Provider Website Overview - Washington State Physical...
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association Stephanie Cole Healthcare Implementation Manager Prepared for Physical Therapy Association of Washington May 11, 2017 Provider Website Overview
Transcript of Provider Website Overview - Washington State Physical...
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Stephanie Cole
Healthcare Implementation Manager
Prepared for Physical Therapy Association of Washington
May 11, 2017
Provider Website Overview
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Agenda
• Introduction
• Quick Facts
• Live Demo Benefits
Code checks
Online resources
• Introduce eviCore
• eviCore Website Overview
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Website Overview
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Quick Facts
• Accessing all of our secure tools requires registration through
OneHealthPort (OHP)
• Our website is updated nightly
• Accumulators for physical therapy are available
• You can find the deductible, out-of-pocket and exclusions to the out-
of-pocket on our eligibility and benefits tool
• You can find two years of eligibility, claims and prior authorization
info online
• If the Managed Care Coordinator message appears when you’ve
selected physical therapy or massage therapy from the benefits
dropdown list, that indicates we require evICore review for that
member’s plan
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Online Resources
• Provider orientation and online tool guides premera.com/wa/provider/learning-center
• Eligibility and Benefits: Verify member’s eligibility and benefits,
effective dates and accumulators online.
• Prospective Review Tool: Check a code to see if review is
required. This provides a member specific response.
• Give feedback 24/7 with Premera Listens
• Provider News: Sign up for email alerts to stay up
to date
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
eviCore Website Overview
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
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Case Initiation
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Initiating A Case
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• Choose “request a clinical certification/procedure” to begin a new case request.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Select Program
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Select the Program for your certification.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Service Options
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Select Date Extension, Continuing Care, or Build a New Case.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Select Provider
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Select the Practitioner/Group for whom you want to build a case.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Select Health Plan
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Choose the appropriate Health Plan for the case request.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Select Address
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Contact Information
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Enter the Provider name and appropriate
information for the point of contact individual.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Member Information
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Enter the member information including the Patient ID number, date of birth, and patient’s last name. Click “Eligibility Lookup.”
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Clinical Details
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Verify Service Selection
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ICD-10 Code
ICD-10 Code
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Site Selection
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Verify all information entered and make any needed changes prior to moving into the clinical collection phase of the prior authorization
process.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Clinical Certification
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You will not have the opportunity to make changes after that point.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Finish Later/Save Option
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Once you have entered the clinical collection phase of the case process, you can save the information and return within (2) business days to
complete.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Medical Review
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If additional information is required, you will have the option to either upload documentation, enter information into the text field, or contact us
via phone.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Medical Review
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Acknowledge the Clinical Certification statements, and hit “Submit Case.”
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Approval
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Once the clinical pathway questions are completed and if the
answers have met the clinical criteria, an
approval will be issued.
Print the screen and store in the patient’s
file.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Building Additional Cases
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Once a case has been submitted for clinical certification, you can return to the Main Menu, resume an in-progress request, or start a new request. You can indicate if any of the previous case information will be needed for
the new request.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Authorization look up
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• Select Search by Authorization Number/NPI. Enter the provider’s NPI and authorization or case number. Select Search.
• You can also search for an authorization by Member Information, and enter the health plan, Provider NPI, patient’s ID number, and patient’s date of birth.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Authorization Status
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The authorization will then be accessible to review. To print authorization correspondence, select View Correspondence.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Eligibility Look Up
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
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Provider Resources
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Musculoskeletal Online Resources
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Clinical Guidelines, FAQ’s, Online Forms, and other important resources can be accessed at www.evicore.com. Click “Solutions” from the menu bar, and select the specific program needed.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
eviCore Provider Blog Series
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• The eviCore blog series focuses on making processes more efficient and easier to understand by providing helpful tips on how to navigate prior authorizations, avoid peer-to-peer phone calls, and utilize our clinical guidelines.
• You can access the blog publications from the Media tab or via the direct link at https://www.evicore.com/pages/media.aspx.
Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Web Portal Services-Assistance
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Email [email protected]
Call a Web Support Specialist at (800) 646-0418
(Option 2)
Connect with us via Live Chat
Web Portal Services-Available 24/7
