AboveHealth, User Manual - Maryland Physicians Care
Contents
1. 1 MMR 3 HIB 3 Hepatitis B 1 VZW 4 Pneumococc l conjugate CIS Childhood Immunization Status Page 1of1 Required Fields Maryland Physicians Care AH v3 26 18 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide 4 1 3 Claim Status The Claims Status inquiry enables you to search view and print an Explanation of Benefits EOB report of your claims Select the Claim Status Search option from the PRODUCT tab The Claim Status Search window displays Enter the claims information to perform the search Search criteria data fields include member information and claims information including the service date range After entering the search criteria click the Search button Claim Status Search This page allows you to conduct a claim search by identifying the patient subscriber and provider Enter the requested patient subscriber search information and provider last name organization name You can search for a provider by clicking search or enter a provider s last or organization name Clicking clear removes a provider from the search and allows you to insert a different provider Clicking search displays the results Search Patient Subscriber Information e cc MemberID 0 2 123456 DOB lv mm dd yy Gender Claim Information Servicing Provider Name Claim Type Claim Status Service Date From El to EH Maryland Physicians Care AH v3 26 19 Version 1 0 Maryland Ph2. Authorization No WEBMPC 7 Auth Status APPROVED Auth Type Scheduled Admit Auth Submission Date 09 03 2009 Submitted By Test Sinai Hospital Member Member First Name View Member Detail Member Last Name Member No Member Date of Birth 10 25 19 Member Gender MALE HEDIS Ind No g View HEDIS Indicators Member Policy Benefit Upgrade Health Choice MD N Elig Effective Date 01 13 2007 9 Term Date 12 31 2078 9 e The Intervention List window displays showing all current HEDIS measures interventions required for the member HEDIS interventions will only be displayed in the Intervention List section of the page when the label on the HEDIS hyperlink is Yes Home gt Member Eligibility Search gt Member Eligibility List Intervention List Search amp Printer Friendly Format 7 Search Date 05 15 2009 FS 2 mm dd yyyy Required Fields Member Information Member Name 7 Member ID 7 DOB 7 04 27 2007 9 Member Age 2 years Intervention List Intervention Intervention Measure s ps Code Intervention Measure Intervention Steps ADV Annual Dental Visit Has the patient had at least one dental visit this calendar year CAP Children and Adolescents Access to Primary Care Practitioners jeni patient received preventive ambulatory health services this calendar Are the patient s immunizations up to date The following are required on or before the Member s 2nd birthday 4 DtaP DT 3 IPV
3. e If the browser prompts you with a request to remember your password click No The Provider home page will display Maryland Physicians Care AH v3 26 4 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide Q RANA D clan rT ME Ce p YSIC lar 5 a re Providers Home FAQ Sign Out Welcome ACCOUNT Welcome to the Maryland Physicians Care electronic health care community The purpose of this web site is to provide you with immediate access to the health plan information Whether you are a member or provider you ll find helpful information and resources within this section of our Web site In a secured environment you can review your claims and or authorizations dika eligibility status search for providers or submit requests Contact If you have any questions or need assistance with this website please call the Provider Relations department at 1 800 953 8854 Get Adobe Reader Dovnload the latest version of Adobe Reader Event Calendar N Related Documents 2 2 3 To Request Your Password If you are not able to login to the system because you have forgotten your password e At the login window click the Forgot your password Click Here link Enter your Username User Last Name and First Name and click the Next gt button On the confirmation screen click the Send Password button Your password will be sent to you via the e mail address assigned to the u
4. Detail window appears Click on the Delete User option Provider Employee Welcome Temp Provider Home gt User List User Detail This page allows you to view details for the selected user You can edit or delete the user and reset the user s password User Information diy Reset Password g7 Edit Usef a Delete User Name Provider Temp Username Role Provider Super User Password Question Password Answer Email test test com Office Locked N Deleted MH Yerbose Level None e The Delete User window displays Click on the Delete button Provider Employee Welcome Temp Provider Home gt User List gt User Detail Delete User This page allows Health Plan users to remove a user from the database the user will no longer be permission Provider Employees and Employers can perform this operation Members with active be delete your own User account User Information Name Provider Temp Username Role Provider Super User Password Question Password Answer Email test test com Office Locked Deleted N Yerbose Level None Maryland Physicians Care AH v3 26 12 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e The User List window displays with the Deleted column Y for the selected user e Use the breadcrumbs or menu tab options to return to the previous screen s 3 1 4 Reset a User Password e Select the User List option from the ACCOUNT tab The User List window displays e Searc
5. File Name Upload Delete oP Add another Attachment Required Fields Metrix Tools Start Recording 2009 Copyright Healthstion com All Rights Reserved Source Detail Component WorkflowClient Maryland Physicians Care AH v3 26 32 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide 5 2 Completing the Authorization Request Once the type is selected the specific authorization detail is entered 5 2 1 Member Information Member Enter a Member No Search for a Member Member First Name Member Last Name Member No Member Date of Birth Member Gender HEDIS Ind No Member Policy Benefit Elig Effective Date Term Date e The first step in the authorization submission process is to select the member for which the referral is being made e Ji the member ID is known simply enter it in the Enter Member No field Note that if the member s ID is entered directly in this field the member s information will not be displayed on the page e Otherwise click on the Search for a Member magnifying glass symbol to perform the search The Member Eligibility Search window displays Enter the member information to perform the search The member ID number is required as the minimum search data set Search data fields include Date of Birth Member ID and Member Last First Name Note that the dropdown field Include Ineligible is defaulted to No indicating t
6. panel raster link allows you to see a list of members who have selected this provider as PCP Click any add links to add addition Information for subject area or click any existing information link to edit that information Clicking submit saves the information General Information Provider Last Name Provider First Name Middle Name M Suffix Additional Name Salutation Gender MALE DOB Ethnicity SSH EIN Provider Type PHYSICIAN Degree MD Provider No Comments State License No Issuing State Phone J Pager Fax J Cell Phone Email URL Provider Identifiers Identifier Type HIPAA Primary Specialty MPT Y Payer Assigned H Provider Languages Language Use of Language Is Primary FRENCH K EMGLISH M Provider Specialties Specialty Status Effective Date Expiration Date Pediatrics O7 01 2004 Tea ene Provider Locations Office Name Address Address city State Zip Code Provider Network Affiliations Network Preferred M Provider Affiliations Mame Provider M Affiliated Location Hospital and Group Affiliations Mame Affiliated Location Maryland Physicians Care AH v3 26 Par Code Participating Provider Inplan Effective Date Mo results found Effective Date 01 01 2008 29 Q view Panel Roster Location Board Certified Office Contact Mame Telephone Affiliation Type PRIMARY CARE PROVIDER Expiration Date Expiration Date 12731 2078 Version 1 0 Maryland Physicians Care Provider Web
7. user to submit an outpatient authorization request If the authorization request is urgent or an unscheduled inpatient admission please call the Prior Authorization department at 1 800 953 8854 Emergency room services do not require authorization or notification to the health plan There were problems with this page Please correct the entries flagged with the 4 before proceeding Member Enter a Member No XXXXXXXXXX Search for a Member 9 Member First Name Member Last Name Member No Member Date of Birth Member Gender HEDIS Ind No Member Policy Benefit N Elig Effective Date Term Date Medical Indications ii Diagnosis Code 945 5 Search for a Diagnosis Code 9 cP Add a Diagnosis Code Medical Clinical Indications e Correct any error s and click the Submit button again e Upon successful completion of the authorization submission the Request Submitted Successfully window will display with the assigned authorization number shown in the Authorization No field Home REQUEST SUBMITTED SUCCESSFULLY Thank you Your Authorization Request has been submitted This is only a request for authorization You will be notified of the authorization approval or denial within 3 5 business days unless additional information is needed to complete your request If a determination cannot be made based on what you provided you will be contacted Authorization No WEBMPC00034 Email Notifi
8. 0 953 8854 Emergency room services do not require authorization or notification to the health plan MEMBER ELIGIBILITY Member SEARCH Enter a Member No Search for a Member PANEL ROSTER PROVIDER LIST Member First Name CLAIM STATUS SEARCH Member Last Name REMITTANCE ADVICE Member No SEARCH Member Date of Birth AUTHORIZATION LIST Member Gender SUBMIT AUTHORIZATIONS HEDIS Ind No t SCHEDULED ADMIT Member Policy Benefit gt OUTPATIENT Elig Effective Date Term Date Medical Indications vi Diagnosis Code Search for a Diagnosis Code 9 Add a Diagnosis Code Medical Clinical Indications Requesting Provider Provider Affiliations w NPI Reguesting Provider No Servicing Provider Search for a Provider O First Name Last Name Enter a Servicing Provider No NPI Servicing Provider No Service Line Information Start Date 09 14 2009 TP Add another service line End Date CPT Code CPT4 HCPCS Search for a Code 9 Codes Rev Code NUBC Search for a Code 9 Revenue Code Units File Attachments To attach a file to this auth select the appropriate value for Report Type then click the Upload button plus sign Follow the instructions provided to search for and attach the file If you need to attach an additional file click the Add another Attachment button select a value for Report Type then click the Upload button Report Type
9. 2009 Check No Adjudication Date 05 14 2009 Service Line Information Line No Service Date Qualifier Billed CPT Adjudicated CPT Modifier Revenue Code Units Claim Status Remarks Billed Amt Payment 1 06 19 2003 06 19 2003 CPT 80048 80048 300 1 Okay 40 16 65 14 78 2 06 19 2003 06 19 2003 CPT 83690 83690 301 1 Okay 40 5 96 5 29 3 06 19 2003 06 19 2003 CPT 82150 82150 301 1 Okay 40 5 33 4 73 e Use the breadcrumbs or menu tab options to return to the previous screen s Maryland Physicians Care AH v3 26 20 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide 4 1 4 Authorization Status The Authorization Status inquiry enables you to search view and print an authorization request e Select the Authorization List option from the PRODUCT tab The Authorization List window displays e Enter the authorization information to perform the search The member ID number is required as the minimum search data set Search criteria data fields include member provider and authorization information along with service submission date ranges After entering the search criteria click the Search button Authorization List This page allows you to search for an authorization by a variety of search criteria The member search function to locate and specify a member for the authorization search the provider search function is used to specify a provider for the authorization search The search can also be narrowed
10. 6 13 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide 3 2 User Profile Users of the secure web portal are allowed to maintain specific information regarding their user account such as name password e mail address password security question notification preferences and verbosity level e Select the User Profile option from the ACCOUNT tab The User Profile window displays User Profile This page displays information associated with the currently logged in user and permits that user to make name password and email address changes Click submit o Save to save your changes and return to the Home Page Personal Information yi User Last Name Provider First Name Temp Middle Name Change Password If no text is entered in this section your password will remain unchanged Old Password Password Confirm Password Email Address Email Providerl emp provider com Security Question Password Question K3 Password Answer Preferences Preference Selected Accept notification emails Receive Updates to the Formulary LI User Verbose Level N z Verbose Level None Reguired Fields e Ataminimum the user s Last Name First Name and E mail Address are required e To change the account password enter the current password into the Old Password field the new password into the Password field and the new password again into the Confirm Pass
11. Auth Line Submission Member Name Requesting Servicing No Cert Auth Type Status Date Service Dates Member ID career ME Detail WEB Bi pe 80 OP Surgery PPROVED goyi6 2008 0 07 2008 2 WEB 81 Surgical APPROVED 09 24 2008 Ay g a 9 2 8 of a im Detail WEB Inpatient 09 16 2008 09 25 2008 Maryland Physicians Care AH v3 26 21 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e The Authorization Detail window displays with the authorization request header and detail information Home FAO Sign Out Home gt Authorization List Authorization Detail ACCOUNT This page displays the selected authorization s detail PRODUCT Printer Friendly Format MEMBER ELIGIBILITY Authorization Information iri Authorization No WEB 10017 PANEL ROSTER Auth Status APPROVED gp PROVIDER LIST CLAIM STATUS SEARCH Auth Type Scheduled Admit REMITTANCE ADVICE Auth Submission Date 09 03 2009 SEARCH Submitted By AUTHORIZATION LIST SUBMIT AUTHORIZATIONS Member SCHEDULED ADMIT OUTPATIENT Member First Name View Member Detail Member Last Name Member No Member Date of Birth 10 25 1988 Member Gender MALE HEDIS Ind No Member Policy Benefit Upgrade Health Choice Elig Effective Date 01 13 2007 9 9 View HEDIS Indicators Term Date 12 31 2078 9 Medical Indications Diagnosis V22 2 PREGNANT STATE INCIDENTAL Medical Indications Services Provider Requesting Provider Firs
12. MARYLAND Q C physicians care gt MANAGED CARE ORGANIZATION Maryland Physicians Care Web Portal Provider Web Portal Navigation Guide Ver 1 0 June 2012 Maryland Physicians Care Provider Web Portal Navigation Guide TABLE OF CONTENTS LO Se Clea Site OVeE Vie ep MM RAN RR A seta ascent et We Me ER l PLACCON EMm N A AM KN YE EM AM PE MEY l L PRODUCT M m TiO a e a es WE m aa ala E Sa l 2 0 NAGI PIU Tps and Geine Starte Os por ce tot ante ind mailde Bae al ike eee Sale 2 N PULT p en ie esc te ea e Me uote io Ml e Ee e es eG 2 ZREN anom Breadcrum DS aens A eee yala gt 2 12 Orme RESOUS mad plane nesi si aa ek dual anasi si asan kaka ade aaa il una aka 2 2A Ponin ING DO Se tie anes eh a lamam da halada means oo iissm men abner 3 2AF Bue Bolded VOX hoaia a A e AM AE dl Meanie ER DOM eee e 3 DD m ze gz RE E VA MV KA ei Me 3 222M e el Ni m eye NOW a e e e e e e ve 3 2 2 2 To Access the Secured Portion of the WebsStte 4 22 VO Redgnesi OUT PASS WONG i a a a a a Gal ar e ale el l ila emin 5 Died ANG SIC e m e e e aan 5 30 Primary Representan ye ROl espic a a haha t asnionasacte anlamama siena 6 3 4 User ACCOUNL IVI alte Maine Ceanna a a ate a ilke 6 co ei Ya Ve Ve EOS e caret ee eee MER re OD or ted te aE MEYE PR SEAL ER eR ny Pree ee er 6 NM NO SO M NE A ML K 10 Cle Slm ia cure ki toot eae ee eae eos lak ai 11 NEER T W Sel FASS WO e A EM EEEN AA 13 YL E ll bd 0 6 NAR
13. Member ID Patient Control No Member Name Subscriber ID Claim No Claim Status Patient Responsibility 00 Claim Date 06 02 2008 Service Lines 1 e An additional search is available to allow the user to find a specific member or specific claim within the RA If desired enter the additional criteria and click Search e Click on a specific claim number to show the Claim Status Detail screen e Click on the Expand Collapse option next an individual claim to display the claim payment detail information e Use the breadcrumbs or menu tab options to return to the previous screen s Maryland Physicians Care AH v3 26 25 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide 4 1 6 Panel Roster The Panel Roster inquiry enables the user to view print and download a list of members currently assigned to the provider as primary care physician PCP e Select the Panel Roster option from the PRODUCT tab The Panel Roster window displays Provider Employee Welcome Temp Provider Home Panel Roster This page enables you to view a list of members currently assigned to the provider as primary care physician PCP Select a Provider Provider Name e The desired provider name must be selected as the first step Click on the magnifying glass symbol to search for the affiliated providers Provider Employee Welcome Temp Provider Home gt Panel Roster Provider List This page allows you to search for and selec
14. OSTER PROVIDER LIST CLAIM STATUS SEARCH REMITTANCE ADVICE SEARCH AUTHORIZATION LIST SUBMIT AUTHORIZATIONS t SCHEDULED ADMIT t OUTPATIENT Member Eligibility Search Verify current eligibility on one or more members Maryland Physicians Care AH v3 26 1 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide Panel Roster View the list of members currently assigned to the provider as the primary care physician PCP Provider List Search for a specific health plan provider by name specialty or location Claim Status Search Search for provider claims by member provider claim number or service dates Only claims associated with the user s account provider ID will be displayed Remittance Advice Search Search for provider claim payment information by check number provider claim number or check issue service dates Only remits associated with the user s account provider ID will be displayed Authorization List Search for provider authorizations by member provider authorization data or submission service dates Only authorizations associated with the user s account provider ID will be displayed Submit Authorizations Submit an authorization request on line Two types of authorization types are available Scheduled Admit Outpatient 2 0 Helpful Tips and Getting Started This section provides some tips for navigating the web site as well as information to get the user starte
15. Physicians Care Provider Web Portal Navigation Guide e The Add User window displays Enter the required user account information required fields are marked with and click Submit Provider Employee Welcome Temp Provider Home gt User List gt User Type gt Provider Employee List Add User This page steps you through definition of a new User Depending on where you are in the process tr The following are the basic steps 1 Select UserType and click Next Depending on the user type one of the following pages displays Employer gt employers page Health Plan gt health plan offices Provider Employee gt provider list Member gt member eligibility search Broker gt broker list 2 For Employer Health Plan or Provider Group select the office that the new user is to be associate and Brokers find and select a user 3 Enter required information needed to complete the account and click submit User Information First Name Temp User Role Password Yerbose Level None Required Fields E Email Maryland Physicians Care AH v3 26 9 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e The User List window will be displayed Search for the new user account to verify creation and active status Note Upon the user s first login with their new account the system will require the password to be changed e Use the breadcrumbs or menu tab options to ret
16. Portal Navigation Guide Patient Restrictions Seren kli Network Business Location Affiliation pone Se ne Accepting Patient ACCE nting New HOSPITAL I 0 216 alee ele Provider Employees qr 4dd Employee Name Title Position Telephone No results found Provider Employee Roles Role Provider Group Wo Auth Submit Provider Group Provider Group Admin No Auth Submit Provider Super User e To display the provider s panel roster click on the View Panel Roster option e Use the breadcrumbs or menu tab options to return to the previous screen s 4 2 2 To Perform a Provider Directory Search To perform a search of all providers use the following link http www marylandphysicianscare com ProviderSearch aspx for the Provider Directory Search function on the Maryland Physicians Care static web site Welcome to Maryland Physicians Care Please take a moment to explore our newly updated site We have Included valuable information and resources to assist you with all of your health care needs Here are some of the helpful features of our Web site e searchable Provider Directory Member Handbook With a variety of medical services and a large network of primary care doctors and specialists Maryland Physicians Care is committed to giving our members the care they need and the respect they deserve Maryland Physicians Care AH v3 26 30 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide 5 0 Submitting a
17. Provider Employee Welcome Temp Provider Home Remittance Advice Search This page allows you to search for claim payment information You can access all claims by clicking Search all inform display To narrow the search complete as many fields as desired If no results are found widen your search criteri RA will only display when a check has been issued Search DOS Date Range fs He Hie immidd yyy Payment Method Code Payer Name S O Check Issue Date oo Bale immiddiyyyy Mame e The Remittance Advice Search window will redisplay with those RAs meeting the criteria Click on an individual check number Results H Download File Check No Payer Name Payee Name Check Issue Date CLINIC 06 17 2008 CLINIC 06 17 2008 Page 1 of 1 Maryland Physicians Care AH v3 26 24 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e The Remittance Advice Detail window displays with the RA total payment amount and associated claim detail information Provider Employee Welcome Temp Provider Home gt Remittance Advice Search Remittance Advice Detail Remittance Advice No Payment Information Printer Friendly Format 7 Expand All gt Collapse All ACH 06 17 2008 ATLANTA G amp A 30384 273 017 78 Contact Search Provider Summary CLINIC PRO VOO0O0 NPI Expand collapse Claims 1549 Paid 273 017 75 Total Charged 820 786 00 Claim Information gt Expand Collapse Patient
18. R ee TONA E O EE gl e E ea ee ei 14 AA SEARCHES and TOOU eS ami a an an a ban a o la b sa a dl 15 El ale are Data MOU Yaaa eme an aa m alel ana e Mama ali 15 4 1 1 Member Eligibility Verification sen irisi maa a il ae Ba ala l almis a 15 77 12 Member HEDIS Measures mk yala ein yeli anla lll ea alan e i ni unla ears 17 Ay ls DV ip ei 2 RE EREN EREN e Ee S daa MAN E MR e eo Eee 19 AAPL NOPIZ 2 0 Ke nie ez b e e RE YE PM e e Me lan ee 21 AAD RCM MACC NOVICE S ea A MER e EN ties 24 Aral 0 e ANNO UES OS CI EN E ME NM EM ME YE MAL 26 KEZ A Uo ee e iy Se GA N NERE EE SM a SERE Va KR A Se ANAL Dn e 28 AD To Perforar a Provider List Se ane Mann deki akide inanin ai elemeli aaineilal 28 4 2 2 Lo Perlomya Provider Directory SC ME N sa sana ei as cle al a lal b le tenc sees 30 5 0Submit nganAuthorizattonReguest 0 31 3 1 Selectime thes AUINOrZ ALLO Type ani yaa ad yala nan ya i aaa alsa oan aog sika 31 32 Completing the A uthor za o Ke ES bs caccuenttssstabincucearinbulabesiatuenide setae akel lal iidemeeiinii 33 5 2 el Member N Orma Geren di e ekb e ae ae da a l sek adr n bla E m 33 VaMe diical Mae aO araa e gina Balla ie a asa ml lim ka al 33 ee OLE en Alaz AG NVA 8c e e e e e ee e ee yey 34 DV CID EO V Em e nk a a na Na 34 5 2 5 Authorization Service lnformatlon Geeeeee erer 35 yok A tac MIN CS scot arent whan end mala el aki i anarak even uum leGi
19. ailed description of the services being requested Also include a contact name and phone number should the health plan need to contact you for additional information regarding the authorization request 5 2 3 Requesting Provider Requesting Provider Search for a Provider 4 First Name Last Name No NPI Requesting Provider No e With the member selected and the authorization medical information entered the next step in the authorization submission process is to select the requesting provider who is making the referral e If the provider ID is known simply enter it in the Enter a Requesting Provider No field Note that if the provider s ID is entered directly in this field the provider s information will not be displayed e Otherwise click on the Search for a Provider magnifying glass symbol to perform the search The Provider List window displays e Enter the provider name and or ID information to perform the search After entering the search criteria click the Search button The Provider List window redisplays with the providers who match the search criteria e Click on the Select link next to the desired provider The Authorization Request window is redisplayed with the requesting provider s information now populated 5 2 4 Servicing Provider Servicing Provider Search for a Provider 4 First Name Last Name NPI Servicing Provider No e After the requesting provider is chosen the user must now selec
20. alue for Report Type then click the Upload button plus sign Follow the instructions provided to search for and attach the file If you need to attach an additional file click the Add another Attachment button select a value for Report Type then click the Upload button Acceptable file types pdf jpg gif bmp zip txt html csv doc docx xIs ppt Report Type Diagnostic Report v Report Type N File Name Upload View Delete DinanaslirBengri 20090826 doc oP a ot lt P Add another Attachment lt 4 Required Fields e To attach additional documents click the Add another Attachment link You can attach up to 10 documents Max size of each document is 5 MG e To delete an attached document click the Delete icon Maryland Physicians Care AH v3 26 36 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide 5 2 8 Final Submission of the Authorization e When all authorization information has been entered click the Submit button e If there are any errors in the data entered on the authorization the Authorization Request window will redisplay with the message There were problems with this page Please correct the entries flagged before proceeding Each field containing an error will be indicated by a red triangle Hover the pointer over the red triangle to display the specific field error message Home Authorization Request This page allows the
21. an number and display results in a form suitable for printing Active Download File amp Printer Friendly Format Cov Provider Prov Eff MemberID DOB Member Name HEDIS Elig Eff Dates Benefit Plan ID Type Network rim Data 08 06 2009 Upgrade Health Maryland i 06 04 19 Yes 12 31 2078 Choice MD MPC0001 Medical Physicians Care 08 06 2009 Page 1of1 Note If you wish to search again the information you originally entered for these members will be retained allowing you to correct any information you previously entered Search Again e The HEDIS measures hyperlink is also available from the Member Detail window display Click on the hyperlink in the HEDIS field Employer Karade A EO a MA ili i Member Name c0cncnrnr000 Member Name Member ID Member DOB 06 04 1962 5 Gender FEMALE Marital Status Code Address OLD EMMORTON RD ABINGDON Maryland Home Phone 410 569 2089 Work Phone Fax HEDIS Yes Maryland Physicians Care AH v3 26 17 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e Alternatively the HEDIS measures hyperlink is also available from the Authorization Detail window when viewing authorization requests specific to the member Click on the View HEDIS Indicators hyperlink Home gt Authorization List Authorization Detail This page displays the selected authorization s detail amp Printer Friendly Format Authorization Information
22. are listed To narrow the list enter search criteria If displayed during a selection process clicking the select link next to the provider number selects that provider Clicking the provider name displays detailed information for the selected provider Clicking the add link allows you to add a new provider to the list Search Download File amp Printer Friendly Format Provider Last Name Provider First Name Provider No Provider Type Specialty Selecta Provider Type to Populate List Network Ali Networks v Affiliation Type Par Code In Directory City State Results Provider No Identifier Provider Name Provider Type Specialty Network Address Maryland Physicians Wolfe St Baltimore MD re Physician Anesthesiology 21287 e After entering the search criteria click the Search button The Provider List window will re display with those providers meeting the criteria Maryland Physicians Care AH v3 26 28 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e Click on the provider s name The Provider Detail window displays with the provider s current demographic specialty and affiliation information Provider Employee elcome Temp Provider Home gt Provider List Provider Detail This page allows you to view fedit information for the selected provider Clicking the edit link allows you to change general information The view
23. by specifying specific authorization information authorization number type status etc Authorizations can also be search for by dates and workgroup information When search criteria has been specified click search to display the results To view a screen of the results suitable for printing click the Printer Friendly Format Use the clear functions to clear member and provider search data Click an authorization s detail link to view more information about the authorization Search amp Printer Friendly Format Member Information a Member Last Name Member First Name Member ID Provider Information g Provider Last Name Provider No Servicing Provider Provider Type Requesting Provider Authorization Information Authorization No Cert Cert Type vi Auth Line Status v Auth Type i Submitted Online Date Information d Search Date Type O Submission Date Service Date Time Frame l OR Single Date mm dd yyyy OR N Date Range to mmn dd yyyy e The Authorization List window will redisplay with those authorizations meeting the criteria Hyperlinks are available on the Member Name Requesting Provider and Servicing Provider These links will take you to the corresponding detail page for that entity e Click on the Detail link next to the authorization number Results g Download File Authorization
24. cation Member and or Provider s must have a valid email address in the system to receive a notification email Send Email Notification to Member Send Email Notification to Reguesting Provider Send Email Notification to Servicing Provider e Check the desired e mail notification boxes to inform the other provider and member of the authorization submission e Click the Submit Another button to create another authorization or the Done button to return to the home page or use the breadcrumbs or menu tab options to navigate to other screens Maryland Physicians Care AH v3 26 37 Version 1 0
25. com click on the Login option and print off the Provider Web Portal Registration Form to be faxed into the Provider Relations Department Maryland Physicians Care AH v3 26 3 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide 2 2 2 To Access the Secured Portion of the Web Site Passwords are case sensitive and must be entered exactly as they are maintained in the system Usernames are not case sensitive To logon the secure web site e Access your Internet Explorer or other browser session e Inthe address field enter www marylandphysicianscare com e From the Maryland Physicians Care main page click the Login option j LOGIN e The secured web site login screen will display Enter your User Name and Password and click the Login button Note that passwords are case sensitive and must be entered exactly as assigned Q MARYLAND physicians care MANAGED CARE ORGANIZATION Log In Username password O Why Register with Maryland Physicians Care Whether you are a member or provider you ll find helpful information and resources within this section of our Web site In a secured environment you can review your claims or authorizations search for providers or submit requests We invite you to register and learn more about what Maryland Physicians Care can offer you If you are a current member and wish to access your account Register Here Forgot your password Click Here
26. d using the system 2 1 Helpful Tips 2 1 1 Navigation Breadcrumbs To help you navigate through the application you can use a navigational assistant referred to as a Breadcrumb Breadcrumbs are the links at the top of the page that show a trail of where you have been in the application Do not use the browser back button to navigate through the application Use the navigation breadcrumbs to move from screen to screen Provider Employee Welcome Temp Provider Home gt Claim Status Search gt Claim Status List Claim Status Dd 2 1 2 Sorting Results On most screens searches display the resulting information in a table To sort the information by one of the table columns move the pointer over the column heading title Note that only column titles that are underlined are allowed to be sorted Click the column heading title to resort the result set Results Claim N Claim Type Name Service Date yiz Claim Status Maryland Physicians Care AH v3 26 2 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide 2 1 3 Printing Reports On most screens search results and detail information can be printed in one of two manners e Printer Friendly Format button When clicked a separate browser window will open with the resulting report After printing click the red X to close the window and return to the secured section of the web site Note that the printed report will only contain the information that 1s v
27. ditional file click the Add another Attachment button select a value for Report Type then click the Upload button Mi ei file ae pdf jpg gif bmp zip txt html csv doc docx xIs ppt gt Report Type ye Report v Report Type File Name Upload View Delete qP 3 cP Add another Attachment Required Fields e You may attach supporting documentation in the File Attachment section of the Authorization Submission form Acceptable file types are listed in the notes section of File Attachment e To attach a document click on the Report Type drop down menu to select the appropriate value Note you must select a report type before you can upload a document e Click the plus sign under the Upload label You will be taken to the Upload Attachment screen Upload Attachment This page allows you to browse and upload a file from your hard drive Click browse to locate a file on your harddrive and click upload to attach the file to the message Only files less than 5MB can be uploaded successfully Upload Find es e lt lt e Use the Browse button to search for and select your document e Select Submit to complete the attachment of your file and return to the Authorization Request screen Select Cancel to return to the Authorization Request screen without attaching a document File Attachments To attach a file to this auth select the appropriate v
28. earch for ineligible members select yes from the dropdown menu SEA it z Search PANEL ROSTER DOB Member ID Member Last Name Member First Name PRONTOER LIST ERS Ear AEM EARC ih MICE fale F 7 7 Delete ah Se Delete Dil AUTHORIZA MEDICAL ca T 7 elete es Esiri 2 Delete Include Ineligible No Required Fields Member ID or DOE amp Member LastName Search Maryland Physicians Care AH v3 26 15 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e The Member Eligibility List window displays Click on the member s name MARYLAND hysicians care Providers a OP Home FAQ Sign Out Home gt Member Eligibili e Member Eligibility List This page displays the members meeting the search criteria You can conduct another search by clicking search again view member detail by clicking a member name PRODUCT link view benefit plan information by clicking a plan number link and display results in a form suitable for printing MEMBER ELIGIBILITY Active Download File amp Printer Friendly Format li Cov Provider Prov Eff PANEL ROSTER MemberID DOB Member Name HEDIS Elig Eff Dates Benefit Plan ID Type Network sass Date PROVIDER LIST 08 06 2009 l Maryland i l ee 06 04 1962 12 31 2078 IT MPCo001 Medical physicians Care 08 06 2009 REMITTANCE ADVICE i TARN Page 1 of 1 AUTHORIZATION LIST Note If you wish to search again the information you ori
29. et A ened atlanta dase 36 5 2 8 Final Submission oftheAuthorizatlon Gene 37 Maryland Physicians Care AH v3 26 1 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide 1 0 Secured Site Overview MPC provides a web based platform enabling health plans to communicate healthcare information directly with providers Users can perform transactions download information and work interactively with member healthcare information Providers can use the secure web site application to e Verify member eligibility View member HEDIS intervention requirements View and print panel rosters Check on claims status View remittance advice claim payment information Submit authorizations referrals to the health plan Check authorization referral status 1 1 ACCOUNT Menu Tab The ACCOUNT Menu Tab allows the provider to manage the administration tasks within the secure web site ACCOUNT USER LIST USER PROFILE User List Available to provider office site administrators allows the user to create view and manage office employee user accounts User Profile Displays user account information and permits the user to make name password email address and security question changes 1 2 PRODUCT Menu Tab The PRODUCT Menu Tab allows the provider to view member provider claim authorization remit and panel roster information within the secure web site PRODUCT MEMBER ELIGIBILITY SEARCH PANEL R
30. ginally entered for these members will be retained allowing you to correct any information you previously SUBMIT AUTHORIZATIONS entered t SCHEDULED ADMIT OUTPATIENT e The Member Detail window displays with the member s current demographic eligibility and assigned PCP information Home gt Member Eligibility Search gt Member Eligibility List Member Detail _ This page displays member specific information The drill down options may vary depending on permissions set up by the health plan Among options for members are the ability to edit their their address add dependents select PCPs view their eligibility history and others If a user account has been defined its information will be displayed Members may also elect to share information with family or the subscriber Search Search As Of Date 09 14 2009 Ely mm dd yyyy Required Fields Employer Birisin ciara ee ee Family Member Name Member ID ad Q View Claims Member Name O O O Member ID Member DOB 06 04 1962 Gender FEMALE Marital Status Code Address OLD EMMORTON RD ABINGDON Maryland 21009 Home Phone Eligibility Information Q View Eligibility History Benefit Cov Type Eff Date Term vate Upgrade Health Choice MD Medical 08 06 2009 12 31 2078 Primary Care Physician Provider Name Cov Type Provider Type Network Prov Eff Date Medical Physician Maryland Physicians Care 08 06 2009 Other Coverage LOB Coverage Ty
31. h for and select the user whose password you would like to reset by clicking on their Name The User Detail window displays Click on the Reset Password option Provider Employee Welcome Temp Provider Home gt User List User Detail This page allows you to view details for the selected user You can edit or delete the user and reset the user s password ie Reset Password g Edit User taf Delete User User Information Name Provider Temp Username Role Provider Super User Password Question Password Answer Email test test com Office Locked H Deleted N Verbose Level None e The Reset User Password window displays Click on the Reset Password button The randomly generated password eight uppercase letters will display Click Submit Provider Employee Welcome Temp Provider Home gt User List gt User Detail Reset User Password This page allows health plan users to reset a user s password If granted permission provider empla operation Clicking submit activates the new password The current password remains in effect if you Password Information Username Password Question Password Answer Reset Password New Password EGTOLYGF k e The User Detail window displays Click the User List breadcrumb to return Note Upon the user s next login the system will require the password to be changed e Use the breadcrumbs or menu tab options to return to the previous screen s Maryland Physicians Care AH v3 2
32. hat the search should only result in a member that has current enrollment benefits e After entering the search criteria click the Search button The Member Eligibility List window displays e Click on the Select link next to the member The Authorization Request window is redisplayed with the member s information now populated 5 2 2 Medical Indications Medical Indications Search for a Diagnosis Code di Diagnosis Code ar Add a Diagnosis Code Medical Clinical Indications In the Diagnosis Code box enter the first diagnosis code for the member If the actual code is not known click on the Search for a Diagnosis Code magnifying glass symbol The Diagnosis List window displays Enter the diagnosis description a partial description is okay and click Search From the resulting list of ICD9 Details click the Select link next to the desired code The Authorization Request window is redisplayed with the selected diagnosis code populated Maryland Physicians Care AH v3 26 33 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e To enter an additional diagnosis code up to four can be submitted on the authorization click on the Add a Diagnosis Code option e If multiple diagnosis codes are displayed and one or more need to be removed click on the Delete a Diagnosis Code option next to the code to be removed e In the Medical Clinical Indications box enter a det
33. iewed on the page If the result set comprises multiple pages and the entire block of information needs to be printed please refer to the next option C Printer Friendly Format e Download File button When clicked a dialog box window will display If the browser popup blocker is enabled click on the yellow information text bar at the top and then click Download File to continue A second dialog box will open to allow the user to Open the file in a spreadsheet format Save the file to the desktop in a spreadsheet format or Cancel the file download action For ease of use it is recommended that the Save action be take to download and save the file The provider is then able to open and work with the search result file using their normal desktop spreadsheet office application Download File Total Billed m Total Payment 2 1 4 Blue Bolded Text Many page displays contain blue underlined text that can be clicked on to show further associated detail Results ein Claim Type Name J Service Date Provider Claim Stat Professional 04 10 2008 Paid 2 2 Getting Started 2 2 1 To Register as a New User A user name and password are required to access the secure Web site User names and passwords are distributed by the Maryland Physician Care Provider Relations Department They can be reached at 800 953 8854 You can also go to the Maryland Physicians Care web site www marylandphysicianscare
34. igation Guide Address Bi https delawarephysicianscare abovehealth com servigf attachmentGet File Download Do you want to open or save this file w Name Fisher JPT Daily 08 19 09 rtf A Type Rich Text Format From delawarephysicianscare abovehealth com oen seve canca While files from the Intemet can be useful some files can potentially 7 ham your computer f you do not trust the source do not open or save this file What s the risk e When you have finished viewing the document click the red X in the upper right corner of the document and the attachmentget window to return to the Authorization Detail screen e Use the breadcrumbs or menu tab options to return to the previous screen s Maryland Physicians Care AH v3 26 23 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide 4 1 5 Remittance Advice Status The RA Inquiry enables you to search view and print a Remittance Advice summary report of paid claims e Select the Remittance Advice Search option from the PRODUCT tab The Remittance Advice Search window displays e The initial default display will be those RAs specific to the user s associated account provider ID Enter the RA information to perform the search Search criteria data fields include check number claim number member information check issue date and the service date range After entering the search criteria click the Search button
35. l Navigation Guide e The Edit User window displays Update the desired user account fields and click Submit Provider Employee Welcome Temp Provider Home gt User List gt User Detail Edit User This page allows you to change a Users name email address preference role and verbose level Click Information User Information Username User Role Provider super User w Password Question Password Answer Email test test cam Office Locked Deleted Verbose Level Preferences Preference Accept notification emails Receive Updates to the Formulary Campaigns Name Participating Wo results found Required Fields e The User Detail window displays e Use the breadcrumbs or menu tab options to return to the previous screen s 3 1 3 Delete a User e Select the User List option from the ACCOUNT tab The User List window displays Maryland Physicians Care AH v3 26 11 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e Search for the user you would like to delete and click on the Delete option next to the user on the right side of the screen Results L Download File 4 Add User Name Username Office Role Locked Lockout Time Deleted Provider Temp Provider Super User N N Delete Provider Temp Provider Super User Ki N Delete Page i of i1 e Alternatively you can search for and select the user you would like to delete by clicking on the user s name The User
36. lected provider s panel roster Members as of 07 75 7008 03 54 76 PM CJ Downoad File Printer Friendiy Format Member Member iD Language Pp Address Home Phone Pare HEOLS DOR Gender Rel Reneti e Click on the member s name The Member Detail window displays with the member s current demographic eligibility and assigned PCP information e To display all historical eligibility periods click on the View Eligibility History option e To display any member claims submitted by the provider click on the View Claims option e If the member has outstanding HEDIS intervention measures the value in the HEDIS field on both the Panel Roster window as well as the Member Detail window will display as Yes Click on the link to display the member s HEDIS measures e Use the breadcrumbs or menu tab options to return to the previous screen s Maryland Physicians Care AH v3 26 2J Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide 4 2 Provider Search 4 2 1 To Perform a Provider List Search Provider users are allowed to view all affiliated providers to their office Based on the provider ID assigned to the account the web site determines which provider records are allowed to be viewed on line e Select the Provider List option from the PRODUCT tab The Provider List window displays Provider List This page allows you to search for and select a service provider By default all providers
37. n Authorization Request There are two different types of authorization requests that can be submitted on line Scheduled Admit and Outpatient Emergency services do not require authorization or notification to the health plan Note If the authorization request is urgent or an unscheduled inpatient admission please call the Prior Authorization department at 1 800 953 8854 5 1 Selecting the Authorization Type e To submit an authorization request for a Scheduled Admit select the Scheduled Admit sub option under the Submit Authorizations option from the PRODUCT tab e To submit an authorization request for Outpatient select the Outpatient sub option under the Submit Authorizations option from the PRODUCT tab ACCOUNT PRODUCT MEMBER ELIGIBILITY SEARCH PANEL ROSTER PROVIDER LIST CLAIM STATUS SEARCH REMITTANCE ADWICE SEARCH AUTHORIZATION LIST SUBMIT AUTHORIZATIONS t SCHEDULED ADMIT t OUTPATIENT Maryland Physicians Care AH v3 26 31 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e The Authorization Request window displays Q eridi D WQ 1C1ans care M p yS1 1 CARE ORGANIZATION Pr ovid CIS Home FAQ Sign Out Home Authorization Request ACCOUNT This page allows the user to submit an outpatient authorization request If the authorization request is urgent or an unscheduled inpatient admission please call the PRODUCT Prior Authorization department at 1 80
38. nue code being requested for the member e If the actual code is not known click on the Search for a Code magnifying glass symbol The Procedure List window displays Enter the service code description a partial description is Okay and click Search From the resulting list of Revenue Code details click the Select link next to the desired code The Authorization Request window is redisplayed with the selected Revenue code populated e In the Units box enter the number of units days services increments etc being requested for the selected procedure or service The Units requested is a required field for all authorization types Maryland Physicians Care AH v3 26 35 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e To enter an additional authorization service up to 99 can be submitted on the authorization click on the Add another service line option Note that the authorization dates previously entered will be defaulted into the new service line authorization date fields e If multiple authorization service lines are displayed and one or more need to be removed click on the Delete Service Line option next to the authorization service line to be removed 5 2 7 File Attachments File Attachments To attach a file to this auth select the a bi lea vae arth Pepot Type then click the Upload button plus sign Follow the instructions provided to search for and attach the file If
39. orization types and the format must be entered as mm dd yy or mm dd ccyy e Inthe End Date box enter the requested ending date of the authorization period Click on the calendar symbol next to the box to display a calendar and choose a date The authorization End Date is a required field only for the Medical Inpatient authorization type If populated the format must be entered as mm dd yy or mm dd ccyy e When the Medical Inpatient authorization type 1s selected the Admit Date will be displayed on the page and is a required field In the Admit Date box enter the date the member will admitted to the inpatient facility Click on the calendar symbol next to the box to display a calendar and choose a date The format must be entered as mm dd yy or mm dd ccyy e Inthe CPT Code box enter the first service code being requested for the member The CPT Code 1s a required field for all authorization types e If the actual code is not known click on the Search for a Code magnifying glass symbol The Procedure List window displays Enter the service code description a partial description is Okay and click Search From the resulting list of CPT details click the Select link next to the desired code The Authorization Request window is redisplayed with the selected CPT code populated e f applicable for the authorization service line in the Revenue Code box enter the service reve
40. p Provider Home gt User List gt User Type Provider Employee List This page allows you to select the provider employee from a list of eligible employers when creating a new provider employee user Results dP Add Employee Select Name Title Pos Phone search Maryland Physicians Care AH v3 26 7 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e The Add Provider Employee window displays Enter the employee s information and click Submit Provider Employee Welcome Temp Provider Home gt User List gt User Type gt Provider Employee List Add Provider Employee Provider Name This page allows you to view the provider s employee information If adding enter employee first and last name to change the name Click delete to remove it Clicking submit saves the information Provider Type Middle Initial sid Email Address Po Title Position Po Required Fields e The Provider Employee List window displays again Search for and select the employee record that was just created Click on the Select link next to the name Provider Employee Welcome Temp Provider Home gt User List gt User Type Provider Employee List This page allows you to select the provider employee from a list of eligible employers when c Search LastName dS Results Select Name Tithe Pos select Admissians Rep select 7 Admissians Rep Maryland Physicians Care AH v3 26 8 Version 1 0 Maryland
41. pe COB Code Eff Dates Insurer Name Insurer Payment Order Employee ID No Policy No No results found Nam irad Cialda e To display all historical eligibility periods click on the View Eligibility History option Maryland Physicians Care AH v3 26 16 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e To display any member claims submitted by the provider click on the View Claims option e If the member has outstanding HEDIS intervention measures the value in the HEDIS field will display as Yes Click on the link to display the member s HEDIS measures e Use the breadcrumbs or menu tab options to return to the previous screen s 4 1 2 Member HEDIS Measures The Healthcare Effectiveness Data and Information Set HEDIS is a tool used by the health plan to measure performance on important dimensions of care and service Member HEDIS information is available to providers via the secure web portal e HEDIS measures for individual members can be obtained through the result set of a member eligibility search from the Member Eligibility List window Click on the hyperlink in the HEDIS column next to the member s name Home gt Member Eligibility Search N Member Eligibility List This page displays the members meeting the search criteria can conduct another search by clicking search again view member detail by clicking a member name link view benefit plan information by clicking a pl
42. r directory search 4 1 Healthcare Data Inquiry 4 1 1 Member Eligibility Verification The Member Eligibility Verification inquiry enables you to search view and print member specific health plan eligibility and enrollment information e Select the Member Eligibility Search option from the PRODUCT tab The Member Eligibility Search window displays e Enter the member information to perform the search The member ID number or combination of member DOB and member Last Name is required as the minimum search data set Search data fields include Date of Birth Member ID and Member Last First Name Users can enter one or more members to perform the eligibility check Note that the dropdown field Include Ineligible is defaulted to No To see all matching members regardless of their current eligibility status change this dropdown selection to Yes e The initial search screen provides the option to select up to five members If more are needed click the Add Member option to the right of the screen Each click will add another block of five members to be selected for eligibility verification e After entering the search criteria click the Search button Provider Employee Welcome Temp Provider Home FAQ Sign Out Home Member Eligibility Search Te mses m ey mimar pasrah eritans fap s a y T yes ape ya i bam ER ea 5 amhare calar vee fam Hian arcade mer This page allows you to enter search oritena for a member f you wish to s
43. ser account If you do not receive an email with the new password contact Maryland Physicians Care s Provider Relations call center for assistance e Ifyou are a current member and wish to access your account Register Here e Forgot your password Click Here 2 2 4 To Sign Out Click the Sign Out button at the top right of the screen p tome FAQ Sign Out Maryland Physicians Care AH v3 26 5 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide 3 0 Primary Representative Role A provider s office has only one primary representative If necessary the primary representative is allowed to add authorized representatives within their office who can then utilize the secure web site The primary representative is responsible for maintaining the accounts of authorized users within their office 3 1 User Account Maintenance 3 1 1 Add a User There are two steps required to add a new authorized user account First the primary representative needs to add the employee to the system and then the new user account can be created e Select the User List option from the ACCOUNT tab The User List window displays e Click on the Add User option Provider Employee Welcome Temp Provider Home User List This page lists all the users defined for your system To narrow the list you can sort the list by last name username or role You can add users to the list by clicking the add link Names tn the resul
44. t Name Last Name NPI Requesting Provider No View Provider Detail Servicing Provider First Name View Provider Detail Last Name NPI Servicing Provider No Service Line Information Line No 1 Service Group Start Date 09 03 2009 End Date Status Reason P For additional Medical Information Reqeusted CPT Code 90717 Yellow fever vaccine live for subcutaneous use CPT4 HCPCS Codes Rev Code NUBC Revenue Code Units 1 Health Plan Response Comments Please review for approval Reason Medical Information Regeusted Nurse s User ID File Attachments Report Type File Name View Diagnostic Report Mojito GIF gt a View Historical Versions of this Auth You can view previous values on any field including the original values entered by the Provider by selecting a choice from the Version list below and clicking Search History Version INITIAL v Search History Show History e To view any attachments click the magnifying glass to the right of the document name e A security window will open and ask you to Open Save or Cancel the request to view the document Select the appropriate option o Open will open the document in a separate window o Save will prompt you to select a location and save the document to your computer o Cancel will terminate the action Maryland Physicians Care AH v3 26 22 Version 1 0 Maryland Physicians Care Provider Web Portal Nav
45. t a service provider By default all providers are listed To narrow the list enter search criteria If displayed during a selection process clicking the select link next to the provider number selects that provider Clicking the provider name displays detailed information for the selected provider Clicking the add link allows you to add a new provider to the list Search i Download File Printer Friendly Format Provider Last Name Provider First Name Provider No Specialty selecta Provider Type to Populate List AllMetworks Affiliation Type Par Code In Directory city CdS Results Provider No NPI Provider Name Provider Type Specialty Phone Select ele PHYSICIAN Pediatrics TE _ GROUP OF ir Sog PROVIDERS 154 Select PHYSICIAN Anesthesiology e The Provider List window displays The initial result set is the list of all affiliated providers If the list is long you can also enter selection criteria to reduce the result set e Click on the Select link next to the desired provider Maryland Physicians Care AH v3 26 26 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e The Panel Roster window will be redisplayed with the selected provider s name Click the Search button Panel Roster This page enables you to view a list of members currently assigned to the provider Select a Provider Provider Name A e The Panel Roster window will redisplay with those members assigned to the se
46. t the servicing provider who will be performing the requested referral services e If the provider ID is known simply enter it in the Enter a Servicing Provider No field Note that if the provider s ID is entered directly in this field the provider s information will not be displayed e Otherwise click on the Search for a Provider magnifying glass symbol to perform the search The Provider List window displays Maryland Physicians Care AH v3 26 34 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e Enter the provider name and or ID information to perform the search After entering the search criteria click the Search button The Provider List window redisplays with the providers who match the search criteria e Click on the Select link next to the desired provider The Authorization Request window is redisplayed with the servicing provider s information now populated 5 2 5 Authorization Service Information Service Line Information Start Date 09 14 2009 Gir T Add another service line End Date yy CPT Code CPT4 HCPCS Search for a Code Q Codes Rev Code NUBC Search for a Code l Revenue Code Units e In the Start Date box enter the requested beginning date of the authorization period Click on the calendar symbol next to the box to display a calendar and choose a date The authorization Start Date is a required field for all auth
47. ts list link to the user s detail page from where you can edit the user information reset the user s password or delete the user Search Locked Deleted Results Download Kile HE Add User Mame Username Office Role Locked Lockout Time Deleted Maryland Physicians Care AH v3 26 6 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide e The User Type window displays Select the User Type Provider Employee from the list and click on the Next gt button Provider Employee Welcome Temp Provider Home gt User List User Type Select User Type This page steps you through definition of a new User Depending on where you are in the process the page display varies The following are the basic steps 1 Select UserType and click Next Depending on the user type one of the following pages displays Employer gt employers page Health Plan gt health plan offices Provider Employee gt provider list Member gt member eligibility search Broker gt broker list 2 For Employer Health Plan or Provider Group select the office that the new user is to be associated with then select a us and Brokers find and select a user 3 Enter required information needed to complete the account and click submit User Information User Type Provider Employee Required Fields e The Provider Employee List window displays Click on the Add Employee option Provider Employee Welcome Tem
48. urn to the previous screen s 3 1 2 Edit a User e Select the User List option from the ACCOUNT tab The User List window displays e Search for and select the user you would like to edit by clicking on their Name Provider Employee Welcome Temp Provider Home User List This page lists all the users defined for your system To narrow the list you can sort the list by last name username or role You can add users to the list by clicking the add link Names in the results list link to the user s detail page from where you can edit the user informatio reset the user s password or delete the user Search Username Po T Locked Deleted 7 Results L Download File d Add L Name Username Office Role Locked Lockout Time Deleted Provider Temp Provider Super User I I Dele Provider Temp Provider Super User N N Dele Page i of 1 e The User Detail window displays Click on the Edit User option Provider Employee Welcome Temp Provider Home gt User List User Detail This page allows you to view details for the selected user You can edit or delete the user and reset the user s password User Information Reset Password g7 Edit User i Delete User Name Provider Temp Username Role Provider Super User Password Question Password Answer Email test test com Office Locked M Deleted N Verbose Level None Maryland Physicians Care AH v3 26 10 Version 1 0 Maryland Physicians Care Provider Web Porta
49. word field Note that the web portal will require the password to be changed at least every 90 days The system will not allow the account user to reuse any of the last eight passwords that have been assigned to the account e n the Preferences section this contains the notification preferences which allow the account user to receive system generated notifications Note that this preference is the indicator used when the field enter the desired information to be sent to the health plan e Ifa document attachment is to be included with the message click the Add Attachment button The Upload Attachment window displays e Browse for the desired file on your hard drive or network When the file is selected click the Submit button to upload the attachment Multiple attachments can be included with the message by clicking the Add Attachment button Note that there is a 5Mb size limit on attachments e Once the message to be sent is complete click the Submit button to send the communication to the designated health plan department Maryland Physicians Care AH v3 26 14 Version 1 0 Maryland Physicians Care Provider Web Portal Navigation Guide 4 0 Searches and Inquiries The provider user has the ability to perform detailed searches and inquiries on a variety of member healthcare information including eligibility verification claim status authorization status remittance advice payments and panel rosters Users can also do a provide
50. ysicians Care Provider Web Portal Navigation Guide e The Claims Status List window displays Click on an individual claim number Home gt Claim Status Search Claim Status List This page displays a list of claims submitted for a specific patient subscriber according to the search criteria Click on the Claim Number to access claim detail information If available click on the View EOB link to view benefit information for a claim Click on the member name to view member detail information Click on the provider name to _ view provider detail information Click EOP Search to begin a remittance advice search or Submit a New Claim to begin a claim submission process Click Search Again to initiate a new search Results 3 Download File Claim No Claim Type 18 Service Date Provider Claim Status akan Total Payment Institutional 06 19 2003 Paid 15 85 7 58 Institutional 12 08 2003 Paid 40 92 16 33 e The Claim Status Detail window displays with the claim header and service line detail information Home gt Claim Status Search gt Claim Status List Claim Status Detail This page displays the selected claim s detail _ Patient Information GG Printer Friendly Format DOB 09 10 1987 Gender FEMALE Servicing Provider Information Provider Name Claim Information Claim No 03 Claim Type Institutional Claim Status Paid Service Date 06 19 2003 Remarks Total Billed Amount 695 85 Total Payment 617 58 Check Issue Date 05 19
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