January Authorization Log Guide

Transcription

1 Authorization Log Guide January 2018 Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East, and QCC Insurance Company, and with Highmark Blue Shield independent Page 1 of licensees 17 of the Blue Cross and Blue Shield Association.

2 The Authorization Log through the NaviNet web portal provides a repository of all authorization requests for Independence Blue Cross (Independence) members that are originated through the new Authorizations transaction.* The log offers you the ability to view previously submitted requests including the status. In addition to viewing authorization details, you may create new authorizations, amend authorizations, delete incomplete authorization requests, and view historic authorization details. *As previously communicated, the legacy authorization log for Independence was removed when the new transaction was introduced. Important notes The Authorization Log is not available to billing agencies and third-party administrators. The new Authorization Log will not be available for health plans who have not transitioned to the Open platform. Authorization requests that were originated on the legacy platform will not be included in the new Authorization Log. Authorization requests initiated outside of NaviNet are not available in the Authorization Log. Attestation must be performed to view authorizations in the Authorization Log. If the attestation process is not completed, the Authorization Log is accessible; however, you will not be able to view, create, amend, or delete authorizations. We encourage you to monitor the Authorization Log on a regular basis to assist with managing your requests. Accessing the Authorization Log From the Independence Workflows menu, select Authorization Log from the Authorizations fly-out menu. Authorization Log attestation All NaviNet users are required to attest their supported Billing Entities upon their first time accessing the Authorization Log. Note: By selecting these Billing Entities, you are attesting that you are authorized to access the Protected Health Information for the patients of the entities that you have selected. Page 2 of 17

3 The following steps outline the process for completing the attestation: Step 1: Upon entering the Authorization Log, select the Billing Entities tab to view a list of tax ID numbers tied to the Billing Entities associated with your NaviNet office. Step 2: Review your supported tax ID numbers tied to the Billing Entities using the following steps: Place the cursor over View Addresses, then select to view a list of addresses for a tax ID number. Page 3 of 17

4 Select the in the top right corner when you are done viewing the list of addresses. Select the next to a Billing Entity to view all of the Billable NPIs for the entity. Select the top row for a Billing Entity tax ID number to select all rows for that entity. Select an individual NPI row to select a single row. Check Select All to select all rows for all tax ID numbers tied to the Billing Entities associated with your organization. Page 4 of 17

5 To find a Billing Entity in the list quickly, type the entity s tax ID number in the Search box. Step 3: When you are done selecting the Billing Entities your office supports, read the attestation statement for important information, and then select Save Changes. Note: When you select Save Changes, you are attesting that you are authorized to access the Protected Health Information for the patients of the entities that you have selected. Page 5 of 17

6 Navigating the Authorization Log The Authorization Log screen displays the list of authorizations accessible to you based upon your attestation. The log includes all authorization requests submitted through NaviNet and associated with your organization, regardless if you are the requesting or servicing provider. Authorization Details The Authorization Log displays member name, member ID, health plan name, requested date of service, authorization number, the date of submission, and authorization status. Authorizations captured within the log can display one of the following statuses: Approved. An authorization request has been submitted to the health plan and has been approved. Authorization Not Required. The health plan s response indicates that no authorization is required based on the member and criteria submitted. Cancelled. An authorization request has been submitted to the health plan, but the health plan cancelled it (e.g., duplicate request). Denied. An authorization request has been submitted to the health plan, but it has been denied. Modified. The health plan has updated the status on one or more of the requested services on a previously submitted request. Pending. An authorization request has been submitted to the health plan and is pending determination. Note: Independence authorizations will not be labeled with several statuses used by other health plans, for example the Partially Approved status. To make sure you're viewing the latest status of the authorization, select Refresh Status. Page 6 of 17

7 To view additional details for a specific authorization, hover your mouse over the authorization to reveal the available options, and select the Auth Details button. You will then be redirected to the Authorization Details screen. Page 7 of 17

8 Authorization Log filters To narrow your search, you may use several authorization filters. You may filter authorizations based on member ID, member name, authorization number, servicing provider, date of service, authorization status, and health plan. Click inside any of the offered filter fields to enter your criteria. Page 8 of 17

9 Sorting the Authorization Log You may sort authorizations by date of submission or date of service by clicking inside the Sort by field. Creating a new authorization through the Authorization Log There are two options to create new authorizations in the Authorization Log. Option 1: You may create a new Authorization by selecting the Create New button and then select the desired health plan. Page 9 of 17

10 You will then be redirected to the Patient Search screen of the Authorization Submission transaction. Option 2: You have the ability to initiate a new authorization for a member through their existing authorization. To create a new authorization for a desired member, hover your mouse over their existing authorization, and select Create New. Page 10 of 17

11 You will then be prompted to enter a date of service for the new authorization before you are redirected to the Authorization Submission screen for that member. Follow the same submission steps as outlined in the Authorizations user guide. Amending an Authorization You have the ability to amend existing authorizations through the Authorization Log. At this time, amendment requests are restricted to authorizations that originated through the new NaviNet transaction. If the authorization was submitted through the legacy NaviNet transaction or calling our Care Management team, you will not be able to submit the amendment request through NaviNet. Note: Only the ADD functionality will be available at the time of the initial release. AMEND and EXTEND features will be introduced at a later time. Submission of an amendment request to extend the service end date of existing approved service lines is permitted for outpatient services in an Approved or Modified status. The service end date cannot be extended more than one time for five days. Page 11 of 17

12 The following Service Types can be amended by extending the service end date: Ambulance (Land) Chemotherapy Infusion Therapy Durable Medical Equipment (rental only) Home Health Home Infusion You can add a new service line in the following situations: the existing authorization is in a Pending, Approved, or Modified status; services are in an outpatient, office, or home setting; you are adding a NEW service to an existing authorization; you are requesting more Visits/Days/Units for an existing service for a newly defined time period. Only the following Service Types allow the ADD capability: Ambulance (Land) Chemotherapy Infusion Therapy Durable Medical Equipment Purchase and Rental Home Health Home Infusion To initiate an amendment request from the Authorizations Search Results screen, hover your mouse over the specific authorization and click the Amend link. Page 12 of 17

13 You will then be redirected to the Amend Authorization screen. To initiate an amendment request from the Authorization Details screen, click the Amend link at the top of the screen above the status bar. Adding a New Service At the bottom of the screen you can add a new service line by selecting the button. Page 13 of 17

14 The following screen is returned and you will be prompted to enter details of the new service including: a. from date b. procedure code c. units d. visit/dates e. When complete, select Save. Your new service line will appear. Additional service lines can be added as needed. Extending a Service To submit a request to amend the service end date, hover your mouse over the service line to reveal the Amend Dates option, then select Amend Dates. Page 14 of 17

15 Enter the new service end date in the field labeled To. When complete, select Save. When you have finished adding new services or amending service end dates, select Submit to send your changes to the health plan. Authorization history The authorization history is available in the Authorization Log. History details include the name of the individual responsible for submitting or modifying the request. To obtain the history of an authorization, hover your mouse over the desired authorization and select the History button. Page 15 of 17

16 A new window will appear displaying historic details regarding the individuals associated with the processing of the authorization request. Refreshing an authorization You have the ability to refresh an individual authorization through the Authorization Log. To refresh an authorization, hover your mouse over the desired authorization and select the Refresh Status button. Page 16 of 17

17 Continue an authorization You have the ability to edit authorizations that have been saved but have not been submitted to the health plan. These authorizations appear with an Incomplete status. To continue an authorization, hover your mouse over the desired authorization and select the Continue button. Delete an authorization You can delete authorization records you no longer need or do not want to submit. You are prompted to confirm the action before a record is deleted. You cannot delete authorizations that have already been submitted to the health plan for processing. To delete an authorization, hover your mouse over the desired authorization, and select the Delete button. If you have any questions about the Authorization Log, please call our ebusiness Hotline at NaviNet is a registered trademark of NaviNet, Inc., an independent company. Page 17 of 17