Maryland Provider Portal Training – Submission of 3871b for Long Term Care Facilities April 2016

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Introduction to Telligen

Security Registration

Provider Portal User Training – 3871b Reviews

Security Administrator Training

Questions and Answers

Agenda

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Introduction to Telligen

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Our mission is to improve quality and cost effectiveness of healthcare for consumers and providers

Overview

Employee-owned: company founded in 1972 with headquarters in Iowa and offices in Maryland, Illinois, Oklahoma, Colorado, Minnesota, Massachusetts, Nebraska

Clinical Expertise

Technical Expertise

Healthcare Intelligence

Combining extensive clinical and technical expertise

to solve complex healthcare challenges

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Areas of Practice

• Healthcare solutions for state agencies that result in appropriate utilization, improved clinical outcomes & lower costs

State Health Solutions

• Quality improvement, data analytics & IT solutions for national programs measuring quality & cost-effectiveness

Federal Health Solutions

• Resources for employer & employees to better understand their healthcare options, reduce costs and obtain better outcomes

Commercial Health Solutions

• Innovate data analytics & health IT solutions clients use to measure the value and effectiveness of care

Federal Information Management

Overview

Currently managing Medicaid populations in

Iowa, Oklahoma, Nebraska, Minnesota & Massachusetts

Federally designated Quality Improvement

Network for Iowa, Illinois & Colorado

Developed & implemented the first pay-for-

performance reporting system for CMS

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Utilization Control Experience Utilization Control

Telligen’s Health UM Programs:

Continuous URAC accreditation since 1992

Experience IA OK MN NE

Manage Medicaid costs and reduce the administrative burden on providers and payers

Analyze healthcare data to identify opportunities for reducing inappropriate utilization

Create, maintain and update web portal

Work with partners to help providers adopt

and implement new practices

Perform prospective reviews and/or prior

authorizations for medical necessity

Medicaid participants 556,147 822,930 1,025,464 233,555

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Engagement & Education

WebEx Trainings for 3808 Retrospective Reviews were done in April

WebEx Trainings in April for additional services including 3871 b

Follow up with providers on questions and on an individual as required

Provider Partnership

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Order of Events

Customization for Maryland medical community

Provider outreach and introductions

Transmittal from DHMH to providers for portal training and registration

Opening of public informational website

Webex training / distribution of education materials

Complete registration of Security Administrators and Users

Facility designated “Security Administrator”

Security Administrator manages user(s) for the facility

DHMH Announcement of portal opening

Submit Reviews

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Acute Care Reviews

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Security Registration

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The Telligen Provider Portal is a web application that allows healthcare providers to submit review requests.

The Provider Portal utilizes a delegated security model – A delegated security model requires an organizational executive

(Provider Executive) to “delegate” administrative rights to one or more individuals within their organization (Security Administrator)

The Security Administrator will: – There should be 1 Security Administrator per facility

– Be the point of contact for the organization;

– Add, remove or edit Provider Users accounts PLEASE NOTE - HIPAA and DHMH compliance requires all staff entering reviews or accessing the portal MUST have their own logon and password. Do not create generic logons

Provider Portal Security

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The 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

Registration Process Overview

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Protecting your security and in compliance with HIPAA

To comply with security requirements for the State of Maryland and with HIPAA hitech standards, we do require that page 5 of the request be notarized.

This can be done at the original submission OR be done within 30 days of electronic submission by sending a hard copy of the form to Telligen at the Telligen Maryland office.

Provider Registration Requirements

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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.

Methods of submission of Provider Registration

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Provider Portal Training- 3871b Reviews

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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

Telligen Portal – How the Provider Benefits

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Assist us to assist you

Please only submit a single request once – you can check on your request using the Case ID

Tips for Submission and Prompt Response

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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

Provider Portal: Start a New Request

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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.

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Enter the member’s Medicaid ID and Date of Birth – The data entered MUST be an exact match to continue.

– Utilize the “Member does not have a Medicaid ID” link to enter patient information and receive a temporary ID

Provider Portal: Patient Information

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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 a

required field but should be

entered if available.

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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.

Request and Diagnosis Information

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The submitter will move in to the Medical Eligibility Questionnaire.

All questions must have answers to proceed

Medical Eligibility Questionnaire

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Attach supporting documentation. – This is where the medical record will be attached to the file along with

any other supporting documentation.

Provider Portal: Supporting Documentation

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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.

Tips For Eliminating Errors When Uploading Documents

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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.

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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.

Provider Portal: Summary and Attestation

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Patient Portal: Landing Page Use buttons to filter the cases in your queue.

Use search boxes to find specific information.

Use column headings to reorder the data.

Click on Case ID to get more details.

Use to navigate through the pages

Use this button to begin entering a new case.

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After a case has been submitted, Users can look up the case and perform additional actions or view details.

A User can search for a case using the search fields or by navigating through the pages.

Patient Portal: Case ID

Once the case has been located, click on the Case ID field to select it.

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Clicking on the Case ID opens the Case Details page.

Patient Portal: Case Details

Click the Reference ID to see a summary page and view correspondence

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When the User clicks on the Reference ID, a summary page opens where the case information, supporting documentation, and status can be reviewed.

This page contains any correspondence attached to the case.

Patient Portal: Summary Page and Correspondence

Clicking on the link(s) contained in the Letters section will open the correspondence for review.

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Security Administrator Training

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Security Administrators will receive an email once their Provider Portal account set-up is completed.

The email will contain the link to the portal and the temporary password assigned to the account.

First time accessing the Portal, the Security Administrator will: – Change their password

– Agree to the Terms of Use

Security Administrator: Accessing the Portal

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Step 1: Go to the User Management Tab

Security Administrator: Adding a User

Step 2: Select “Add User” at the bottom of the page

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It is very important that all information is completed, including name and address.

Required fields are marked with a red asterisk (*)

Check the Provider Group or Facility the User is associated with in the Group Membership section.

Select “Save”.

Security Administrator: Adding a User

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Once the User is created in the system, the Security Administrator will need to: – Communicate to the User that the account is established and provide

the User with their User Name

All email addresses and User Names must be unique in the system.

The system will not allow a User to be created if either the User Name or email address is duplicated in another account.

– Utilize the “Reset Password” functionality to send the User an email with a temporary password. Once the User receives the email, they will be able to log-in, change their password, and agree to the Terms of Use.

Security Administrator: Adding a User

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Click the User Management Tab

Search for the User that you wish to modify

Click the User’s name to navigate to the Details page

Click the “Edit” menu option on the upper right hand side

Security Administrator: Modifying Information for a User

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The Edit screen will display.

Update the values that need to be changed.

Click “Save” when finished with modifications.

Security Administrator: Modifying Information for a User

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Click the User Management tab

Search for the User

Select the User

Click “Reset Password” on the upper right hand side

Security Administrator: Resetting a User Password

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You will be prompted to continue. Click Yes

Security Administrator: Resetting a User Password

The screen will provide notification of successfully resetting the password.

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Telligen will become your partner in serving Medicaid clients

Questions