ProviderConnect 101

ProviderConnect 101 Entering Authorization Requests

Please Note • The OK Authorization Request is required for all PA requests except the “instant” PA’s for DMH services created from the CDC (DH codes) • The slides in this presentation are of a “fake” client – no actual client information is presented. • All parts of the ProviderConnect request are presented in this presentation – some providers may not have to provide all this information. If you are not sure what information is required please contact us for assistance. • Information, resources, and the link to Provider Connect are available on our website www.optumhealthoklahoma.com

The first time you log on you will be prompted to change your password.

Remember - the information on ProviderConnect is confidential. Please guard your username and password carefully and do not “share” them with others.

After catching up on the latest news you can jump to the Main Menu by clicking “Skip to Main Menu”

Lookup Client will ONLY find clients who already have a request in ProviderConnect. You will use “Add New Client/Client Search” to start new records and can use it to find existing records as well.

Required fields are outlined in red (Last Name and Medicaid Number). Fill in ONLY these fields and click “Search by Criteria”.

Be sure to give the system time to find your client’s information. As long as it says “Please wait, searching” it is looking for the information.

If you use email to communicate with reviewers about a ProviderConnect record use this number ONLY. Do NOT send the client’s name, SSN, or Soonercare number by email. Randomly generated ID # for client. Click this to move to the next screen. Ignore this field The ID on the left side is a randomly generated number assigned by ProviderConnect.Clicking this will move you to the next screen.

If the search returns “No Client Found”: • It will take 24-48 hours for new client eligibility information to populate after completing the online enrollment. Please wait until this period of time has passed then search for them again. • 2. If the client has had their number longer than 48 hours you will need to have the eligibility information manually uploaded to the system. Submit a fax with the client’s name, SSN, date of birth and Soonercare (or MHSAS) ID with a note that the client is not in ProviderConnect

Click “OK Authorization Request” to start a new request or access a previous request entered in ProviderConnect Do not change demographic information. If you notice an error have the client/guardian contact Soonercare Member Services to have their file updated.

When you click any of the form buttons on the left side of the Demographics screen) you will see one of three possible “views”. How you start entering the data depends on what information is already there. Look at the table at the top of the page before you start entering data.

Table has no open lines and all fields in the form are grayed out Click “Add New Record” to open form fields for editing and then begin entering your data.

Table has an open line (highlighted in yellow with “Delete” on the left hand side) that is empty – no Provider ID, Data entry date, etc. DO NOT click “Add New Record” – Just begin entering information in the form. Clicking “Add New Record” will cause an error.

Table has one or more lines with information (Provider ID, Data Entry date, etc) in the spaces. • If you are starting a new record – Click “Add New Record” before you begin entering data • If you want to view, print, or edit a previous record click “Select” at the end of the row for the record you want. This will display that record. If you make changes, be sure to save/submit when you are finished or your changes will be lost.

WARINING!! If you just begin entering information into the form when there are previous records displayed in the table you will overwrite the information entered on the last record and that information will be lost!! Remember that records can be modified even after they are in Submit status.

Enter either your full 9-digitProvider ID without the letter, or part of your agency/personal name without spaces (i.e. “horizon” instead of “horizon house”) and click “Search” then select your agency (or name, for LBHP’s) from the drop down list. Fields with Red Type (like the Provider Agency) must be completed for your request to save or submit. Other fields NOT in red type may be required for authorization purposes. If you are not sure what is required for your requests refer to the Provider Manual available on the OKHCA website www.okhca.org

FYI on Searching In ProviderConnect: If you search in any field by name rather than number (provider name, diagnosis description name, etc) the drop down may appear to be blank due to multiple results being found. If this happens just click the drop down box and you should see a list of choices. You can fill in the field by clicking the choice you want. Even if there is only one option listed in the drop down list you MUST click on it and then hit “Tab” on your keyboard to make sure the system recognizes the information. A FIELD WITH A DROP DOWN IS NOT COMPLETE UNTIL SOMETHING IS SELECTED IN THE DROP DOWN LIST. JUST HAVING INFORMATION TYPED IN THE SEARCH BOX WILL RESULT IN A ERROR THAT THE REQUIRED FIELD IS NOT COMPLETED!

Should always be answered “Yes” If you answer “Yes” to “Is the client receiving services from another agency” you must answer the next question “Do you have a Letter of Collaboration.” Your request will submit even if you answer this question “No” or “Unknown”

Authorization Type indicates if this is a Prior Auth or Courtesy Review, and if it is an Initial, Extension, Modification, or Correction Request. You don’t need to change these. Just leave the default info. You can manually enter a date as well as using the “Today” button. Date format should be mm/dd/yy. Diagnosis search is built in. You can search by a word in the description Or by the diagnostic code. You can even search by a partial code (EX: 296 to find an exact mood disorder diagnosis). Please note you must type the “dot” in a 5 digit code Both ICD-9 Primary and Axis I Diagnosis Primary are required fields. If you only have one diagnosis you can enter it for both. You must also enter a Primary Axis II diagnosis. Axis II can be Deferred (799.9) or None (v71.09)

Axis III is an open field – you do not need to provide ICD-9 codes for medical disorders. You must enter something in the field – “None” is acceptable You must select something from the drop down for every psychosocial stressor. As these fields default to blank you will need to select “01-None” if the client does not have difficulty in that area.

GAF: Current and Highest in Past Year are both presented in drop down screens. Select the correct score. GAF score of zero is only acceptable on Initial requests (current & past for LBHP’s, past score ONLY for all others)

Historical and Current sections are not required. Your reviewer will not see information entered here. Required for Acute, RTC, CBT, and Crisis Unit requests Interpretive Summary is a required field for saving/submitting but not all requests require current clinical information. If your request does not require clinical information in the Interpretive Summary then type “N/A” in this field.

Interpretive Summary The Interpretive Summary must include the current, critical clinical information in behaviorally descriptive terms to support the need for services or continued services. • OP Agencies – REQUIRED for Initial, Extension, and Modification requests. NOT REQUIRED for Correction requests. • LBHP’s – NOT REQUIRED for most Initial requests or for Correction requests. REQUIRED for all Extension requests and some Initial requests (children in Therapeutic Foster Care, under age 3, etc). • IP Facilities (including TFC) – Not required. Current clinical information supporting the need for services should be documented in your template. As the request won’t submit without something in the Interpretive Summary area you can type “None” or “See Template”

Click “Add New Record” to open the fields for data.

Different fields will open depending on what Review Type you are submitting. Any fields with red type that are open for data entry are required for your request to save or submit.Note to Reviewer is not a required field.

Notes to the Reviewer about Letters of Termination, Collaboration, etc can be entered in the “Provider Notes to Reviewer” area. If you are requesting multiple services you only need to type the note once.If you submit by EDI these notes should go at the top of the Interpretive Summary in all caps.

Do NOT click “Add New Record” again unless you want to request more than one service. Clicking this again will populate a blank line in the Services Requested table, and you will get an error that required information is not provided. If you are requesting more than one service click “Add New Record” to move the current information into the table and open the fields to include the additional service. When you get to the last service you want to request leave it in the drop down box area – do not click “Add New Record” again.

Blank line created by clicking “Add New Record” when a second service isn’t being requested. This will create an error message.

CAR, ASI, & T-ASI scores are in drop downs. You can either click the arrow to open the drop down then click the score you want…

…OR use the keyboard by tabbing to the drop down then clicking the first digit of the number you want repeatedly to populate the number (Ex: for “25” you would hit “2” – after 6 taps the number displayed will be “25”). You will know which field is selected because it will be highlighted in gray.

REMEMBER • Outpatient providers only need to complete either the CAR or the ASI/T-ASI, depending on request type. You do not have to do both. Scores are not required for Correction requests. • LBHP’s do not have to provide assessed CAR scores on most initial requests and can use “99” for unknown. Current, accurate assessed CAR scores are required on all Extension requests for LBHP’s • Inpatient providers – Acute, RTC, CBT, Crisis Units, and TFC – do NOT do the CAR or ASI/T-ASI

Remember that CAR descriptors are not required. Do not put “See CAR” in the Interpretive Summary - your reviewer will not see information you enter here.

Communication is not required on all requests. See the Provider Manual for information on when this should be used.

Required for OP Agency Initial, Extension, and Modification requests. “Add New Record” opens fields for data. Just like on the Services Requested, don’t hit this button again after you enter the last data you want on the request.

Need/Skill area drop down – if you don’t see what you want to work on select “Other” and type in the form field box below the drop down.

Information moves to the table as it is being entered

After you hit “Add New Record” (to put in another goal/objective area) OR save the request all the information entered in the service plan fields will move up the table as shown below If you have a blank line in the table after entering all your goal/objective information you will need to delete it to prevent an error when you try to save/submit.

Use the “Transaction Status” Drop Down to tell the program whether you want to Save or Submit your record, then click “Create Record/Save Changes” to complete the step. The record will not be sent for processing as long as the Transaction Status is set to “Save”. A “Transaction Status Date” is not required.

Error Message Box for Missing Fields You will not be able to do anything else with your record until you acknowledge you have seen this information box by clicking “OK.” On submitting your record this will include the error message “Overlapping Dates” if the client already has a PA with another agency or with your agency. The error message generated will depend on what fields are missing – it will not always show all the fields like in this example. To proceed, click “OK” then complete the fields the error message indicated were needed.

IMPORTANT! PLEASE NOTE! • IF YOU GET THE ERROR MESSAGE BOX WHEN TRYING TO SAVE YOUR RECORD YOUR INFORMATION WILL NOT SAVE UNLESS YOU COMPLETE THE MISSING FIELDS AND RESAVE!!! ALL REQUIRED (RED TYPE) FIELDS MUST BE COMPLETED FOR THE REQUEST TO SAVE. DO NOT LEAVE THE PAGE UNTIL ALL THESE FIELDS HAVE DATA IN THEM!! • If you need to leave a record before completing it and want to save: Enter one or two characters in each required box or select the first item in each drop down then save. This will allow the record to be saved successfully and you can return to correct/update the information when you have time. Our IT department is working to fix this error in the system, so the work around will be temporary. Please check optumhealthoklahoma.com &/or the news section of ProviderConnect for notices on when this has been corrected.

If there are no missing fields or errors on the record you will see the following screen.Either wait for a minute or click the link on the screen to be returned to the Demographics screen.

ATTACHMENTS You can attach an electronic record that is saved on your computer. These attachments will be visible to your reviewers. Documents you might attach include Letters of Termination or Collaboration (if required), Psych testing results, etc. Using the attachments feature is not required – you can still just document the information in the record if you want.

To attach a document, first click “Browse” – this will bring up a box with the documents saved on your computer in it (usually “My Documents” if you use a PC)

Select the document you want to attach by clicking on it, then click “Open”

This document has been selected for attaching

The document name will appear in the “File Name” box. You can add notes explaining what the document is for, if you want, but it is not required. Then, click “Attach File”Please note that the document won’t show up on the File Attachments table immediately, but should appear there in a very short period of time.

Printing in ProviderConnect Printing is done using the print function in your web browser. In the future, a print option will be added to ProviderConnect to allow direct printing from the program.

Internet Explorer • Go to File – Print Preview • Toolbar • If you don’t see “File” at the top of the web page you may be in Full Screen view or not have the Menu Bar activated. • Click “ESC” on the keyboard (this will take you out of full screen). • If you still don’t see the “File” option then right-click in the toolbar area (right under where you see the website address). If “Menu” isn’t checked in the list that drops down click on it – this will activate the Menu Toolbar that has the “File” option in it. • In the Print Preview screen: • Change the format from “As laid out on screen” to “All frames individually” • **If this box shows page numbers (“1 Page View”) then printing is already set up correctly and you do not need to change anything. • Click the printer icon in the menu bar. The print menu will pop up. • You can then select options to print all the pages, or just print specific pages by entering individual page numbers or page ranges (2, 4 or 1-4) • Click “Print” to send to printer

Google Chrome • Click the wrench icon in the upper right hand corner of the browser, near the address bar, then click “Print” • A new tab will open with the print view of the webpage. • The print view should default to framed (individual page) printing. Page breaks should be visible by scrolling down the print view using the scrollbar on the right. • Printing specific parts of the page can be done by clicking the radio button below “All” under “Pages” in the menu frame on the left hand side of the page and entering individual page numbers or a page range (1 or 1,3 or 2-4) in the box. • Click “Print” to send to printer

ProviderConnect 101