Electronic Prior Authorization
What is Electronic PA ? Electronic PA Details – Web-based solution for managing medical information – Allows providers to submit PA requests over the Internet by providing online access to enter specific information needed for the member’s medical necessity review to occur
4/17/2013
2
Value / Benefits of Electronic PA Provider Benefits – Authorization Requests - Requests, whether simple or complex, are contained in one simple, clean web page – Inpatient Admission Notifications – Inpatient admission can be submitted securely over the internet 24 hrs. day 7 days/week – PASRR Submission – Submit applicable PASRR documents with an Authorization by using document attachment feature – Security - Security framework was specifically designed to meet the rigorous requirements of the HIPAA security and privacy regulations
4/17/2013
3
Required Information What is needed to successfully submit a PA? – – – – – – – –
Access to KYHealth Net Facility Medicaid ID # Member Medicaid ID # ICD-9 Diagnosis Codes Procedure codes (Revenue codes for Ancillary requests) Dates of Service Quantities of items requested (If applicable) Notes to gather appropriate clinical information – Use Map 726 as a guide – Attachments as applicable – PASRR documents
4/17/2013
4
System Access
4/17/2013
5
How to access Electronic PA Access gained through KYHealth Net 1.Using your Internet browser, navigate to the https://home.kymmis.com Web site either by selecting a predefined bookmark or typing the Web site address into the Address Bar of your Internet browser 2.Enter your user name and password in the appropriate fields
4/17/2013
6
How to access Electronic PA Select Electronic Prior Authorization from the Applications Menu
4/17/2013
7
System Navigation and Functionality
4/17/2013
8
Main Menu
4/17/2013
9
Navigation Bar Navigation – Allows navigation to any module – Contains a link to the online help
4/17/2013
10
Navigation Breadcrumbs Navigation with Breadcrumbs – Standard way of displaying current location within a browser-based application – Can always return to the home page by clicking the Main Menu hotlink in the breadcrumbs
4/17/2013
11
Calendar Icons Date Entry – Dates can be manually typed into a text box, or – Select the Calendar icon to launch a standard calendar pop-up window
4/17/2013
12
Drop-down Lists List Selection – Type directly into a drop-down list, or – Click the down arrow to view an entire list of choices
4/17/2013
13
Detail Hyperlinks Additional Information – Text labels that have colored text and are underlined indicate a hyperlink – Opens a details pop-up window with information relative to the field
4/17/2013
14
Required Fields Required Information for submission – Required fields exist in submissions that must be completed to successfully allow a provider to submit an electronic PA request – Any field or drop down selection box highlighted with a yellow background indicates that field is required for successful PA submission
4/17/2013
15
Required Fields – Error Messages Required Information Errors – If an electronic PA is submitted with one or more of the required fields that is not completed, an error message will appear – PA submission will not be complete until the required information is added to the electronic PA request
4/17/2013
16
New PA Submission
4/17/2013
17
New PA - Step 1 Select Submit Authorization Request – Use the Main Menu or Navigation Bar – Will open the Authorization Request module
4/17/2013
18
New PA - Step 2 Verify Contact Name – Should list the name of someone at the provider office who can be contacted by Carewise Health – Name can be changed by deleting the current name and re-typing a contact name
4/17/2013
19
New PA - Step 3 Enter Required Information – Contact Phone number – Member Identification Number – Requesting Provider Identification Number
4/17/2013
20
New PA - Step 4 Select appropriate Request Type – Select the proper type of Prior Authorization request being submitted – Will advance the module to the next screen
4/17/2013
21
New PA - Step 4 – NF Request Types • • • • • • • •
4/17/2013
Nursing Facility Brain Injury Locked Unit Nursing Facility Brain Injury Non –Locked Nursing Facility ICF MR/DD Nursing Facility IMD Nursing Facility Oxygen/Therapy Nursing Facility Room & Board Nursing Facility Swing Bed Room & Board Nursing Facility Vent
22
New PA - Step 5 (Room & Board) Diagnosis Codes, Facility, Dates – – – – –
Enter all available diagnosis codes Enter your Nursing Facility provider number Enter the Service From Date Enter Service End Date (30 days from the Service From Date) Enter Quantity – (will always be 30)
4/17/2013
23
New PA - Step 5 (Ancillary) Diagnosis Codes, Facility, Dates – – – – – –
Enter all available diagnosis codes Enter your Nursing Facility provider number Enter the Service From Date Enter Service End Date Enter Rev Code (0410 – O2, 0420 – PT, 0430 – OT, 0440 – ST) Enter Quantity Requested
4/17/2013
24
New PA - Step 6 Enter Notes and Complete Assessment – Additional information can be entered in Notes • Comments regarding Ancillary requests should be entered here, Assessment is not required for Ancillary requests
– The Assessment questions follow the MAP 726
4/17/2013
25
New PA - Step 6 (Continued) Attachment Details – Click Select to open a Windows browser dialog box and select a file – Click Add to repeat the process to add another file
4/17/2013
26
New PA - Step 7 Electronic PA Submission – Click the Submit button at the bottom of the Authorization screen to submit the PA request – Reference number will be displayed
4/17/2013
27
What to expect after successful submission
4/17/2013
28
New PA Confirmation Screen – Reference number will be displayed
4/17/2013
29
Status Checks
4/17/2013
30
Checking Status of a PA Use existing 3 methods
– KY Health Net website - http://home.kymmis.com – Automated Voice Response system 800-807-1301 – Receive PA Letter - letters can also be downloaded from KyHealth Net
4/17/2013
31
Resources
4/17/2013
32
ePA materials are available on kymmis website under Provider Relations/ KyHealth User Manual/Electronic Prior Authorization Documentation
4/17/2013
33
4/17/2013
34
4/17/2013
35
PRO Cert
4/17/2013
36
• PRO Cert is a electronic record that is created when a member is admitted to a nursing facility • PRO Cert records are required to be on file with the local DCBS office prior to the member completing their Medicaid application • When do I advise a family to go to the DCBS office to apply or complete the financial eligibility process? • A PRO Cert is transmitted to the DCBS office when the level of care is approved. *It can take up to 2 business days from the date of the approval for the PRO Cert to be visible in the system to the DCBS workers.
• I have a Prior Authorization letter for services, but the DCBS office is telling me the PRO Cert is not on file? • Contact Carewise Health. Staff will review the case for any errors and will work with HP staff and Member Services staff to resolve any confusion or errors.
• PRO Certs are not issued for a recertification 4/17/2013
37
Contact Information Tracy Treat 502-326-4512
[email protected]
Pam Smith 502-209-3159
[email protected]
4/17/2013
38
