Provider Web-Portal User Manual
Contents
1. 08 31 2009 and we would like the search result sorted in ascending order by request date _ Search By Member Name X e Search For Member Status All v Requesting Referred Provider es M Provider e Request Date From 08 01 2009 EES To 08 31 2009 IPA All v Health Plan All Sort By Request Date vj fo Descending Order e Find Member New Request In Ascending Order Search Result Request Request Track Health S A X Open Standard 45823 8 3 2009 98765432A UCMM CCHP ae dag i uu S X Accept Standard 45825 8 5 2009 162011 EE 98765432A MM CCHP SE Silver Alan M D sn X Reject Standard 45826 8 6 2009 98765432A MM CCHP Silver Alan SR SH M 3 Authorization Requests match your search criteria ee Ai of l gt gt 3 Notice in the search result list there is a Status column to indicate the current status of your request For further information or to edit your request click on the pencil icon to open the record If your request has a Reject status and you would like to see the reject reason open the record and scroll to the bottom of the record If your request has an Accept status and you would like to view the Authorization Record associated with your request you can do an authorization search for the Track from your request The authorization request Track is the same and the Auth which uniquely identifies an authorization record Note An Accepted request does2. X Accept Standard 45825 8 5 2009 162011 ee 987654324 MM CCHP er Silver Alan M D X Open Standard 45823 8 3 2009 re 987654324 UCMM CCHP Silver Alan Basta e Si 3 Authorization Requests match your search criteria 1 Authorization Sub Tab Sub Tabs are additional screens modules that relate to the current screen module This sub tab will navigate you to the Authorization Screen 2 Search By Search criteria drop down will list the available options for finding a submitted authorization request record Note that for all options except ALL a search string is required in the Search For field The available options are ALL Unfiltered and will return all available results Member Name will look for records for the indicated search for string Write In Specialist will look for request where the Write In Refer To Provider matches the search for string Write In Facility will look for request where the Write In Refer To Facility matches the search for string 3 Search For free text field for search string associated with the Search By criteria 4 Status Filter indicating the status of the request being searched The available statuses are ALL Unfiltered and will return all available results Open this status indicates that the authorization request has been created and is currently in queue for UM review Accepted this is an acknowledgment status indicating that the authorization request has been pulle
3. return a result oe Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices And For Free text field for search string associated with the And By criteria IPA Search filter that limits the results to the selected IPA only HP Search filter that limits the results to the selected Health Plan only Search Button Click this button to refresh the search result list Search Result List List of result from previous search Each line is considered one unique record To view details about any individual record click on the Member Name 10 Page Scroll Click on the double arrows to scroll to additional pages oe SS KA Checking Member Eligibility To check member eligibility please follow the below steps Please understand that MaxiMedIPA receives member eligibility information from the Health Plans on behalf of the IPA Medical Groups on a regular basis in the form of a batched electronic file Therefore eligibility data displayed is not considered to be real time data If you question the validity of any information displayed please inform us immediately and verify with the member s health plan 2 Search for the member for with you would like to check eligibility and Open the record Example A Select Last Name from the Search By drop down B Type Member1 in to the Search For field C Click on the Search button D Click on the
4. By On 08 05 2009 eUpdate Reason Additional Information I planarian btema This will bring up a printer friendly authorization request summary window 3 Click on the Print button to print 4 After printing is complete click on the Close button to close the window and return to the previous screen Authorization Request Preview Member Member1 Test PCP IPA Name Health Plan Silver Alan M D MaxiMed Honored Citizens Choice Health Plan fedicare Age Effective Date Terminated Date 69 12 01 2008 close Print Authorization Request Open Request From Silver Alan M D Request ID Request Date Med Record Type Retro DOS LMP Refer To Specialist Write in Refer To Specialist Phone Ext Specialty Sitver Alan M D internal Medicine OR M Place Of Service Facility Write in Facility Phone Ext Office 11 Ea o RE OE ee Diagnosis 1 Diagnosis 2 CUSHINGS SYNDROME Diagnosis 3 Diagnosis 4 ETT Rule Out DQ SS Request Notes a LJ Requested Procedures i Procedure Description noad Mod g t Qty 99213 OFC OUTPT VISIT E amp M EST LOW MOD SEVERITY 15 MIN Notes D ER Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices Authorization Request Screen Field Description Home gt Auth Request button gt New Request button gt S
5. Member Name in the search result list to open the member record SS ee a mem eg een eHealthCare Systems Inc 5 Member Search Login User test SS e Search Members iN IPA Auth Ir Search By Last Name vy search For C ein 1 Sall and By andre Dd AE Search Result Care Coordination 1 Member D CIN HP ID SSN IPA HP PlanCode PCP Eff Date PCP Term Date Memberi Test 123456 123456 123 45 6789 01 01 1940 UCMM HN Medicare HS2T8 7 11 2009 1111 W 6 1 member matches your search criteria ge a of l gt gt 3 Scroll down to the Member Current Coverage Information section of the Member record The member is eligible with the Health Plan for dates of service within the Eff Date and the Term Date If the Term Date Field is blank then the member is currently eligible with the Health Plan Member Current Coverage Information Member Current Cap Statistics Claim Count By PCP IPA Name Health Plan Plan Code First PCP Visit Last PCP Visit Current Universal Care Maxi Med Health Net Medicare HS2T8 01 28 2009 01 28 2009 3 PCP Eff Date Term Date PCP Eff Date Group Last CAP Paid Last CAP Amt Life Time Silver Alan M D 07 11 2009 07 30 2009 07 11 2009 07 28 2009 1 20 3 Medicare ID Medi Cal Medicaid History Of all Claims Paid 1111111714 Billed Paid 2 4 00 CIN ID Aid Code Current Year 12 200 00 2 123456 Life Time 12 200 00 24 00 Accountable Health Care IPA Provider Web P
6. New 0 Messages match your search criteria zg of l gt gt 1 Search By Search criteria drop down will list the available options for finding a message Note that for all options except ALL a search string is required in the Search For field The available options are ALL unfiltered and will return all available results Subject will look for messages with subjects containing the indicated search for string Content will look for messages with body content containing the indicated search for string 2 Search For Free text field for search string associated with the Search By criteria 3 Status Filter indicating the status of the message being searched The available statuses are ALL unfiltered and will return all available results Received this status indicates that the message has been received but has not been read aka unread messages Read this status indicates that the message has been received and read Replied this status indicates that the message has been replied to Forwarded this status indicates that the message has been forwarded 4 Within Filter limiting the result by time Click on one of the radial buttons to chose one of the following options All unfiltered and will return all available results Past prior days weeks or month s messages Enter only integer value 5 Category Filter search result by category assigned to the message 6 Provider Filter search re
7. Offices Leaving a non required field blank null indicates unrestricted If the field is used as a search filter then leaving it blank means the filter will not apply to the search _ When checkboxes are present a check inside the box indicates that the record on the same horizontal line is selected and vice versa Registered Users Username a my ID on this computer Secured by thawte 2009 07 31 1 Connect tO http webportal ahcipa com Note you will automatically be re directed to a secure website 2 Enter your assigned Username amp Password 3 Click Login Logging Out 1 Make sure that you save your work and click the Logout button Note The system will automatically log you out after several idle minutes Search By All Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices Home Screen The Home Screen is the first screen you see after logging in From here you are able to see any new messages you have received since you last logged on You are also able to jump directly into data entry screens by clicking on one of the available Request buttons Home Screen Field Description HEALTHCAR 1 f Members Authorizations Y os Cams Y Messages 1 H P Bme Oriz 2009 Ta OB oa2009 LES OLS Auth Ref Type 1 Screen Module Tabs by clicking on the Tabs you bring up the different screens modules for which you
8. Quick Navigation Buttons these self descriptive buttons will take you directly to search or data entry screens 4 Member Record Info This is information about the selected member from the member record These fields are read only 5 Authorization Request This will field shows the current status of the loaded authorization It is blank when the authorization is new and has not been saved This is a read only field 6 Request From The provider originating the authorization request Clicking on the drop down list will list all available options 7 Request ID The authorization request record ID This is system generate once the record is saved 8 Request Date The date that the authorization request was made This date may be different from the data entry and save date This is the date evaluated when searching for authorization requests 9 Med Record This is a free text reference field intended for the medical record number 10 Type This indicates the type of authorization being requested Clicking on the drop down menu will list the available types which are describe below Direct Emergent In House Specialist Retro Standard Urgent 14 Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Direct Referral Type Refer To Specialist
9. search for string in any part of the member CIN Medicare ID will return any record that has the search for string in any part of the member s Medicare ID PCP will return any record that has the search for string in any part of the member s primary care physician s name Health Plan ID will return any record that has the search for string in any part of the member s health plan ID SSN will return any record that has the search for string in any part of the member s social security number Note space and dashes should not be used DOB will return any record that has the search for string in any part of the member s date of birth The additional DOB search options are more specific versions of this search see the formatting in the search for option name for details Member No will return any record that has the search for string in any part of any one the member s IDs CCS will return any record that has the search for string in any part of the member s CCS case number Cal Optima Case will return any record that has the search for string in any part of the member s Cal Optima case number AKA will return any record that has the search for string in any part of the member s also known as name 3 Search For Free text field for search string associated with the Search By criteria 4 And For Search criteria same as Search By Using this option means that both search criteria must be meet to
10. 5 1 member matches your search criteria ee a of 1 gt gt 5 Fill in all field in the Authorization Request data entry screen as completely as possible For an example of how to fill in this data entry screen please refer to the section Authorization Request Data Entry Example For the full field descriptions please refer to section Authorization Request Screen Field Description 6 Save the Authorization Request by clicking Save button At this point you have completed and submitted an Authorization Request A message has automatically been sent to MaxiMedIPA s UM department notifying them of your request and your request has an Open status Please Note the Request ID for future reference and check back periodically to see if the status has changed see section Checking Remote Authorization Status for more information Find Member Find Request updated By Onl E If you would like to attach external documentation i e scanned documents please continue to the next step Adding Attachments to a Request 7 After saving your request click on the Attachment button at the bottom of the screen Update Find Member Find Request Print Request Attachment Updated By On 08 05 2009 Update Reason other _ An Attachments window will appear 8 Click on the Browse button and select the file you would like to attach 9 Click on the Attach butto
11. 7 1 2009 Street Angeles Medicine 2nd Floor 3 Providers match your search criteria J Trusted sites Protected Mode Off F Click the first Silver Alan M D Van Nuys Office Once you click on your selection the window will close and the Refer To Specialist field will populate G Select Office 11 from the Place of Service drop down list Note Depending on the authorization request it may be necessary to indicate a Facility i e surgery Authorization Request Request From Silver Alan M D Request ID Request Date Med Record Type Direct Referral Type Detail New soso e IT engen eRefer To Refer Te Specials r hien Refer To Specialist e Add Phone Silver Alan M D Internal Medicine Siver Alan M D InternalMedicne ss O Place Of Service Facility Write in Facility OR Pharmacy 01 Diagnosis 2 os ee OS ee Homeless Shelter 04 Indian Health Svc Free Standing Fe Diagnosis 4 indian Heath SvcProvider basedF 1 Po Tribal 633 Free standing Facility 0 See Tribal 638 Provider based Facitty 1 of Visit Office 11 Home 12 Mobile Unit 15 Urgent Care Facility 20 Inpatient Hospital 21 E ER Hospital 23 Ambulatory Surgical Center 24 Birthing Center 25 Modifier 1 Modifier 2 Modifier 3 Modifier 4 Quantity Miltary Treatment Facility 26 Skilled Nursing Facility 31 Nursing Facity 32 rr Custodial Care Facility 33 Hospice 34 e Code Des
12. Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices v1 1 ACCOUNTABLE HEALTH CARE IPA A Healthcare Partnership you can depend on http www ahcipa com webportal Provider Web Portal Reference Guide for Clinics amp Provider Offices Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices v1 1 Table of Contents INEKOGUCTION EE 3 Pre requisites amp Minimum System Requirements ccscccsscccsscccseccesecceneceenceeeueesaecceueesesessusenseeeees 3 POG REISE ee BEE 3 Haraware e De NEE 3 SOnWare e Me En EE 3 Other e EI EE 3 Remote Access Usage Tips amp CONVENTIONS ceccccseccesecceseccencceecceecceucessnceseuceseecseeseusessusenseeeaes 3 OG SU NR a A tania cinerea cacacmaeecineuan ini O S 4 LOS SIG OU E 4 HOME SCION cssvcidevessdivacvasssicsupeneconeiues A denen aanadnesdeoensderacsacseiasmaniens 5 H me Screen e Wel de ge EE 5 VE Le 6 Member Search Screen Field Description csccscsssscsessssescousvectonesscuenssseneosressoussscnenesscneousrense 6 Checking Member Tele E 7 PUTNONI ZATIONS icccpenescoradtosceiasueotcartbscedevecsdesectaceatoiesuedsaccsnes eumsahiwadtonsntauemedcacnines AS 8 Authorization Screen Field ere EIERE erte EE 8 PRINT ANVAUTIONI ZA BION EE 9 Authorization Request Summary Screen Field Description 10 AUTHOnizati
13. Find By Provider Last First Tovider License Any Name o C LSdes eucer Vendor JUUU Test Ko Newport Beach CA 90606 Your Vendor TEST TaxID 00 12345 Check that this is the member you are entering a Claim Encounter for Check that the IPA Health Plan and Eligibility dates are appropriate within the date of services Check that the place of service is correct Check that the auto populate rendering provider is correct same as box 31 on CMS1500 If the rendering provider must be changed click on the Select Provider button to search for the appropriate rendering provider E Check that the auto populated vendor along with billing address and tax ID is appropriate Same as box 33 on CMS1500 5 Type in the diagnosis code in the available fields Codes should be entered in the following format If you are unsure of the exact ICD 9 code you may click on the adjacent Select button for available codes and GOO PDP 20 Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices descriptions Please be sure to include all diagnosis codes If there are more than 8 diagnosis codes please submit the rest of the codes on another claim encounter Find By Provider Last First Provider License Feon TT L ke pege Vendor 0000 Test Rd Newport Beach CA 90606 Your Vendor TEST TaxID 00 12345 ICD 9 3 ICD 9 6 ICD 9 7 ICD 9 8 Se 6 If the billin
14. On REQUEST Creation EE 11 Adding Attachments to a REQUESE sciatica ee a es 12 PINE SEENEN ENEE 13 Authorization Request Screen Field Description 14 Authorization Request Data Entry Example ssssssesessenssrrerssrrrsssreresererssreressrersseeresererssreresereesseerese 15 Checking let giel E ge STUS Sinera a E A 18 CLAIMS P A E E E A E E E E A E A A E 19 Pilling Eng lee 19 VT 23 Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices Introduction This document is a reference guide for remote access via the internet in to Accountable Health Care IPA s information system Accountable Health Care IPA offers this web access to contracted providers on a per request basis in an effort to ensure secure timely and accurate electronic exchange of information Pre requisites amp Minimum System Requirements Login Registration To use Accountable Health Care IPA s Remote Access system all users must obtain login credentials by registering requesting access through Accountable Health Care IPA s IT Department The Remote Access Registration Form is available online http webportal ahcipa com Hardware Requirements Intel P4 1GHz CPU or greater 40GB Hard Disk Drive or greater 512 MB RAM minimum 2 GB recommend SVGA Monitor minimum 17 19 LCD recommended Windows Compatible Keyboard amp Mouse Network Interface Card or Modem for Internet conn
15. This is the specialist that the member is being referred to Click on the select button to search for a known specialist If the specialist cannot be found you may try Write In option Click on Select button next to Write In Refer Specialist to check for specialist with one time contracts or click Add to request that that an LOA be executed for a specialist Place of Service Click on the drop down to see the available places of service Then fill in or select the facility at which the service will be rendered If the facility cannot be found you may try Write In option Click on Select button next to Write In Facility to check for facilities with one time contracts or click Add to request that that an LOA be executed for a facility Diagnosis These fields are for ICD 9 codes You may enter up to four Description field will automatically fill if the ICD 9 code enter is valid Rule Out This is a free text reference field that is meant to be use for rule out of Visit The number of visits being requested as part of this authorization request Procedure CPT code for the procedure this authorization request is requesting authorization for Modifiers Modifiers for the associated CPT code Quantity Quantity for the associated CPT code Notes Free text reference field meant for any note related to procedure line Add to List Button Saves the procedure request data entered in i
16. able Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices down and selecting a criterion 2 type in your search string 3 click on the Search button E search Member Internet Explorer provided by Dell Member Search Search By Any Name Any Name Last Name First Name Search RejLast First Test Don M D 123 Test Rd Cerritos 90613 Home 5 222 22 2272 1 1 1930 TESTIPA YHPTEST YHP a DOB HM DOB MM DD If you are unable to find the member you are looking please contact MaxiMedIPA at 866 209 1071 and ask for assistance from a our Member Services Representative 3 Select the appropriate member by Clicking on the Member s name from the search result list Member Search Search By Any Name 7 Search For And By J ador _ Lesen Loic Search Result Member Test 2 TEST12345 222 22 2222 1 1 1930 TESTIPA YHPTEST YHP Test Don M D 123 Test Rd Cerritos 90613 Home 1 member matches your search criteria 4 After selecting the Member from Step 3 notice that the Data entry screen has been updated with the members information Please verify that the information highlight below is correct Find By Name Last First Find By CIN Member2 Test 2 nn E Deem Find Member Claim Encounter D DOB 01 01 1930 IPA Your IPA TEST ID PCP Test Don M D Claim ID Rcvd Date Service Place Account HP Your Health Plan TE 01 21 2010 Elig From 08 01 2009 Elig Thru
17. ch By criteria Auth Search for the records with authorization number entered Age Filter by age of the member on the authorization UM Review Status Filter by status of the authorization Type Filter by type of the authorization Category Filter by category of the authorization LOB Filter by the line of business for which the authorization is related Requesting Provider Filter by the provider who is the originator of the authorization Referred Provider Filter by the referred to provider of the authorization PCP Filter resulting authorization records by the member s primary care physician Referral Facility Filter resulting authorization records by the facility the member is being referred to Review By Filter resulting authorization records by the UM staff whom reviewed or is assigned to review the authorization Add By Filter resulting authorization records by the coordinator or UM staff who initially created the authorization record Referral Date Filter resulting authorization records by the effective date range of the authorization 8 Accountable Health Care IPA 16 17 18 19 20 21 22 Provider Web Portal Reference Guide for Clinics amp Provider Offices Enter Date Filter resulting authorization records by the creation date range of the authorization record IPA Filter resulting authorization records by IPA Health Plan Filter resulting authorization
18. ch as demographic information current coverage and authorizations Member Search Screen Field Description Home gt Members tab gt Member Search Login User testi Search Members Claim Gof Jana By 5 urr I7 Search Result Care Coordination 3 Search Add New Member PL Member CINS HP 1D SSN TPA HP PlanCode PCP Eff Date PCP Term Date ey Mejia Miguel Angel Espin M D 9 Memberi TEST 98765432A 123456 123 45 6789 01 01 1940 UCMM CCHP CCHP 6 1 2009 14600 Sherman Way 1st Floor Van Nuys 91405 1 member matches your search criteria i foe 1 Quick Search Allow search and navigation directly to an authorization or claim by record id 2 Search By Search criteria The following are the available options and description Any Name will return any record that has the search for string in any part of the member first or last name Last Name will return any record that has the search for string in any part of the member last name First Name will return any record that has the search for string in any part of the member first name Last First will return any record that has the portion of the search for string before the comma in any part of the member first name and the portion of the search for string after the comma in any part of the member last name Note that there should not be a space between the comma and the fist name in the search for string CIN will return any record that has the
19. cription Mod 1 Ambulance Land 41 Ambulance Air Water 42 Federally Qualified Health Center Inpatient Psychiatric Facility 51 Psychiatric Facility Partial Hospita Community Mental Health Center 5 Intermediate Care Facility Mentally Residential Substance Abuse Trea Y v Yv b H Type 250 0 in to Diagnosis 1 field Note If you are unsure of a specific ICD 9 code you may click on the Select button to bring up a search window L Type 1 in to of Visit field 16 Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices J Request ID Request Date Med Record Type Direct Referral Type Refer To Specialist Write in Refer To Specialist Phone Siker Alan M D Internal Medicine Place Of Service Facility Write in Facility P Diagnosis 1 Diagnosis 2 7 E e Diagnosis 3 Diagnosis 4 i Ee O a Rule Out eut Request Notes Type 99213 in to the Procedure field K Type 1 in to the Quantity field H Click Add to List button Requested Procedures Procedure Modifier 1 Modifier 2 Modifier 3 Modifier 4 Quantity Notes Procedure Code Description ods Mod 2 Mods moda Qty xX 1 99213 OFC OUTPT VISIT E amp M EST LOW MOD SEVERITY 15 MIN Notes M Click Save button at the very bottom of the screen You have completed an Authorization Request A message will a
20. d from queue and is under review by UM Accepted does not indicate that the authorization has been Approved Rejected this is an acknowledgment status indicating that the authorization request has been reviewed and denied Requesting Provider Filter indicating the relevant requestor for the search Referred Provider Filter indicating the relevant referred to provider for the search Request Date the date range in which the authorization request was made IPA Filter by IPA from the selected drop down Health Plan Filter by Health plan from the select drop down 10 Sort By allow the sorting of the search results 11 Order Toggles the order ascending or descending of the search results 12 Search Button Clicking this button will refresh the Search Result List oo Am 210s Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices 13 Search Result List The results from the prior search 14 Search Result Page Scroll display additional search result if there are too many to display on a single page 15 Find Member Button Quick navigation button that will take you directly to the Member Search Screen 16 New Request Button this button takes you to the next step in creating a new authorization request Authorization Request Creation To create a remote authorization request for an existing member please follow the steps below 1 Click on the Aut
21. earch amp Select a Member Record gt Authorization Request Screen gt Login User Testi d d Uni I i Authorization Request Member1 Test leen r r d Momber Demographic Guarantor Coverage Authorizations Claims Save Find Member Find Request New Same Mem New Other Mem View Auth History 3 IPA Name Health Plan Universal Care Maxi Med Honored Citizens Choice Health Plan Medicare Effective Date Terminated Date PCP Eff Date 12 01 2008 06 01 2009 5 Authorization Request 6 Request From e 7 Request ID Request Date Med Record Type 12 Direct Referral Type Retro DOS LMP 7 10 11 Lew L pensano g il zen L 2 ea Write in Refer To Specialist SE Specialty de Place Of Service Facility Write in Facility Select Add Phone Office 11 JL oR PO 1 Diagnosis 2 as IT Iesel E Diagnosis 3 Diagnosis 4 Jet tg a Requested Procedures Procedure Ges Modifier 1 Modifier 2 Modifier 3 meters ay e v v v L Procedure code RER Mod moda moda ow 7 a Updated By 7 of 7 1 Screen Module Display this region will display text to indicate the Screen Module currently on screen In the case of the Authorization Request screen a member name will appear indicated who this request is for 2 Account In red is the user account name that is currently logged in In black is important information about member record that is currently loaded on screen 3
22. ection Software Requirements Operating System Windows XP SP2 or Vista Web Browser Internet Explorer 6 0 or higher Antivirus Software Strongly recommended Note Firewalls and Protection software should be configured to not block pop ups from and trust http webportal ahcipa com Other Requirements Internet Service 56Kbs minimum broadband connection highly recommended Printer laser printer is recommended if form letter needs to be printed Remote Access Usage Tips amp Conventions Donot use the Back button on your browser Due to the web base technology and application security rules set within the Remote Access Web Application doing so may cause the application to log you out P The Pencil Icon indicates a record that can be modified Click on it to open the record The Cross Icon indicates that the record can be deleted Click on it to remove the record The Check Icon is the same as an approval button The Dot Icon indicates a required field To save or process this Fa emm A To return to the Home Screen from any location within the application click on the Home button on the top left hand corner of the main window HH The Calendar Icon will bring up a calendar window where you chose a date The Calendar Icon with the red dot will enter the current date in to a date field when clicked on D Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider
23. g place of service POS is any of the following please enter the Facility Name where services where rendered 20 Urgent 21 Inpatient 22 Outpatient 65 Skill Nursing For a list of available Facility Names click on the Select Facility button to locate the rendered facility If the correct Facility is not within the system please contact MaxiMedIPA at 866 209 1071 and ask for assistance from a Provider Services Representative oe Wee lr ICD 9 1 ICD 9 2 ICD 9 3 ICD 9 4 ICD 9 6 ICD 9 7 ICD 9 8 Eer Sele sde ma ea Cie Sie ei Sei Facility Select Facility Claim Remarks ES New Services Rendered Date Of Service Procedure Modifier 1 Modifier 2 Modifier 3 Modifier 4 ra Billed Amount Pe Pen If there are any related comments or note you may enter them in hea available free text Claim Remarks box NOTE Please DO NOT click Save Claim at this point 7 A Enter the date of service for each single procedure rendered in the MM DD CCYY format B Enter the CPT HCPC code C Enter Modifiers if applicable from the dropdown D Enter Quantity Note this cannot be 0 E Enter Bill Amount value Note Leaving this field blank is the same as bill a zero dollar amount F Click Add to List to save this line item to the claim Repeat steps A E for all additional line items Line Item Note EE a a Total D a Accountable Health Care IPA Provider Web Po
24. h Request button on the Home screen Clm Request CHDP Request From 07 29 2009 To 08 03 2009 Category Subject Status Login User testi Search By All SearchFor i Status Open v Requesting Referred Provider s o Provider A Request Date From 07 29 2009 To 08 03 2009 d IPA All e Health Plan All Sort By v In Descending Order Search In Ascending Order oe Search Result Status Type Request ID Request Date Track Member Mem ID IPA Health Plan Req Provider Ref Provider D Authorization Requests match your search criteria c lt kA of EE Search button Search Members wm el dl came sl wn ze E v s nd For Search Result Care Coordination Ai tees Hember a Member CIN HP ID SSN IPA HP PlanCode PCP Eff Date PCP Term Date Sen of l gt gt 44s Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices 4 Click onthe appropriate Member Record underlined member name Make sure to verify you are selecting the correct record by checking at least two identifiers Names DOB HP ID Login User testi Search Members Last N Member1 IPA Claim Co o o And By DOB v AndFor 01 01 1940 HP Search Result Care Coordination Add New Member Le Mejia Miguel Angel Espin M D Memberi TEST 98765432A 123456 123 45 6789 01 01 1940 UCMM CCHP CCHP 6 1 2009 14600 Sherman Way1st Floor Van Nuys 9140
25. have access These modules are essentially search screens for various types of data i e member information authorizations claims 2 Logout when you are ready to end the session click this button to logout If you would like to login to a different account you may click Switch 3 Screen Module Display this region will display text to indicate the Screen Module currently on screen In the case of the Home screen your username will appear 4 Account this is the user account name that is currently logged in 5 Request Buttons shortcuts to the appropriate data entry screen to file claim encounter CHDP or authorization requests 6 New Messages Date Range the date range for which un read message would be displayed 7 List Button click this button to refresh the list of new messages 8 New Messages List list of new messages that are within the new messages date range Once you click on a message to read it it will be removed from this list To view read message please go to the Messages screen by clicking on the Messages Tab F ki Home ho dl From any screen module you can return to the home screen by clicking on the Home button at the top left of the window next to the Logout button Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices Members The Members Module is where you would find data pertaining to an individual member su
26. n 10 Wait for the attachment to be uploaded The progress bar at the bottom of the window will indicate your upload progress Once the upload is complete the file name will show in the attachment list Note The time it takes to upload is dependent on the size of the file and the speed of your internet connection oe ee Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices Attachments File Name C Sample_Medical_Chart pdf File Name Add Date 8 5 2009 Wi Jv Trusted sites Protected Mode Off f e 100 e 11 TE steps 8 TEES 10 until all file are attached then click on the Close button to close the attachment window and return to the Authorization Request 12 Select an Update Reason reason from the drop down list and click Update Note You must Update the request for any changes to be saved including attachments Find Member Find Request Print Request Attachment Updated By On 08 05 2009 Update Reason Additional Information 3 BEES Print an Authorization Request To print an authorization request you must have a printer configured on your local PC then please follow the below steps 1 Bring up load the authorization request you would like to print 2 Click on the Print Request button on the bottom of the screen Find Member Find Request Print Request Attachment Updated
27. n M D MaxiMed Honored Citizens Choice Health Plan Medicare Age Effective Date Terminated Date PCP Eff Date 69 12 01 2008 08 01 2009 Authorization Request Request From Silver Alan M D e Request ID Request Date Med Ts d Type Direct Referral Type Retro DOS LMP New 08 04 2009 Standard DH m eRefer To Specialist OR Write in Refer To Specialist Select Add phone Ext Specialty Silver Alan M D Internal Medicine Select Place Of Service Facility Write in Facility Select Add phone ms es 3h Select Last Name from the Search by drop down list Type in Silver in the Search For field 45 Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices E Click the Search button Note that multiple records appeared from the search This is common if the provider works at multiple locations Please be careful to select the correct record Provider Search Specialty All Search By Last Name D Search For Siver Sak All Any Name Language All First Name Is City Specailty Phone State OneTime Provider 14600 Internal 818 7 1 2009 Sherman Way Contracted Medicine with IPA Geriatric Medicine Mate IPA No 1700 E Cesar Internal 323 Silver Alan IPA Contracted 7 1 2009 Chavez Medicine with IPA Ave Angeles Geriatric Suite Medicine 3300 Silver Alan Contracted Los Internal M D wali with IPA
28. not indicate that the requested authorization for service has been approved 18 Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices Claims Filing Claims Encounter To submit claim encounter for an existing member please follow the steps below 1 From the Home screen Click on the Clm Request button This will bring up the Claim Encounter data entry demo user Auth Request Clm equest CHDP Request New Messages From 01 16 2010 T FromTo Category Subject Status Auth Ref Type screen 2 Search for the member by filling i in at least one of the available criteria then click Find Member Find By Name Last First Find By CIN Find By SS Health Plan ID Claim Encounter Date Claim ID Rcvd Date Service Place Account BE Find By Provider Last First Provider License Any Name Test Don WD Doo L deg rage Vendor Po ICD 9 1 ICD 9 2 ICD 9 3 ICD 9 4 ICD 9 5 ICD 9 6 ICD 9 7 ICD 9 8 TC Sei ses Ise Sea Select Setect Seea Select Facility Claim Remarks Services Rendered sm oo Modifier 1 Modifier 2 Modifier 3 Modifier 4 Qty Billed Amount DOS From Billed After clicking Find Member a Member Search window will appear with search results If there are no results you may try your member search again with a different search criteria by 1 clicking on the Search By drop 19 Account
29. o the Requested Reviewer section towards the bottom of the authorization Click on the Print Reply button A Referral Authorization Reply window will appear Total Authorized 0 00 Current Medical Director Requested Reviewer OR Total Paid Find Member Find Auth P Send Admission Notices Date Notified Visit Authorizg Universal Care Maxi Med Health Net Medicare PATIENT Member Test ADDRESS 1234 Test St TestVill CA 90755 REQUESTED DATE 07 30 2009 REVIEWED DATE 07 30 2009 EXPIRATION DATE 10 30 2009 REFERRAL AUTHORIZATION REPLY AUTHORIZATION 161942 Approved Standard Authorization MEMBER ID H PHONE SEX D O B ELIGIBLE RETRO DOS l Print Close 123456 213 111 1111 Female 01 01 1940 Yes 07 11 2009 Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices Authorization Request Summary Screen Field Description Home gt Auth Request button gt Remote Authorization Request Summary E morean se rch By A lesch to 1 O status All Requesting All BR Referred Al Provider Provider 7 Request Date From To 08 06 2009 PPS 3 iPa All 9 Health Plan A sort By Ob In Descending Order z Ls Search Result siren Request se Health X Reject Standard 45826 8 6 2009 ai 98765437A MM CCHP Siver Aan me ua M ES SE g ZE SE Silver Alan
30. ortal Reference Guide for Clinics amp Provider Offices Authorizations Authorization Screen Field Description Home gt Authorization tab gt Authorization Screen The Authorization Screen is a search screen to locate authorizations Leave fields blank or in the default state for it to not affect the search Authorization zess lume CT Den ess mv gt gt Ld UM Review Status All 6 frype All Ke 7 category a s ko All D Requesting y 10 Beane All h ha Provider Provider PCP A Referral Al TER h Facility Review By 114 Jada By All 17 IPA All 18 Health Plan Al Y 15 referral Date From MM Tol bs 16 Enter Date From To wY E Consult Only El In Patient Only Out Patient Only Sort By In Descending Order SS p Ze Se Pe 2 Ze e k k L WN e O 14 15 Search Result Search By Search criteria drop down will list the available options for finding an authorization record Note that for all options except ALL a search string is required in the Search For field The available options are ALL unfiltered and will return all available results Member Name will return any record that has the search for string in any part of the member name One Time Provider will return any record that has the search for string in any part of a One Time Provider name Search For free text field for search string associated to the Sear
31. records by IPA Sort By allow the sorting of the search results Order Toggles the order ascending or descending of the search results Search Button Clicking this button will refresh the Search Result List Find Member Button Quick navigation button that will take you directly to the Member Search Screen Print an Authorization a e E Click on the Authorization tab Search for the Authorization by typing the Auth in to the Auth field Click on the Search button Click on the Pencil icon for the correct authorization record to open Search By All Auth 161942 sd UM Review Status All Category All Requesting All Provider PCP All Review By Sesrchfer Age all gt Type All LOB Referred Provider Referral Facility v Add By Al SW Referral Date From sd mm tol m Enter Date From To IPA All Consult Only Sort By Search Result In Patient Only vr v Health Plan All v Out Patient Only In Descending Order In Ascending Order Search Find Member Print Sum eferral SC ClaimID Member deem Category Type aa mor Ref To mem In Out Date Stains Provider 7 30 2009 161942 Cosenza mm Carlos Migu Memberi Test UCMM HN HFP In Patient Standard Medicare Approved ee 00 62 a I No 1 Authorization matches your search criteria Espin M D General Surgery 5 Scroll down t
32. rtal Reference Guide for Clinics amp Provider Offices 8 Once all line items have been entered Now Click Save Claim button to generate a claim number and submit K PIs JL Claim Encounter Member 2 Test Find By Name Last First Find By CIN Health Plan ID Lo LC ind tember Claim Encounter Date DOB 01 01 1930 IPA Your IPA TEST ID PCP Test Don M D Claim ID Revd Date Service Place Account HP Your Health Plan TE nn LE Elig From 08 01 2009 Elig Thru Find By Provider Last First Provider License Any Name Se SS Vendor 0000 Test Rd Newport Beach CA 90606 Your Vendor TEST TaxID 00 12345 ICD 9 1 ICD 9 2 ICD 9 3 ICD 9 4 ICD 9 5 ICD 9 6 C Era Gda TI Select Eea Eea Ssa Select Facility Claim Remarks Save Claim Print Request Services Rendered Date Of Service Procedure ICD 9 7 ICD 9 8 Modifier 1 Modifier 2 Modifier 3 Modifier 4 Qty Billed Amount Line Item Note DOS From 01 07 2010 Claim has been saved Claim ID 1056591 D e Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices Messages 1 Sea rch By 2 les rch For Status All Received Read Replied Forwarded Within All Past Day s Week s Month s From DP rel POP Ls Jeategory All MM es e ia Al Mark All Unread as Read 7 sye Received R Send 5 Search Result Write anew message
33. sult by sender 7 S R All messages addressed to you the account that is logged in are known as Received R All messages sent from you the account that is logged in is known as Send S 8 Search Button Clicking this button will refresh the Search Result List 9 Mark All Unread as Read This button will change ALL messages with Received status to Read status 10 New Button Click this button to draft a new message A new message window will appear 11 Search Result List The results from the prior search 12 Delete Clicking this button will permanently remove all selected messages 13 Download Clicking this button will download to the local PC the selected message in text format 92
34. tems 17 20 to the procedure request list Procedure List a list of all procedures that is part of this authorization request Save Button This button saves and submits the authorization request to the UMQI department Print Request Button Activated only after the authorization request is saved Brings up a print friendly window with a summary of the authorization request Attachment Button Activated only after the authorization request is saved This button launches a window that will allow attachment of files to this authorization request i e scans of medical charts in PDF or TIFF format Updated By Automatically populated with the current username and system time when the authorization request record is save or updated Authorization Request Data Entry Example This example will demonstrate the most minimal data entry necessary to generate an authorization request A B C D From the Authorization Request Screen select any available Provider from the Request From drop down box Click the Select button next to Refer To Specialist A Provider Search window will appear Login User testi DOB 01 01 1940 IPA MaxiMed ID 123456 Test PCP Silver Alan M D a Momber Demographic Guarantor Coverage Authorizations Claims i Save Find Member Find Request New Same Mem New Other Mem View Auth History PCP IPA Name Health Plan Silver Ala
35. utomatically be sent to MaxiMedIPA s UM department notifying them of this request _Save Find Member Find Request updated By fd Dn Ef Once you have click the Save button notice that the Save button has changed to Update and additional buttons and fields are activated Update Find Member Find Request Print Request Attachment Updated of On osiosi2009 Update Reason other Please note that any changes made to this request record will not be saved until an Update Reason is entered and the Update button is clicked 17 Accountable Health Care IPA Provider Web Portal Reference Guide for Clinics amp Provider Offices Checking Remote Authorization Status Once an authorization request is created the creator can and should regularly check to see if the request status has changed To do this please follow the below steps 1 Fromthe Home screen Click on the Auth Request button to navigate to the Remote Authorization Request Summary Screen Clm Request CHDP Request New Messages From 07 29 2009 To 08 03 2009 Se ee ee Go 2 Fill in your search criteria see section Authorization Request Summary Screen Field Description for a full description of all fields and Click on the Search button For the purpose of this demonstration we will search for All Auth Request for the member with last name Member1 that was created in between 08 01 2009 and
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