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Authorizations Application-CareAffiliate Training Manual Behavioral Health Outpatient

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Table of Contents Training ................................................................................................................................................................... 3

Log out - do not “X” out .......................................................................................................................................... 3

Coordinated Behavioral Health Management contact information ...................................................................... 3

Important phone numbers ..................................................................................................................................... 3

Time Saving Tips! .................................................................................................................................................... 4

Helpful Tips ............................................................................................................................................................. 5

Adding providers to your drop down .................................................................................................................. 5

Copying and pasting into fields ........................................................................................................................... 5

Default provider .................................................................................................................................................. 5

In-line messages .................................................................................................................................................. 5

Reference number .............................................................................................................................................. 5

Submission outcomes......................................................................................................................................... 5

Request Types ......................................................................................................................................................... 6

Alert Messages ........................................................................................................................................................ 7

Steps for entering a new authorization .................................................................................................................. 8

Note: The member data found in this Training Manual is fictitious data.

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Important

Training

• There are several helpful tools to assist you with CareAffiliate.

• Log in at hap.org and select the CareAffiliate Help link under Quick Links.

• You can also find this information on the CareAffiliate home page.

Log out - do not “X” out

• When logging out of the application, always select Log Out and not the X.

Coordinated Behavioral Health Management contact information

• (800) 444-5755

• Monday – Friday, 8 a.m. to 5 p.m. Closed on all major HAP holidays.

Important phone numbers

For Contact Hours

Help with Authorizations application-CareAffiliate:

• Authorizations link missing from home page

• Password resets

• System lockout

Provider Services at: (866) 766-4708 OR prelweb1@hap.org

Monday-Friday 8:00 a.m. to 4:30 p.m.

The fastest and most efficient way of submitting authorizations and checking status is online! It’s not quicker to call in.

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Time Saving Tips!

To determine eligibility of a member or if a procedure is a covered benefit and meets criteria, providers must utilize HAP's online Member Eligibility Application and the Benefit Administration Manual. It is imperative that you verify benefit coverage, including the maximum number of mental health or substance abuse visits, prior to rendering service, as failure to do so may result in denial of payment. To avoid a potential unpaid claim, it’s crucial providers and members communicate and coordinate any behavioral services that may have occurred outside of your clinic. Claims are not reimbursable if the benefit limit is exceeded for mental health and behavioral services.

1. Check to see if the service or procedure needs an authorization.

• Log in at hap.org; select Procedure Reference Lists under Quick Links.

• Select CBHM Outpatient Authorization Requirement List (formerly called CBHM Referral Requirement list).

HAP doesn’t require an approved authorization for select mental health and substance abuse outpatient services for contracted behavioral providers. This allows our providers to service members without any delays and eliminate additional paper work for your staff. The CBHM Outpatient Authorization Requirement List is inclusive of all possible procedure codes as identified by HAP.

• Check the column – Authorization Required for Members to see if an authorization is required. It’s also important to check the legend at the beginning of the document. If a procedure code is not on the list, it requires HAP review and an authorization number.

2. Choose the correct Request Type – see tips in this manual. 3. Submit complete information.

• Ensure all required fields outlined in orange are completed.

• The more information you provide upfront, the better your chances of receiving a quick determination.

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Helpful Tips

Tip Details

Adding providers to your drop down

• The first time you request an authorization for an individual provider in your site, you’ll need to search by clicking the magnifying glass icon.

• Once the provider is selected, the Requesting Provider/Facility field will populate. • For all future authorizations, you won’t need to search. Begin typing the NPI or name

and the provider will appear for you to select. • If you can’t find one of your providers, contact Provider Services at (866) 766-4708 or

prelweb1@hap.org.

Copying and pasting into fields

• Do not paste directly into a field from a document or application.

• Field types must match (i.e., do not copy text into a date field, etc.).

• All formatting must be removed from your document. You can do this via Notepad or a similar application if you’re not using a Microsoft based system. Simply: ­ Copy document or item from your system or file (Epic, Word, etc.). ­ Open Windows Notepad and paste the document or item into the Notepad. ­ Copy text from Notepad and paste in the appropriate field in Assessments or Notes.

Important:

• There is a 2,000-character (including spaces) limitation for each field. There is no warning. Any characters exceeding the limit will be cut off.

Default provider

From the Service 1 screen:

• Select the magnifying glass to search by NPI or name. If provider or facility doesn’t return, uncheck “Contract Only” and search again. If no records return, enter provider NPI AUTH99999999 (AUTH9*), or facility NPI FAC999999999 (FAC99*) and select the record – Provider, Default

• Select Note link in left navigation and enter the full provider or facility name, NPI or Out of Country Code, address, phone, fax and specialty.

• You can also select the for instructions.

In-line messages

• Fields with this icon contain instructions on the information that should be entered. Select it to see details.

Reference number

• After you submit an authorization, you’ll receive a Reference Number.

• It doesn’t indicate approval. You need to go to the Authorizations home page to see if your authorization was Certified in Total (approved).

Search using wild card (asterisk *)

For Member and Provider Names Type 5 characters and * Example: Johns* or Lee__ __* (use spaces for last names with less than 5 letters)

For Diagnosis and Procedure Code/Description Use * before and after first 3 characters of a code/description. Example: *123*; *bar*

For Request Type Description Use the * before and after the first 3 letters of a description. Example: *out*

Submission outcomes

• No Action Required: Indicates no authorization required for the request • Certified in Total: Indicates authorization approved • Pended: Indicates requires review • Not Certified: Denied

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Request Types

The Request Type is the place of service and service combined. It determines what fields auto populate throughout the authorization. The 10 Request Types specific to outpatient behavioral health are outlined below.

Code Description Details

OPCHEM_CLINIC Chem Dep OP Tx in Facility Outpatient Chemical Dependency treatment in a HAP contracted clinic

OPCHEM_INDPROV Chem Dep OP Tx with an Independent Provider

Outpatient Chemical Dependency treatment with a HAP contracted individual provider

OPCHEM_RES Chem Dep OP Tx-Res. Sub. Abuse Tx Facility

Outpatient Chemical Dependency treatment in a HAP contracted substance abuse treatment facility

IOPCHEM_CLINIC Chemical Dependency IOP Treatment in a Clinic Intensive Outpatient (IOP)

Intensive Outpatient (IOP) Chemical Dependency treatment at a HAP contracted clinic.

NEUROTEST Neuropsychological Testing Neuropsychological Testing

IOP_Clinic Psychiatric IOP Treatment in a Clinic Intensive Outpatient (IOP) Psychiatric treatment in a HAP contracted clinic.

OPPSYCH_FAC Psychiatric OP TX in a Psychiatric Facility Outpatient Psychiatric treatment in a HAP contracted psychiatric facility.

OPPSYCH_CLINIC Psychiatric Outpatient Treatment in a Clinic

Outpatient Psychiatric treatment in a HAP contracted clinic

OPPSYCH_INDPROV Psychiatric Outpatient Tx with Ind. Provider

Outpatient Psychiatric treatment with a HAP contracted individual provider.

PSYCHTEST Psychological testing Psychological testing

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Alert Messages

You can find Alert messages under the navigation bar or as pop-up messages. They indicate a potential issue with your authorization request. Read the warnings carefully as some:

• Will not allow the authorization to be submitted and will provide instructions to correct.

• Are missing required information.

• Are informational only and will allow submission.

Alert message Details

Required Fields

• Required fields outlined in orange must be completed before you can submit the request.

• You can return to the Authorization Request or Service 1 screens to find the missing data.

Potential Duplicate Authorization • The authorization request may have already been submitted for the member.

• If you want to proceed, you’ll need to select Submit twice.

A more specific diagnosis code exists for the condition specified

There may be a more specific diagnosis for the procedure or service.

Authorization required from eviCore The authorization request must be submitted to eviCore.

Authorization required from Pharmacy Advantage

• The medication is included in the Specialty Drug Program requests for coverage.

• It must be faxed to Pharmacy Advantage.

Timing Out

• After 89 minutes of inactivity in CareAffiliate, you’ll receive a warning that your session will time out in 1 minute.

• You’ll lose any information that has not been submitted.

• Select OK to continue working.

• Note: The timeout period for the HAP provider portal is 30 minutes. While you can still work in CareAffiliate for 90 minutes, you could be timed out of other applications (e.g., member eligibility, claims) after 30 minutes of inactivity. Simply log in again.

The following pages illustrate the steps for entering a new authorization.

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Steps for entering a new authorization

• Log in at hap.org.

• Select Quick Links; Procedure Reference Lists; CBHM Outpatient Authorization Requirement List (formerly called CBHM Referral Requirement list) to see if an authorization is required.

• Select Authorizations.

• Select Authorizations.

• Select New Authorization.

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• Complete all required fields outlined in orange. See table below for details.

Field Information to enter

Member ID 11-digit HAP member ID number; tab and Name will auto populate or click magnifying glass to search.

Name Member’s name; tab and Member ID will auto populate. You can enter 5 characters and a wild card * or click magnifying glass icon to search.

Request Type

The appropriate Request Type. The Request Type is essentially the place of service and service combined. It determines what fields auto populate throughout the authorization—less data entry for you! • To search for a Request Type:

• Click on the magnifying glass next to Request Type. • Check Show Behavioral Health/Substance Abuse only box then Search. • Choose appropriate Request Type.

Note: If you realize you have entered the wrong Request Type:

• Select Home (from the navigation bar). • Answer Yes to confirm you want to lose all changes. Start over.

After you enter the Request Type, the screen will change – see next page.

Tip! After you enter Request Type, the screen changes. See next page.

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• Complete all required fields outlined in orange. See table below for details.

Field Information to enter

Event Classification Appropriate field from drop down menu (sometimes it auto populates).

Case Type Nothing, it will auto populate.

Contact Name The name of person entering authorization. Note: The name associated with the NPI you logged in with defaults in this field. Delete it.

Contact Phone The best phone number HAP can contact you with questions.

Requesting Provider/Facility

The name or NPI of the physician or facility used to log in.

Requesting Group Leave blank.

Diagnosis

The ICD-10 DX code with or without a decimal; tab and the description auto populates. You can also search for the code by clicking on the magnifying glass. See searching tips in this manual.

See next page for screen shot of all fields completed.

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Screen shot of General Information, Request and Diagnosis fields completed. • When finished, select Service 1.

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• Complete all required fields outlined in orange. See table below for details on what to enter in each field.

Field Information to enter

Service From The date the service will begin. Typically, this field auto populates with today’s date. The date can be changed.

Service To The date the service will end. Note: not to exceed 6 months.

Provider The physician or facility providing the service. Note: If you logged in with a group NPI and used a Request Type of neuropsychological testing or psychological testing, the Provider field is required. This field will not accept the group NPI or group name. Please choose a default provider. Select the icon in the Default Provider box and follow the instructions.

Facility If you use a facility request type, you need to complete the Facility field.

Provider Specialty Optional unless you’re entering a pharmacy request.

Provider Role Optional.

Procedure Information

The appropriate procedure code: • Select Edit and either enter the code in the Procedure field or select the magnifying

glass to search. See search tips in this manual. • The Quantity will default to Visits. Simply enter the number of units needed.

See next page for screen shot of all fields completed.

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Screen shot of Service 1 fields completed.

• If you have another service to add, select Copy Service. See tip below.

• Next, select Assessment.

• Select Launch Assessment.

Tip for adding more services If you have another service to add, select Copy Service; Edit; highlight and delete information in Procedure field and enter new procedure.

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• Complete all required fields outlined in orange. Complete white fields with appropriate information. Responding with n/a or incomplete information will cause a delay in the turnaround time of your request. (Note: Disregard “Not Met” and “Met” buttons.)

• When finished entering all the fields, select Complete. • You’ll receive an Assessment Summary.

Review the Assessment Summary and make any corrections or additions in Additional Notes.

Tip! If this is the first time you’re seeing a patient:

• You can provide any information you have initially. OR

• You can do the intake, then complete the authorization request.

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Attachments (if you have any) You can attach external files (PDF, Word, Excel, etc.) to a maximum of 32 MB that provide clinical support for your request. Electronic files, including faxes, must be HIPAA compliant and only contain information for one specific member.

• Select Attachments.

• Select Add File.

• Search for your file on your computer and select it.

Select Upload File(s).

You’ll see “Attached” under Status upon successful upload of attachment.

Notes (optional): A free text field to add details about the authorization.

• Select Notes and add text.

• If you are finished with request, click Submit.

• You’ll receive the Confirm message below. If you are ready to submit, select Yes.

Enter text here

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• You’ll obtain a submission outcome and a Reference #.

• The Reference # does not mean the request is approved.

• Record the Reference # and then go to the Authorizations home page to see if your authorization was Certified in Total (approved).

• If you need to enter more authorizations, select Home. If you are finished, select Log Out.