Prior Authorization Submission Dell Personal Computer SX260 NVPA User Manual

User Manual: Dell Personal Computer SX260

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Prior Authorization Submission

Updated June 2014
©2014 Hewlett-Packard Development Company, L.P.
The information contained herein is subject to change without notice

2014 Prior Authorization Submission

Topics
• Submitting a prior authorization using the HP Enterprise
Services (HPES) Provider Web Portal
• Where to go to submit a prior authorization request
• Logging in to the Provider Web Portal
• How to check recipient eligibility
• How to create/submit a request for authorization of
services
• How to submit additional information
• How to view the status of an authorization
• How to search for authorizations
• How to copy an authorization
• Downloadable forms
• Submitting a prior authorization via FAX, Mail, Phone
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2014 Prior Authorization Submission

Where to go to submit a prior authorization request
http://www.medicaid.nv.gov
Select “Prior Authorization” and then “PA Login”

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2014 Prior Authorization Submission

Logging in to the Provider Web Portal
Logging in requires three steps
1. Login ID
2. Verification of identity via security question
3. Password (users must select a site key)

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2014 Prior Authorization Submission

Challenge Question

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2014 Prior Authorization Submission

Site Key and Passphrase

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2014 Prior Authorization Submission

Welcome Screen
• You will be taken to the Welcome Screen/My Home page
where you can verify all provider information on the left
margin of the screen.
• It is important to verify all of the information to ensure that
you are logged in correctly.
• On this page you will find important broadcast messages
from the Division of Health Care Financing and Policy.
• You will also find a section for provider services.
• This page features links to contacts via telephone and secure
email.
NOTE: The top of this page features a tabbed menu bar.
This is the navigation tool for use within the portal.
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2014 Prior Authorization Submission

Welcome Screen

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2014 Prior Authorization Submission

Navigation Bar
The Navigation Bar contains 5 different tabs that allow you to move throughout the portal

• My Home - Provider information, contact information,
messages
• Eligibility - Search recipient eligibility information
• Claims - Search claims and payment history

• Care Management - Create authorizations, view
authorization status and maintain favorite providers
• Resources - Downloadable forms and documents
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2014 Prior Authorization Submission

Navigation Bar
Eligibility

Search for recipient eligibility using one of the
following required criteria:
• Recipient ID and Effective Date or
• Social Security Number, Birth Date and Effective
Date or
• Last Name, First Name, Birth Date and Effective
Date
Results returned include:
• Effective date
• End date
• Coverage type
• Service Type Codes
• Primary care provider
• Ability to view additional coverage information
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2014 Prior Authorization Submission

Eligibility Tab

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2014 Prior Authorization Submission

Recipient Information Entry

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Individual Recipient Information

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2014 Prior Authorization Submission

Member Focused Viewing

Helpful Hint: You can
locate the member first
from the welcome screen
and that will pre-populate
the date automatically
when you select Submit an
Authorization.

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2014 Prior Authorization Submission

Navigation Bar
Care Management
Create authorization
• Create authorizations for eligible recipients
View authorization status
• Prospective authorizations identifying you as the requesting or
servicing provider are listed
Maintain favorite providers
• Allows a provider and their delegates to create a list of
frequently used providers
• The providers on the list will be available for selection as the
facility or servicing provider when you are creating an
authorization
• A provider and their delegates may have up to 20
providers on their favorites list
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2014 Prior Authorization Submission

Care Management Tab

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Create Authorization
Step 1

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2014 Prior Authorization Submission

Create Authorization
The following fields are required:
Personal Information
•
•
•
•

Recipient ID
Last name
First name
Date of birth (DOB)

Authorization Type
•
•
•

•

•

•

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2014 Prior Authorization Submission

M/S Inpatient
 Medical Surgical inpatient PA requests
M/S Outpatient
 Medical Surgical outpatient or lab PA requests
BH Inpatient/RTC/PHP/IOP
 Behavioral Health inpatient, residential treatment
center, partial hospitalization and intensive
outpatient PA requests
BH Outpatient
 Behavior Health outpatient and rehabilitation PA
requests
Home Health
 Home Health and Private Duty Nursing PA
requests
DME
 Durable Medical Equipment, ocular and
audiology PA requests

Create Authorization
Step 1

Enter the recipient information or use Member Focused Viewing to
auto-populate the recipient information on the screen.
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2014 Prior Authorization Submission

Inpatient Authorizations
Required fields are based on the Authorization Type selected in the
previous section.
The M/S Inpatient and BH Inpatient/RTC/PHP/IOP authorization
provider required fields (*) are: Facility ID, ID Type and Facility Type.

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2014 Prior Authorization Submission

M/S Outpatient/Lab and BH Outpatient
Authorizations
Required fields are based on the Authorization Type selected in the
previous section.
The M/S Outpatient/Lab and BH Outpatient authorization type
provider required fields (*) are: Provider ID, Service Type, ID Type.

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2014 Prior Authorization Submission

Home Health Authorization
Required fields are based on the Authorization Type selected in the
previous section.
The Home Health authorization type provider required fields (*) are:
Provider ID, Service Type, ID Type.

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2014 Prior Authorization Submission

DME Authorization
Required fields are based on the Authorization Type selected in the
previous section.
The DME authorization type provider required fields (*) are:
Provider ID, Service Type, ID Type.

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2014 Prior Authorization Submission

Create Authorization
Step 2
When you first arrive on the next page, Step 1 is collapsed. This
section contains all previously entered information from the last
screen.
• To expand and view this information, click on the (–) button on
the right hand side of the screen to expand the screen.
Collapsed fields include:
• Requesting provider information
• Member information and authorization type
• Servicing provider information
Expanded information cannot be modified.
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2014 Prior Authorization Submission

Create Authorization
Step 2

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2014 Prior Authorization Submission

Create Authorization
Step 2
• The type of authorization selected in step 1 drives the fields
present in step 2.
• All authorizations will require a diagnosis (enter without
decimals).

• All authorizations allow for attachment of documents.
• Diagnosis can be entered up to 5 digits.
• Diagnosis, CPT, HCPCS and ICD-9 surgical codes are
searchable.
• Enter the first three letters or the first three numbers of the
code.

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2014 Prior Authorization Submission

Create Authorization

Step 2

Diagnosis information
• Please note that the first diagnosis entered is considered to be the
principal or primary diagnosis code.
• Portal allows for up to 9 diagnosis codes.
• This is a required field (*).
• Click “Add” button to add each diagnosis code.
• Currently, only ICD-9 diagnosis type is accepted (Web
announcements at www.medicaid.nv.gov will provide information
regarding the implementation of ICD-10 codes)

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2014 Prior Authorization Submission

Create Authorization – M/S Inpatient and
BH Inpatient/RTC/PHP/IOP
Step 2

M/S Inpatient and BH Inpatient/RTC/PHP/IOP authorizations
• M/S Inpatient and BH Inpatient/RTC/PHP/IOP authorizations
can now have up to 27 lines
o Line limit includes the bed information lines and surgical
procedure lines. The total lines can’t exceed 27 lines.
• Diagnosis
• Bed information
o From date
o Number of days
• Revenue code – searchable using the first characters of the code or part
of the description of the code
• Medical justification
• Procedures
o ICD-9 surgical codes – searchable using the first three characters of
the code or part of the description of the code
o ICD-10 type is not currently accepted
• Attachments
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2014 Prior Authorization Submission

Create Authorization – M/S Inpatient and
BH Inpatient/RTC/PHP/IOP
Step 2

* Required Fields
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2014 Prior Authorization Submission

Create Authorization – M/S Inpatient and
BH Inpatient/RTC/PHP/IOP

* Required Fields
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2014 Prior Authorization Submission

M/S Inpatient and
BH Inpatient/RTC/PHP/IOP Authorizations
Attention Provider Types 11, 13, 56, 63 and 75:
Instruction for Concurrent Review PAs That Are Greater Than 27 Lines

• For hospital inpatient concurrent reviews that are greater than 27
lines: If a concurrent review PA requires more than 27 lines,
beginning at what would be line 28, please start a new PA with
the next day’s date following the “through” date from line 27.
• For example:
– Line 27:
1/1 to 1/4
– Line 28 of new PA:
1/5
• This change is only for PAs more than 27 lines, and for the first
line of the new PA.
• Please remember that only one (1) PA is allowed per claim. If you
have more than one PA, please split bill the claim if it is for one
continuous stay.
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2014 Prior Authorization Submission

Create Authorization – M/S Outpatient/Lab,
BH Outpatient, Home Health, DME
Step 2

• M/S Outpatient/Lab, BH Outpatient, Home Health and DME
authorizations can have up to 27 service lines
• Diagnosis
• Service details
• From date
• Code type – CPT/HCPCS, ICD-9 surgical code –
searchable using the first 3 characters of the code
• Modifiers
• Units
• Medical justification
• Attachments

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2014 Prior Authorization Submission

Create Authorization – M/S Outpatient/Lab,
BH Outpatient, Home Health, DME
Step 2

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2014 Prior Authorization Submission

* Required Fields

Create Authorization – M/S Outpatient/Lab,
BH Outpatient, Home Health, DME
Step 2

* Required Fields
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2014 Prior Authorization Submission

Create Authorization – M/S Outpatient/Lab,
BH Outpatient, Home Health, DME
Step 2

* Required Fields
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2014 Prior Authorization Submission

Attachments
• Add one Service (Details or Bed Information) before an
attachment, then include additional Service entries
• To include attachments electronically with a prior authorization
request, enter the following information:
• Transmission Method EL- Electronically Only
• Upload File – click browse button and locate file to be
attached and click to attach
• Attachment type – select from the drop-down box the type of
attachment being sent
• Select the ADD button to attach your file
• Repeat for additional attachments if needed (Note: the
combined size of all attachments cannot exceed 4 MB)
• Once attachments are added, a control number will be visible
• Option to remove if you attached incorrectly
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2014 Prior Authorization Submission

Attachments

* Required Fields
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2014 Prior Authorization Submission

Service Details – Unsaved Data Warning
For new a prior authorization request when at least one service line
has been entered and there is another service line added but not
saved by clicking the “Add” button before clicking the “Submit”
button, then the following error message will be displayed:

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2014 Prior Authorization Submission

Service Details – Unsaved Data Warning
For a new or resubmitted prior authorization request when at least
one service line has been entered and there is another service line
added but not saved by clicking the “Add” button before clicking
the “Submit” button, then the following error message will be
displayed:

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2014 Prior Authorization Submission

Summary
Step 1
• Enter recipient information
• Select authorization type
• Enter provider information
Step 2
• Enter diagnosis information
• Enter service details
• Add attachments
Select

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2014 Prior Authorization Submission

Finalizing Authorization
Review all information for accuracy

• Return to step 2 if errors are present
• Use

if necessary

All steps of the authorization are visible
• Use the plus/minus buttons or the
All service details are visible
• Use the plus/minus buttons
Select

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to send your authorization.

2014 Prior Authorization Submission

Finalizing Authorization

Confirming your submission

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Confirmation Page
Authorization tracking number
• Number used to track your authorization in the portal
Print preview
• Opens new window with all of the authorization information
viewable
• Printable page with date and time stamp
Copy
• Copy member data or authorization data to a new authorization
New
• Create a new authorization for a different member

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2014 Prior Authorization Submission

Authorization Tracking Number

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2014 Prior Authorization Submission

Copying an Authorization
The ability to copy an authorization, by recipient or service, is
available on the authorization receipt screen, after successfully
submitting an authorization.
Copy authorizations by member
• You can copy an authorization for an existing recipient when
requesting a new service.
• Only the member data is copied for the copy request.
Copy authorizations by service
• You can copy an authorization by service, so a specialist can
submit authorizations for similar services but for a different
recipient.
• The entire auth data is copied with the exception of the
recipient data and the attachments section.
• The ability to copy an auth, by recipient or service, is available
on the authorization receipt screen, after successfully submitting
an authorization.
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2014 Prior Authorization Submission

Copying an Authorization

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2014 Prior Authorization Submission

Copying an Authorization
Select authorization data
Select

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2014 Prior Authorization Submission

Copying an Authorization
Step 1:
• Enter member data
• Select continue
Step 2:
• Review all pre-populated data
• Add attachments
• Select submit
Review all information
Select
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2014 Prior Authorization Submission

Copying an Authorization
Select member data
Select

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2014 Prior Authorization Submission

Copying an Authorization
Step 1:
• Review pre-populated member data
• Select authorization type
• Enter facility/provider information
• Click continue
Step 2:
• Enter all required data
• Click submit
Review all information
Select

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2014 Prior Authorization Submission

Navigation Bar

Care Management: view authorization status
• Click on the “Care Management” tab
• Click “View Status of Authorizations”

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2014 Prior Authorization Submission

View Authorization Status
Prospective authorizations identifying you as the requesting or
servicing provider are listed. These results include the first (20)
authorizations with a beginning services date of today or greater.
Search results may contain dental authorizations, which cannot be
created through the Provider Portal, but are available for inquiry.
Click the “Authorization Tracking Number” to view the authorization
response details:
• A snapshot of the authorization is displayed
• Click on “View Original Request”
• A new window opens with printable authorization
“Back to View Authorization Status” goes back to authorization
summary.

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2014 Prior Authorization Submission

View Authorization Status
• Click on “Authorization Tracking Number” to view
• Sort columns by clicking on column heading
• NOTE: Since detail statuses may be different, the “Decision” may not
reflect the decision for each line. Be sure to click on the
authorization tracking number to view individual service
line statuses.

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2014 Prior Authorization Submission

View Authorization

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2014 Prior Authorization Submission

Print Authorization

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2014 Prior Authorization Submission

Navigation Bar
Care management: searching for an authorization
• Click on the “Care Management” tab
• Click “View Status of Authorization”

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2014 Prior Authorization Submission

Search for an Authorization
Click on the “Search Options” tab in the view authorization status box

Enter any of the following sets of information into the search box:
1. Authorization information
– Authorization tracking number (if you have the authorization tracking number
you will not need to enter any other information to perform the search)
– Authorization type - select from the drop-down box
– Enter a date range - select from the drop-down box or
– Enter the service date - select from the drop-down box

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2014 Prior Authorization Submission

Search for an Authorization
2. Member information
• Recipient ID
• Birth date
• Last name
• First name
3. Provider information
• Enter the following information
• ID Type - select from the drop-down box
• Click on the box that identifies whether you are the servicing or
referring provider on the authorization
Select

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2014 Prior Authorization Submission

Search Options

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2014 Prior Authorization Submission

Searching for an Authorization
Results returned will appear at the bottom of the search box:
• Click on “Authorization Tracking Number” to view the authorization
• Columns can be sorted by clicking on the column headers
Select

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2014 Prior Authorization Submission

to clear the search and start over

Searching for an Authorization
• Search Results will be listed on the lower section of the search page.
• From this screen you can click on a tracking number to be taken to
the detail of that authorization.

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Navigation Bar
Resources

• Click on the “Resources” tab in the Navigation Bar
• Brings you to the resources page
• Click on downloads

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2014 Prior Authorization Submission

Downloads
This tutorial is available from:
1. The Downloads page

2. The Provider Training page at www.medicaid.nv.gov
3. The Prior Authorization PA Tutorials page at
www.medicaid.nv.gov
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2014 Prior Authorization Submission

Downloadable forms
Use these forms that are available on the Providers Forms page at
www.medicaid.nv.gov when requesting a prior authorization:

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Downloadable Forms Continued…
Downloadable
forms

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2014 Prior Authorization Submission

Fax/Mail/Phone
Submission of
Authorization

Prior Authorization
Submission

Submitting additional information
Additional information including:
• Forms that were not submitted with original authorization
• Notes
• Medical justification
Fax to:

HPES Prior Authorization department
Each form lists the correct fax number to use

*Note: Include the original PA tracking number on all additional correspondence

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2014 Prior Authorization Submission

Faxing Authorization Requests
Requests may be faxed to HPES as indicated:
Dental: 855-709-6848
PASRR: 855-709-6847
PCS: 855-709-6846
All Other: 866-480-9903

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2014 Prior Authorization Submission

Mailing Authorization Requests
Dental and Personal Care Aid (PCA) Requests:
HPES
Attention: “Dental PA” or “PCA PA”
PO BOX 30042
Reno, NV 89520-3042
All Other Services (except Pharmacy):
HPES
Attention: Nevada Medicaid Prior Authorization
6511 SE Forbes Ave., Bldg 283
Topeka, KS 66619-0287

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2014 Prior Authorization Submission

Phone Requests for Authorization
Calls are accepted at our Customer Service Center
Monday – Friday 8:00 a.m. – 5:00 p.m. Pacific Time
Prior Authorization
1-800-525-2395

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2014 Prior Authorization Submission

Thank you for attending today’s session.
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Title                           : Prior Authorization Submission
Author                          : Munguia, Michelle
Create Date                     : 2014:06:23 14:35:59-07:00
Modify Date                     : 2014:06:23 14:35:59-07:00
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