Prior Authorization Submission Dell Personal Computer SX260 NVPA User Manual

User Manual: Dell Personal Computer SX260

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Prior Authorization Submission
©2014 Hewlett-Packard Development Company, L.P.
The information contained herein is subject to change without notice
2014 Prior Authorization Submission
Updated June 2014
Topics
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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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Where to go to submit a prior authorization request
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http://www.medicaid.nv.gov
Select “Prior Authorizationand then “PA Login
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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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Challenge Question
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Site Key and Passphrase
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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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Welcome Screen
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The Navigation Bar contains 5 different tabs that allow you to move throughout the portal
Navigation Bar
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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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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
Navigation Bar
Eligibility
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Eligibility Tab
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Recipient Information Entry
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Individual Recipient Information
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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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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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Care Management Tab
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Create Authorization
Step 1
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Create Authorization
The following fields are required:
Personal Information
Recipient ID
Last name
First name
Date of birth (DOB)
Authorization Type
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
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Create Authorization
Step 1
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Enter the recipient information or use Member Focused Viewing to
auto-populate the recipient information on the screen.
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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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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.
M/S Outpatient/Lab and BH Outpatient
Authorizations
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Home Health Authorization
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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.
DME Authorization
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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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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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Create Authorization
Step 2
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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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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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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
oLine limit includes the bed information lines and surgical
procedure lines. The total lines can’t exceed 27 lines.
Diagnosis
Bed information
oFrom date
oNumber of days
Revenue code searchable using the first characters of the code or part
of the description of the code
Medical justification
Procedures
oICD-9 surgical codes searchable using the first three characters of
the code or part of the description of the code
oICD-10 type is not currently accepted
Attachments
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Create Authorization M/S Inpatient and
BH Inpatient/RTC/PHP/IOP
Step 2
* Required Fields
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Create Authorization M/S Inpatient and
BH Inpatient/RTC/PHP/IOP
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* Required Fields
Attention Provider Types 11, 13, 56, 63 and 75:
Instruction for Concurrent Review PAs That Are Greater Than 27 Lines
M/S Inpatient and
BH Inpatient/RTC/PHP/IOP Authorizations
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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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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Step 2
Create Authorization M/S Outpatient/Lab,
BH Outpatient, Home Health, DME
* Required Fields
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Create Authorization M/S Outpatient/Lab,
BH Outpatient, Home Health, DME
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Step 2
* Required Fields
Create Authorization M/S Outpatient/Lab,
BH Outpatient, Home Health, DME
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Step 2
* Required Fields
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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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Attachments
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* Required Fields
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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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 “Submitbutton, then the following error message will be
displayed:
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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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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 to send your authorization.
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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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Authorization Tracking Number
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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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Copying an Authorization
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Copying an Authorization
Select authorization data
Select
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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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Copying an Authorization
Select member data
Select
Copying an Authorization
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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
Navigation Bar
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Care Management: view authorization status
Click on the “Care Management” tab
Click “View Status of Authorizations
View Authorization Status
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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.
View Authorization Status
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Click on Authorization Tracking Number” to view
Sort columns by clicking on column heading
NOTE: Since detail statuses may be different, the “Decisionmay not
reflect the decision for each line. Be sure to click on the
authorization tracking number to view individual service
line statuses.
View Authorization
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Print Authorization
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Navigation Bar
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Care management: searching for an authorization
Click on the “Care Management” tab
Click “View Status of Authorization
Search for an Authorization
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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
Search for an Authorization
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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
Search Options
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Searching for an Authorization
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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 to clear the search and start over
Searching for an Authorization
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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.
Navigation Bar
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Resources
Click on the “Resources” tab in the Navigation Bar
Brings you to the resources page
Click on downloads
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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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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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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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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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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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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Thank you for attending today’s session.

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