ProviderConnect Inpatient Concurrent Review User Manual
Contents
1. The Current Impairments screen will display next 20 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Completing Concurrent Requests continued Key Step 7 The Current Impairments screen captures a snapshot of the member s current Complete the mental status by allowing providers to complete ratings for twelve 12 different Clinical Screens impairments Current Impairments Saran Below are the key actions for completing this screen Any field with an asterisk indicates that the field is required NOTE For Concurrent Reviews the previous review s ratings will be listed in a box to the right of the field i e L3 Last rating 3 L1 Last rating 1 LN Last rating Not Assessed Additional information can be entered in the Narrative Entry fields and users can view previous or historical information by clicking on and expanding the Narrative History fields Select the radio button for the appropriate rating for Current Impairments MOOD DISTURBANCES DEPRESSION OR MANIA WEIGHT LOSS ASSOCIATED WITH AN EATING DISORDER ANXIET Y MEDICAL PHYSICAL CONDITIONS PSYCHOSIS HALLUCINATIONS DELUSIONS SUBSTANCE ABUSE DEPENDENCE THINKING COGNITION MEMORY CONCENTRATION PROBLEMS JOB SCHOOL PERFORMANCE PROBLEMS IMPULSIVE RECKLESS AGGRESSIVE BEHAVIOR SOCIAL FUNCTIONING RELATIONSHIPS MARITAL FAMILY PROBLEMS ACTIVITIES OF DAILY LIVING PROBLEMS LEGAL Complete additional required2. 23 SUPPORT ANITA 01 112310 26 21 TEMP000740625 SUPPORT ANITA Member Provider ID DOB Provider Alt ID 01 01 1995 CBHPO02120 TEMPFAC 01 01 1995 CBHP002120 TEMPFAC 01 01 1995 CBHPO002120 TEMPFAC CBHP002120 VCB003159 VCB003159 VCB003159 VCB00S769 EDT COMM MH CTR Outpatient Home Health Outpatient IP HOS I P PSYCH Inpatient OP COMM MH CTR Outpatient ascending y oruines I9 E NEUVUTRUTITICLL ProviderConnect Providers eo MPPUILLY LUYI Bg DuyyESicu oes T eJ meg nuu Gy wey site uay Note Users can sort authorization results using the Authorization Search Results bar and by selecting the desired category Select the header once for descending results or twice for tp Do J mm Pager Safety Tools W PROVIDERCONNECT VALUEOPTIONS Home Specific Member Search Authorization Listing Enter an Authorization Request Enter a Treatment Plan View Clinical Drafts Review Referrals Enter Bed Tracking Information Search Beds Openings My Online Profile Auth Summary Auth Details The information displayffd indicates the most current information we have on file It may not reflect claims or other information that has not been received by ValueOptiog Authorization Heade Member ID Member Name Authorization Client Auth 12 NPI for Auth fization Authorization Mtatus From Provide Admit Date Discharge Dte TEMP000740625 S
3. E _ 7 Select the Next button to continue The Requested Service Header will display 15 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Key Step 2 The second key step is to complete the concurrent entry request screen This Complete screen displays for all types of requests However the information entered Initial Entry determines which clinical screens will display and which authorization parameters will be applied to the request The fields with an asterisk indicate the field is required 8 Enter the Requested Start Date The Requested Start Date is the last date authorized on the current authorization 9 Select the Level of Service INPATIENT HLOC When the level of service is selected the screen will update with the required fields specific to the level of service 10 Select the Type of Service MENTAL HEALTH 11 Select the Level of Care INPATIENT 12 Select the Type of Care INPATIENT INPATIENT HOSPITAL Note Inpatient IP Psych Facility Natchaug Hospital Only 13 Enter the Admit Date VMMDDYYYY The Admit Date is the start date on the Original pre certificaton 14 Attach a document CT BHP registered services do not require attached documents users can proceed to step 7 15 If the Admit Time field is not auto populated users should enter 0000 16 Select the Next button Requested Services Header All folds marked with an asterisk are req
4. Thefields with an asterisk indicate that the field is required 1 Select Enter an Authorization Request link from either the left navigational menu or the middle of the ProviderConnect homepage gaging Home Welcome Thank you for using ValueOptions ProviderConnect Specific Member Search Authorization Listing Request YOUR MESSAGE CENTER View Clinical Drafts Review Referrals Your Recent Inquiries box is empty Enter Bed Tracking Information WHAT DO YOU WANT TO DO TODAY My Online Profile Eligibility and Benefits Review Peferrals e Find a Specific Member e Review Referrals Enter or Review Authorization Requests t View My Recent Authorization Letters e Review an Authorization a View Clinical Drafts 13 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Completing Concurrent Requests continued 2 Review the Disclaimer and select the Next Button Disclaimer Please note that ValueOptions recognizes only fully completed and submitted requests as formal requests for authorization recognize or retain data for partially completed requests Upon full completion of the Enter an Authorization Request pre notification that your request has been received by ValueOptians 3 Search for Member Record by entering the Member s 9 digit Medicaid ID OO and Date of Birth MMDDYYYY Then select Search Required fields are denoted by an asterisk J adjacen
5. are the key actions for completing this step Any field with an asterisk Medications indicates that the field is required If user has selected Yes for IS MEMBER CURRENTLY ON PSYCHOTROPIC MEDICATION on the previous clinical screen than Medication information on this page will be required 2 Enter the DATE OF MOST RECENT MED EVALUATION or click UNKNOWN Complete each of the Medication fields as necessary NOTE The hyperlink above each medication name field will bring up a list of psychotropic medications sorted by class If a medication is not listed in this list users can choose Other and then enter the name of the medication in the Other open text field below the Medication field Select the Next button _The Substance Abuse screen will display next Key Step 11 The Substance Abuse screen details the member s substance abuse withdrawal Complete the symptoms vitals and ASAM Other Placement criteria Clinical Screens Substance Abuse Gercen Below are the key actions for completing this step Any field with an asterisk indicates that the field is required Step Action The substance abuse screen will have been completed on the initial pre certification of services 2 Users may update or complete additional fields as needed Select the Next button The Focal Treatment Plan screen will display next 23 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurr
6. collected within each screen varies and not all fields are required Level of Care Current Risks Current Impairments Diagnosis Treatment History Psychotropic Medications Substance Abuse Not Required Focal Treatment Plan Additional MTPPR Information Not Required 10 Treatment Request amp Discharge Planning 11 Results Soa are YS W PROVIDERCONNECT VALUEOITIONS DIAGNOSIS TREATMENT gt PSYCHOTROPIC SUBSTANCE FOCAL TREATMENT ADDITIONAL MTPPR INFORMATION HISTORY MEDICATIONS BUSE PLAN t TREATMENT Ha i DISCHARGE PLAN Below is information for completing each screen Key Step 4 The screens will display in the order listed above when the Next button _ Complete the is clicked within each screen Clinical Screens Tips for Working Requests must be completed in order All required fields must be through the gt completed to move to the next screen Clinical Screens Previous screens can be accessed by clicking the Back button at the BOTTOM of each page Do not click the Back button on the top left corner of your browser window You must click the Next button to proceed forward Within any clinical screen the request can be saved as a draft by clicking the Save Request as Draft button within the screen header 19 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Completing Concurrent Requests continued Key Step 5 The Level of Care screen is
7. for Authorization Vendor ID Member ID CTO05555555 Authorization No spaces or dashes Client Authorization Effective Date 08052010 m MMDDYYYY Expiration Date 08052011 m MMDDYYYY Activity Date span cannot exceed seven 7 days Activity Date Range can only be entered without a value in the Effective or Expiration Date fields above or vice versa Activity Date From T MMDDYYYY Activity Date To T MMDDYYYY Delimiter Type Comma pS C Pipe View All Search Download Select Search to view the client s authorization s Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Features Viewing Authorizations continued Specific Member Search Authorization Listing Enter an Authorization Request Enter a Treatment Plan View Clinical Drafts Review Referrals Enter Bed Tracking Information Search Beds Openings My Online Profile Once the correct authorization is located select the internal Auth the blue hyperlink starting with 01 Date to the left of the member s ID Authorization Search Results The information displayed indicates the most current information we have on file It may not reflect claims or other information that has not been received by ValueOptions Auth Y Member ID View Letter Member Name 01 080411 1 8 TEMP000740625 SUPPORT ANITA 01 070611 1 3 TEMP000740625 UPPORT ANITA 01 011011 45
8. information when the rating is a 2 or 3 for the following fields A sub section will expand to display the fields that need to be completed WEIGHT LOSS ASSOCIATED WITH AN EATING DISORDER SUBSTANCE ABUSE DEPENDENCE Complete additional required information when the LEGAL impairment rating is a 1 2 or 3 A sub section will expand to display the fields that need to be completed Enter additional details in the Narrative Entry boxes for each field that you rated a 2 or 3 Be as specific as possible with your entry so the CT BHP clinician can get a detailed impression of the member s current status Select the Next button The Diagnosis tab will display next zi Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Completing Concurrent Requests continued Key Step 8 The Diagnosis tab allows the capture of multiple diagnoses for Axis Axis Il Axis III Complete the and Axis IV as well as the Current GAF Score for Axis V Clinical Screens Diagnosis Screen Below are the key actions for completing this screen Any field with an asterisk indicates that the field is required Action Update Axis and Axis Il Diagnosis Codes if required If no value or a partial value is entered in the Diagnosis Code or Description fields and the field title is selected a list of codes will pop up displaying the full list of values and descriptions or those that
9. the first screen that will display after the Initial Entry Complete the screen Much of the information is required for completion of this screen Clinical Screens Level of Care Screen Below are the key actions for completing this screen Any field with an asterisk indicates that the field is required Step Action The Level of Care screen will have been completed on the initial pre certification of services and users will not be required to complete fields on this screen Providers can update member s current location preparer phone number and DCF legal status if needed Select the Next button The Current Risks tab will display next Key Step 6 The Current Risks tab captures a snapshot of the member s current mental status by Complete the allowing providers to complete ratings for the member s risk to self and risk to others Clinical Screens Current Risks En Below are the key actions for completing this screen Any field with an asterisk indicates that the field is required Select the radio button for the appropriate rating for Current Risks MEMBER S RISK TO SELF MEMBER S RISK TO OTHERS If either of the above ratings is rated as Moderate 2 or Severe 3 users will have to also check all the areas that apply under the risk i e deation Intent Plan Means etc Additionally providers will have to enter the date and details of the last attempt or gesture blow Select the Next button
10. 12 1 1 UO3532077 CONCURRENT 25 Revised 3 7 13
11. CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews D ProviderConnect Inpatient Concurrent Review User Manual Connecticut BHP Supporting Health and Recovery 1 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Table of Contents Tahoe U et Ce a ameprenetten rE E EEE EE E EE AE EET E eee 3 PCCESSING PTO Vd TO ONOG aera aenn N E O EE 5 Provider onneci ofc 0 ne en E AEE ee ee 7 FF OA Soccernet et ectontatae AE EE AE TE EE EAA EAE E EAA EEEE 9 Completing Inpatient Concurrent Requests ccccecceceeeeeceeeeseeeeeseeeceeeeeseeeeseueeesaeeesanees 13 2 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews b Introduction Introduction The ProviderConnect application provides a variety of self service functions to help providers access and view information about members and authorizations as well as complete requests for service authorizations What is Covered This module covers general functions within ProviderConnect as well as the in this Module Concurrent Review process for Inpatient Psychiatric authorizations Training As a result of this training module you will be able to Objectives Log in to ProviderConnect Search for and view Member records Complete an Inpatient concurrent review request 3 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Introduction continued Navigation Thr
12. ID please contact our e Support Help Line Password Forget Your Password Log In The information and resources provided through the ValueOptions site are provided for informationa ValueOptions site Providers are solely responsible for determining the appropriateness and man 7 Select Log In 8 Select Accept to the User Agreement to proceed to the home page 6 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews b ProviderConnect Basics Searching for ProviderConnect allows users to search for specific members to view additional and Viewing information about that member Member Records Below are the key actions for completing this step The fields with an asterisk indicate that the field is required 1 Select Specific Member Search from the navigational bar or Find a Specific Member on the Home page staging eccttc Member Search Welcome THE HARTFORD DISPENSARY Thank you for using Valu Authorization Listing Enter an Authorization Request YOUR MESSAGE CENTER View Clinical Drafts Review Pererrale Recent Inquires Responded to by ValueQptions Enter Bed Tracking DATE RECEIVED SUBJECT Information e 07 26 10 REFERRAL My Online Profile WHAT DO YOU WANT TO DO TODAY Eligibility and Benefits E Find a Specific Member 2 Enter values for the Member ID and Date of Birth a Note The As of Date MBR Eligibility Date will auto populate with today s date To search a
13. Select the Online Services Account Request Form hyperlink Provider Online Services Welcome to ValueOptions Connecticut Provider Online Services Please note effective January 1 2012 services provided by licensed masters level independent practitioners LCSW LMFT LPC LADC and CADC are reimbursable for HUSKY C and HUSKY D members under twenty one 21 years of age For HUSKY A HUSKY B and Charter Oak Health Plan members services i pi provided by these independent practitioners continue to be reimbursable for es individuals of any age For more information please call the Connecticut Behavioral Health Partnership at 1 877 552 8247 Provider Home Login or register with ProviderConnect an online i AA O LOG IN o Bulletins tool that allows yos to check member HN enter authorization requests for CT BHP registered o Covered Services i C REGISTER services view authorization letters and more o Enhanced Care Clinics ProviderConnect is easy tg use secure and o Forms available 24 7 o Level of Care Guidelines o Provider Manual Forms o Residential Care Team e Online Services Account Request Form o Events Trainings e Registered Services Template Publications e Registered Services Re Registration Template Q Eind a Dravider e Renistered Services Retroactive Fliaihilityv Review Temnlate 4 Complete the form and fax it to the Provider Relations Department at 855 750 9862 Completed form
14. UPPORT ANITA 01 061011 5 10 u0377105 N A O Open TEMP PROVIDER 06 10 2011 Select the Auth Details tab to view the authorization details Return to search results Send Inquiry Complete Discharge Review Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Features Viewing Authorizations continued Auth Summary Auth Details The information displayed indicates the most current information we have on file It may not reflect claims or other information that has not been received by ValueOptions Authorization Header Member ID TEMPOOOS043596 Return to search results Member Name EXAMPLE IMD Complete Discharge Review Authorization Di OF 2712 1 2 Client Auth 1 u0532091 NPI for Authorization N A Authorization Status O Open Authorization Letter s olick to view Service Lines E E EEEE HEE Line Submision Date Service Code Modifier Codes Service Class Descrp Dates of Services Visits Reguested Visits Actually Used Status Resson Approved a e As of Today e 2 3 4 e e er COR o 1 07 27 2012 N A INPATIENT O7 25 2012 gt 32 o O APPROVED HOSPITAL ozm Open AUTH e 2 07 27 2012 N A INPATIENT O7 27 2012 e oo o O APPROVED HOSPITAL 07 27 2012 o x Open AUTH e Seecececeeeeeee Note The Authorization Details screen will list the Dates of Service and the Visits Requested Approved for each service line The Visits Reque
15. e fields will be required when the review is concurrent E a user aaa ees Sain seme T ADULT IN MEMBER S HOUSEHOLD IN NEED OF ANY SUPPORT SERVICES a Select the PRIMARY REASON FOR CONTINUED STAY and PRIMARY BARRIER TO PROGRESS AND TREATMENT Also complete the IS SERVICE REQUESTED FOR HLOC BECAUSE APPROPRIATE LLOC NOT AVAILABLE question by selecting Yes or No Update the EXPECTED DISCHARGE DATE and select the PLANNED DISCHARGE LEVEL OF CARE from the drop down menu 5 Select the PLANNED DISCHARGE RESIDENCE from the drop down menu Update Narrative Entry open text fields as needed for FOLLOW UP ACTIONS CURRENT RECOMMENDATIONS EFFORTS TAKEN AND SIGNIFICANT BARRIERS Select the Submit button Key Step 9 Once the Submit button is selected from the final clinical screen the submission screen will Submit display Inpatient Requests will be pended to the CT BHP clinical team for further review Request and Submission Q iy L L m e The services requested require additional review You will be contacted regarding the status of this request if further information is needed An authorization decision will be made within the required timeframes and details of that decision may be found under the member s authorization history Member Name Member ID Member DOB Subscriber Name Subscriber ID ANITA IMDFOUR TEMP000804350 01 01 1991 ANITA IMDFOUR TEMPO000304350 Pended Authorization Client Authorization Type of Request 0711
16. ent Reviews Completing Concurrent Requests continued Key Step 12 The Focal Treatment Plan screen details the member s focal treatment needs the Complete the care planning team and the intervenable factors goals of those treatment needs Clinical Screens Focal Below are the key actions for completing this step Any field with an asterisk Treatment Flan indicates that the field is required Step Action The focal treatment screen may have been completed on the initial pre certification of services Users will update or add information as necessary 2 Update the Care Planning Team if needed gt S Update the Focal Treatment Need if needed in the Narrative Entry field The Narrative History field will list the original information given during the initial authorization and possible subsequent reviews For each Intervenable goal factor users should update the Progress field from the drop down menu i e Revised Ongoing Achieved and Discontinued and then provide Progress information in the Narrative Entry open text field below the Progress field Users will also need to update Measureable Objective and Intervention fields Select the Next button The Focal Treatment Plan screen will display next 8 250 Narrative Entry aes hy does the Member need this Care What is the focus of the reatment 1 Intervenable Factor Goal Target Date a MMDDYYYY Progress gt Narrative History ONGOING 44 of 2000 g
17. is a section that can be expanded to display fields or information Click on the title to expand or collapse the section Hyperlinked Any underlined codes that are input options for a field Codes 01 4 will populate the field when clicked Hyperlinked Diagnosis Code 1 Any underlined field title will open screens help text a Field Titles T list of codes etc when clicked Radio buttons Any data items with radio buttons next to them O ves O No O Unknown indicate that only one data item can be selected for that field Click inside of the circle to select the value Save Request as A Save Request as Draft button Is available on the Draft Request for Services screens which will save the record when clicked As a saved record it is only available within ProviderConnect and is not available to access in CareConnect A Submit button is available on some screens which heerlen will submit the record when clicked Text Boxes Member Guardian Any open text box indicates that free form text can be entered into the box 4 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Accessing ProviderConnect continued 1 Goto the CT BHP website at www CTBHP com 2 Select the For Providers button A VALUEOPTIONS Recovery an Reform Connecticut BHP Service Supporting Health and Recovery Support Wellness Care Coordination For Providers For Members 3 Under the forms section
18. match the partial value Click the code to populate the CODE and DESCRIPTION fields DIAGNOSIS 2 is optional if needed Update applicable options for Axis Ill if needed Update applicable options for AXIS IV if needed Enter the CURRENT GAF SCORE for Axis V Enter the Baseline Functioning Select the Next button The Treatment History tab will display next Key Step 9 The Treatment History screen details the member s psychiatric substance abuse Complete the and medical treatment in the past 12 months Clinical Screens Treatment History Screen Below are the key actions for completing this tab Any field with an asterisk indicates that the field is required Step Action Complete the PSYCHIATRIC TREATMENT IN PAST 12 MONTHS and the SUBSTANCE ABUSE TREATMENT IN PAST 12 MONTHS sections Indicate Yes No or Unknown for S MEMBER CURRENTLY ON PSYCHOTROPIC MEDICATION Note If user selects Yes then Medication information on the next clinical screen will be required Select the Next button The Psychotropic Medications screen will display next 22 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Completing Concurrent Requests continued Key Step 10 The Psychotropic Medications screen details the Psychotropic Medications that the Complete the member is currently utilizing and additional information regarding these medications Clinical Screens Psychotropic Below
19. oughout the ProviderConnect screens navigation features are available to Features simplify movement through the fields and screens Below are a few basic features available Feature What it Looks Like Description Breadcrumbs T Tabs with titles of each request screen will display on all of the request screens to show progress through the process ende Any field with an asterisk next to it indicates that the field is required and a data item must be entered or selected in order to complete the request Conditionally required fields will not have asterisks Back Button A Back button is available on most ProviderConnect screens to help navigate to previous screens The Back button on the ProviderConnect screens should only be used when navigating to the previous screen Do not use the back button on your Internet browser Calendar Icon E For date fields a pop up calendar can be accessed by clicking the calendar icon When the calendar opens click the date desired and the date field will automatically update with the selected date Cancel Button A Cancel button is available within some screens to ana allow a user to exit from the function Checkboxes B cenie pin Any data items with checkboxes next to them indicate that more than one data item can be selected for that E field Click inside of the box to select the value Expand Collapse Any title with an arrow gt to the left of the title t Narrative Entry indicates that it
20. pended to the CT BHP for further review Authorizations and authorization requests can be viewed and opened by providers from the Authorization Listing on the ProviderConnect homepage Once logged into ProviderConnect select Authorization Listing from the Home Page S PrUviIver UI 7 Pruyivers NUNG W PROVIDERCONNECT VALUEOPTIONS Home Authorization Listina Enter an Authorization Request Enter a Treatment Plan View Clinical Drafts Review Referrals Enter Bed Tracking Information Search Beds Openings My Online Profile Welcome Thank you for using ValueOptions ProviderConnect YOUR MESSAGE CENTER INBOX SENT Your Recent Inquiries box is empty WHAT DO YOU WANT TO DO TODAY Eligibility and Benefits Enter or Review Referrals a Find a Specific Member a Review Referrals Enter or Review Authorization Requests Enter Bed Tracking Information Enter CT case sensitive the Member s Medicaid ID i e CT005555555 in the Member ID field Home Specific Member Search Authorization Listing Enter an Authorization Request Enter a Treatment Plan View Clinical Drafts Review Referrals Enter Bed Tracking Information Search Beds Openings My Online Profile Search Authorizations el Required fields are denoted by an asterisk adjacent to the i orization Search transactions below Please select a Provider ID below to perform any one of the A Provider ID CBHP002120 NPI
21. previous eligibility date users can enter a previous date Eligibility amp Benefits Search hlernber ID Last Hame First Hame Date of Birth AO ee As of Date OHelbeoid roo ry ys 7 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews ProviderConnect Basics continued Review Members record details 3 Demographics Displays basic member information i e address phone etc 4 Enrollment History Displays active and expired enrollment records for member 5 COB Coordination of Benefits Display information on other insurance policies 6 Additional Information Displays claims mailing address for the member Demographics Enrollment History COB Additional Information Member eligibility does not guarantee payment Eligibility is as of today s date and is provided by our clients View Member Auths Displays Member specific authorizations Enter Auth Request Initiates the Request for Services process View Clinical Drafts Display member specific Clinical Drafts 0 View Referrals For Residential Group Home Providers Only os o Work Phone Relationship Gender View Member Auths Enter Auth Request View Clinical Drafts View Referrals 8 Revised 3 7 13 Features CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Viewing Providers have the ability to view and print authorizations as well as view Authorizations authorizations that have been
22. s can also be emailed to the Provider Relations Department at ctoho valueoptions com 5 User Accounts are created within 2 business days Once the Account is created you will be sent an email with your ProviderConnect User Name and Password If you have any questions please contact the CT BHP Provider Relations department at 1 877 552 8247 5 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Overview The ProviderConnect web application is found on the CT BHP website 1 Goto www CTBHP com 2 Select For Providers of A N VA LU EOPTIONS About Services Repo rts Contact CONNECTICUT Connecticut BHP Supporting Health and Recovery For Members 3 Select Log In 4 Providers should never select Register Prowider Online Services Welcome to the Connecticut Behavioral Health Partnership CT BHP Online Services ProwiderConnect Login or register with ProviderConnect an online tool that allows wou to check member eligibility enter authorization requests for GT BHP registered services view authorization letters and more Providerlonnect is easy to use secure and available 24 7 5 New Users without an ID refer to page 6 otherwise 6 Enter User ID and Password Please Log In Required fields are denoted by an asterisk adjacent to the label Please log in by entering your User ID and password below User ID If you do not remember your User
23. sted Approved will detail the status of each authorization by the following o Visits Requested Approved Indicates the number of units days that were requested and the number of units days that were approved o Visits Requested Approved 0 0 Indicates that the request has been pended for further review o Visits Requested Approved 0 Indicates that the request has been denied Submitted Concurrent Requests for Inpatient Psychiatric care will PEND to the CT BHP Clinical Team for further review Users will follow the above steps to view the status of the authorization within 24 hours of a request being submitted 11 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Features i aka While working with requests for authorizations in ProviderConnect providers have the ability to save a request as a draft in the event that they cannot complete it at the time the request was started Saved drafts can be viewed and opened by providers from the View Clinical Drafts screen accessible from the ProviderConnect homepage view Clinical Drafts eer cee Recent Inquires Responded to by Valuedptians Information 2 almevatelea Ea REFERRAL My Online Profile WHAT OO YOU WANT TO DO TODAY Eligibility and Benefits Find a Specific Member Enter or Review Authorization Requests Enter an 4uthorization Request E Review an Authorization E View Clinical Drafts Sa
24. t Narrative Entry Narrative History hat symptomology are you looking hange Measurable Objective gt Narrative Entry 46 of 2000 dditional Progress information can r gt Narrative History go here Seana eae ee Date Revised 02212013 G MMDDYYYY achieve to be ready for discharge Revision History gt Narrative Entry Intervention gt Narrative History gt Narrative Entry ow are you planning to use the ou are requesting to support the ember gi 24 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews b Key Step 13 The Additional MTPPR Information screen is only required for DCF Residential and Complete the Group Homes Clinical Screens Additional MTPPR Information Screen Step Action 1 This Clinical Screen is not required for inpatient requests E Select the Next button he Treatment Request amp Discharge Planning screen will display next Key Step 14 The Treatment Request amp Discharge Planning screen allows for the capture of Complete the information about the authorization request and the discharge plans for the member Clinical Screens Treatment Request amp Discharge Planning Screen Below are the key actions for completing this step Any field with an asterisk indicates that the field is required wa The Treatment Request amp Discharge Planning tab will have been primarily completed on the initial review but som
25. t to the label Verify a patient s eligibility and benefits information by entering search criteria below Member ID temp000 00056 vo spaces or dashes Last Hame First Hame Date of Birth 01151995 MMDDYYYY As of Date 08172010 MMDDYYYY 4 Select the Next button on the Member record to continue Menibenr Member It Alternate ID Member Hame Cate of Birth Address Alternate Address Marital Status Home Phone work Phone Felation ship Gender 5 The Select Service screen will display TEMP 0007 OOOH wr OODD SEIN MHO DOHNE O4 415 1905 3200 ENTERPRISE OR HARTFOREG NE EY Pi Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Completing Concurrent Requests continued 6 Capture the Service Address Vendor by selecting the radio button next to the Provider ID The record that is selected will be attached to the request and authorization that will be created NOTE You must select the same Service Address Vendor that was used on the Pre Cert for the system to recognize this as a Concurrent Review Select Service Address CBHPO02120 TEMP PROVIDER yCBO03159 TEMP PROVIDER 500 ENTERPRISE DR OTP 500 ENTERPRISE DR OTP STE 4D STE 4D ROCKY HILL CT 06067 3913 ROCKY HILL CT 06067 3913 TEMPFAC b CBHF002120 TEMP PROVIDER VCBOOS769 TEMP PROVIDER 999999999 500 ENTERPRISE DR 500 ENTERPRISE DR ROCKY HILL CT 06067 3913 ROCKY HILL CT 06067 3913 999999999
26. tion Process Continuing Care Concurrent Request Enter Discharge Information Cancel If you do not see the Process Continuing Care Concurrent Request button DO NOT continue Return to the previous page and re enter the information again making sure the Requested Start Date and Admit Date fields are correct If you are not prompted with the button above please call the CT BHP to troubleshoot your situation 17 Revised 3 7 13 IMPORTANT NOTE Saving Requests as Drafts CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Once the clinical screens in ProviderConnect have been accessed providers have the ability to save a request as a draft in the event that they cannot complete it at the time the request was started Users can click Save Request as Draft on the top right of the screen ProviderConnect Home ROPIC REQUESTED RESULTS IONS SERVICES Save Request as Draft Saved drafts can be viewed and opened by providers from the View Clinical Drafts screen accessible from the ProviderConnect homepage See pg 11 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Completing Concurrent Requests continued Key Step 3 For concurrent inpatient service requests the clinical screens for the inpatient Complete the request form workflow will display This workflow consists of eleven 11 clinical Clinical Screens screens The amount of information
27. uired Note Disable pop up blocker functionality to view al appropriate links Requested Start Date MMDDYYYY Level of Service INPATIENT HLOC Admit Date MMDDYYYY Provider Tax ID Provider ID Provider Last Name CBHPOO 7170 TEMP PROVIDER t Member Member ID Last Name First Name TEMPOO0DS46407 SSISTANCE ANITA Attach a Document Complete the form below to attach a document with this Request The following elds are only required if you are uploading a document n SET E Does this Document contain clinical information about the Member Ye Nol Document Description SELECT UploadFile Cicek ip attach a document __Delete Dia Attached Document 16 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews Completing Concurrent Requests continued 17 A warning message will display to confirm whether you want to proceed without attaching a document Select the OK button to proceed Microsoft Internet Explorer 2 WARNING You have not attached a document to this Request Please click CANCEL to return to the screen to attach a document or click OK to proceed with your request without attaching a document 18 Select the Process Continuing Care Concurrent Request button to complete the Concurrent Request There is an existing authorization that bridges this date range Is this a request for continuing care concurrent request or do you wish to enter Discharge informa
28. ved drafts are available for completion and submission for 30 days from the initial date the record was saved If the record is not submitted within the 30 days it will automatically expire Log Out TN ea A tts Sees Please select the Provider ID below to view and click the Search Drafts button to view Saved and Expired Clinical Requests or Saved and Expired Plans for a different provider Provider ID CBHPOOG4SS4 vw Search Drafts Saved Clinical Request Drafts eee Saved request drafts will automatically expire 30 days after the Initial Saved Date Delete Request Drafts Nent o Initial Saved Date Member ID Member Hame Provider 1D Lewel of Service Lewel of Care Type of Care Authorized User Requested Start Date A E 08 16 2010 TEMPOOO 00053 WOODSIN MOONEY CBHPOON454 Op Outpatient Family Support Teams FST Home 0816 2010 View pen Nent o gt When a record is saved as a draft it is NOT available for CT BHP clinical staff to review 12 Revised 3 7 13 CT BHP ProviderConnect User Manual Inpatient Concurrent Reviews b Completing Inpatient Concurrent Requests Key Step 1 The first key step is to initiate the request for a concurrent review which starts from Initiatea the ProviderConnect Homepage The function can also be initiated when the Concurrent Member record is located first and then the Enter an Auth Request button is Request for B selected Authorization Below are the key actions for completing this step
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