Download - HP Provider Relations February 2011 Prior Authorization via Web interChange.

HP Provider Relations

February 2011

Prior Authorization

via Web interChange

Prior Authorization via Web interChange February 20112

Agenda

– Objectives

– Valid provider types

– Demonstration

– Attachments

– Prior authorization (PA) inquiry

– PA status defined

– Helpful tools

– Questions


Objectives

Following this session, providers will be able to:

– Determine which provider types can submit a PA request via Web interChange

– Complete the PA Submission screen in Web interChange

– Look up PA requests that were previously submitted

– Mail attachments related to a PA request

DescribeValid Provider Types


Valid Provider Types405 IAC 5-3-10 identifies the provider types that may submit a PA request via hard copy or electronically:

–Doctor of medicine

–Doctor of osteopathy

–Dentist

–Optometrist

–Podiatrist

–Chiropractor

–Psychologist endorsed as a health service provider in psychology (HSPP)

–Home health agency (authorized)

–Hospital

–Transportation provider

–Any provider with prescriptive authority under Indiana law who prescribes drugs subject to PA

DemonstratePrior Authorization


Prior Authorization via Web interChange


Certification TypeDemonstration

Listed below are definitions for the options available under "Certification Type":

– Appeal – Immediate• Informs the IHCP the request is for an administrative review

– Appeal – Standard• Informs the IHCP the request is for an administrative review

– Extension - Indicates the request is for an update to a previously approved PA

– Initial - Indicates a new request

– Renewal – Indicates an update to a previously approved PA

– Revised – Indicates a request for a change or update to a previously approved PA



Type up to 264 characters


Submitting the PADemonstration

– After submitting the PA, a pop-up window will display the member name and a Confirmation Number

– Web interChange will generate the PA number within 30 minutes after submitting the PA

– Until the PA number is generated, use the Confirmation Number to view the PA using the PA Inquiry function

ExplainAttachments


Attachments

– Most PA requests require documentation to support medical necessity• Exception: Non-emergency transportation services

– To send required documentation for PA requests submitted via Web interChange, print the Prior Authorization System Update Request Form• The form is available under the Forms link at www.indianamedicaid.com

• Include the PA number – the PA number alerts CME staff that the documentation is related to a PA that has already been submitted and is in an Evaluation or Suspended status

http://www.indianamedicaid.com/


Attachments

CreateEnter PA #


Attachments

– Fax the Prior Authorization System Update Request Form and supporting documentation to ADVANTAGE Health Solutions for

Traditional Medicaid Fee-for-Service and ADVANTAGE Care Select:

FAX: 800-689-2759

– Fax the Prior Authorization System Update Request Form and supporting documentation to MDwise Care Select:

FAX: 877-822-7186

DescribePrior Authorization Inquiry


Prior Authorization Inquiry

DefinePA Status


PA Status – Defined

Following are some of the statuses commonly assigned to PA requests:

–Approved – medical necessity guidelines are met

–Suspended – additional information requested from the member and/or the provider

–Modified – the request is approved; however, the approval is not in accordance to the requested dates, units, or dollar amount found on the original request

–Denied – the request is not approved

–Rejected – the request could not be processed

–Evaluation – request is awaiting a decision

–No PA required – procedure/revenue code does not require PA

Find HelpResources Available


Helpful Tools

– IHCP Web site at www.indianamedicaid.com

– IHCP Provider Manual, Chapter 6

– ADVANTAGE Health Solutions – Care Select• Telephone: 1-800-784-3981

– MDwise – Care Select• Telephone: 1-866-440-2449

– ADVANTAGE Health Solutions – Fee For Service• Telephone: 1-800-269-5720

– Provider field consultant • http://provider.indianamedicaid.com/contact-us/provider-

relations-field-consultants.aspx

http://www.indianamedicaid.com/

http://provider.indianamedicaid.com/contact-us/provider-relations-field-consultants.aspx

http://provider.indianamedicaid.com/contact-us/provider-relations-field-consultants.aspx