questionnaire • The submitter will move in to the Medical Eligibility Questionnaire. • All questions must have answers to proceed

26. Provider Portal: Supporting Documentation • Attach supporting documentation. • This is where supporting documentation for the requested level of care will be uploaded as well as any other required forms. Examples include ventilator questionnaire and PASRR (if applicable). • The system will provide notification for applicable forms.

27. Summary and Attestation • The submitter will have the opportunity to review all information that was entered including support documentation that was uploaded. • Once everything is correct, utilize the electronic signature and select done to submit the case.

28. Provider Portal: Summary and Attestation • Clicking the “Done” button is necessary to submit the case through the system for review. • An email will be sent to the User with the case number. This confirms that the case has been submitted. • The User will also receive an email when case review is complete. • A User may log in at any time to determine case status, view applicable correspondence, and attach additional information.

29. Resources for Questions and Assistance We are here to help – local resources • For questions regarding acute submissions – please contact Jada Scarborough - JScarborough@telligen.com • For questions regarding 3871B submissions in Qualitrac, please contact Ed Mitchell Emitchell@telligen.com • For general operational questions, please contact Michael Mercado – mmercado@telligen.com

30. Questions Telligen will become your partner in serving Medicaid clients