ProviderConnect Registered Services Autism Service ...Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. Key Step 3: Complete

Created 9/1/17

ProviderConnect Registered Services

Autism Service Provider User Manual

CT BHP ProviderConnect User Manual – Autism Services

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Table of Contents

Introduction .................................................................................................................................. 3

Accessing ProviderConnect.......................................................................................................... 4

ProviderConnect Basics ............................................................................................................... 6

Features ....................................................................................................................................... 8

Registration for Behavioral Assessment, Treatment Plan and Program Book Development ......... 9

Registration for Service Delivery, Observation & Direction and Autism Services Group ............. 20

Viewing and Printing Authorizations ........................................................................................... 33

Completing Discharges .............................................................................................................. 41

Appendix A: Behavioral Assessment, Treatment Plan & Program Book Development ............... 46


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Introduction

Introduction The ProviderConnect application provides a variety of self-service functions to help

providers access and view information about members and authorizations. For CT BHP providers, additional functionality is available including: Obtaining authorizations for the CT BHP Behavioral Assessments, Treatment

Plan and Program Book Development Obtaining authorization for Service Delivery, Observation & Direction and Autism

Services Group Viewing and Printing Authorizations Completing Discharges

What is Covered in this Module?

This module covers general functions within ProviderConnect as well as requests for Autism Service providers, which includes the following key functions: Registration of Behavioral Assessments, Treatment Plan and Program Book

Development authorization requests for Autism Services Registration of Service Delivery, Observation & Direction and Autism Services

Group Viewing and Printing Authorizations Completing Discharges

Training

Objectives As a result of this training module, you will be able to: Log in to ProviderConnect Search for and view Member records. Complete a request for Behavioral Assessments, Treatment Plan and Program

Book Development


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Accessing ProviderConnect

Obtaining an ID and Password In order to obtain a ProviderConnect login ID and password, complete the following steps.

1. Go to the CT BHP website at www.CTBHP.com. 2. Click on the ‘For Providers’ button.

3. Under the Templates section, click on the ‘Online Services Account Request Form’ hyperlink.

4. Complete the form and fax it back to the Provider Relations department at (855)750-9862. Completed forms can also be scanned and emailed back to Provider Relations at [email protected].

5. User ID’s and passwords will be created within 48 hours. Once the ID and password are created, you will be sent an email with your ProviderConnect login details.

6. If you have any questions, feel free to contact the CT BHP Provider Relations department at 1-877-552-8247.

http://www.ctbhp.com/


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Accessing ProviderConnect, continued

Logging In The ProviderConnect web application can be found on the CT BHP website:

1. Go to www.ctbhp.com. 2. Click on For Providers.

3. Click on Log In.

4. Enter User ID and Password.

5. Click Log In.

ProviderConnect Basics

http://www.ctbhp.com/


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Searching for

and Viewing Member Records

One function that is used often to for various ProviderConnect functions is searching and viewing member records. Below are the key actions for completing this step. Any field with an asterisk indicates that the field is required.

1. Click Specific Member Search from the navigational bar or Find a Specific Member on the Home page.

2. Enter values for the Member ID and Date of Birth a. Note: The As of Date (MBR Eligibility Date) will auto-populate

with today’s date. To search a previous eligibility date, users can enter a previous date.

ProviderConnect Basics, continued


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Review Members record details 3. Demographics (Displays basic member information (i.e. address,

phone, etc.) 4. Enrollment History (Displays active and expired enrollment records for

member 5. COB (Displays information on other insurance policies) 6. Additional Information (Displays claims mailing address for the

member)

7. View Member Auths (Displays Member specific authorizations) 8. Enter Auth/Notification Request (Initiates the Request for Services

process) 9. View Clinical Drafts (Display member specific Clinical Drafts) 10. View Referrals (For Residential/Group Home Providers Only)

Enter Member Reminders through View Behavioral Analysis Date functions are currently not utilized for the CT BHP Providers – These functions should not be accessed and information should not be entered into any of these categories.


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Features

Saving Requests

as Drafts While working with requests for authorizations in ProviderConnect, providers have the ability to save a request as a draft in the event that they cannot complete it at the time the request was started. Saved drafts can be viewed and opened by providers from the View Clinical Drafts screen accessible from the ProviderConnect homepage.

Saved drafts are available for completion and submission for 30 days from the initial date the record was saved. If the record is not submitted within the 30 days, it is automatically expired. When a record is saved as a draft, it is NOT available for CT BHP clinical staff to review.


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Behavioral Assessments, Treatment Plan and Program Book Development Registration

Requests


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Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development

Key Step 1:

Initiate a Request for Authorization

The first key step is to initiate the request for authorization function, which starts from the ProviderConnect Homepage. The function can also be initiated when the Member record is located first and then the Enter an Auth Request button is clicked. Below are the key actions for completing this step. Any field with an asterisk indicates that the field is required.

1. Click enter an Authorization Request link from either the left navigational or Home page of

ProviderConnect.

2. Review the Disclaimer and click the Next Button.


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Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont.

3. Search for Member Record a. Enter Member’s Medicaid ID and Date of Birth b. Click Next

4. Click the Next button on the Member record to continue.

5. The Select Service screen will display

6. Locate and select the Service Address/Vendor.

For Clinics and Group Practices – users should always ensure they are picking the correct vendor location for authorization of services. Group Practice users should ensure that they are selecting the appropriate address, followed by the correct licensure level for authorization requests (i.e – 123 Main St. – BCBA, 123 Main St. – LCSW).

7. Click the radio button next to the Service Address to select record. The record selected will be attached to the request and authorization that will be created.

8. Click the Next button to continue. The Requested Service Header will display.


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Attach a Document:This function is included in the next

registration request screen. Users completing requests

for Behavioral Assessments, Treatment Plan and

Program Book Development should NOT attach

documentation at this time but in the registration request.

Key Step 2: Complete Initial

Entry Request Screen

The second key step is to complete the initial entry screen of the request where the requested start date of the service is entered and the specific level of care and service is selected. This screen displays for all types of requests. However, the information entered determines which clinical screens will display and which authorization parameters will be applied to the request. Any field with an asterisk indicates that the field is required. 9. Enter the Requested Start Date (The Requested Start Date is the date for the

authorization to begin in order to cover requested services.)

10. Select the Level of Service = Outpatient/ Community Based. (When the level

of service is selected, the screen will update with the required fields specific to

the level of service.)

11. Select the Type of Service = Mental Health

12. Select the Level of Care = Outpatient

13. Select the Type of Care = ABA Assessment

14. Click Next

15. Click OK on the pop up window that displays.


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Key Step 3:

Complete the Clinical Screens

For Behavioral Assessments, Treatment Plan and Program Book Development requests, the clinical screen workflow will display. This workflow consists of five (2) screens. 1. ABA Assessment 2. Requested Services 3. Results Below is information for completing each screen.

Key Step 3:


- Tips for Working through

the Clinical Screens

The screens will display in the order listed above when the Next button is clicked within each screen.

Requests are completed in order. All required fields are completed to move to the next screen.

Previous screens are accessed by clicking the Back button. However, you must click the Next button to proceed forward.

Within any clinical screen the request can be saved as a draft by clicking the Save Request as Draft button within the screen header.

IMPORTANT NOTE: Saving

Requests as Drafts

Once the clinical screens in ProviderConnect are accessed, providers have the ability to save a request as a draft in the event that they cannot complete it at the time the request was started. Users can click Save Request as Draft on the top right of the screen. Saved drafts can be viewed and opened by providers from the View Clinical Drafts screen accessible from the ProviderConnect homepage. (See pg 9.)


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Key Step 4:


– ABA Assessment

Screen

The Type of Services screen is the only screen that will display after the Initial Entry screen. Much of the information is required for completion on this screen. Documentation of Primary Behavioral Condition is required. Provisional working condition and diagnosis should be documented if necessary. Documentation of secondary co-occurring behavioral conditions that impact or are a focus of treatment (mental health, substance use, personality, intellectual disability) is strongly recommended to support comprehensive care. Authorization (if applicable) does NOT guarantee payment of benefits for these services. Coverage is subject to all limits and exclusions outlined in the member’s plan and/or summary plan description including covered diagnoses. Below are the key actions for completing this screen. Any field with an asterisk indicates that the field is require

Step Action

1 Are you requesting ABA Services for a member with a behavioral health diagnosis? Click Yes

2 Enter the Name of the Professional who gave the diagnosis, the Licensure Type of the Professional and the Date of the diagnostic assessment/diagnosis.

3 Attach a Document - Behavioral Assessments, Treatment Plan and Program Book Development require additional documentation. Documentation samples provided in Appendix A of this user manual.

Attached documentation should NOT be a copy of the Diagnostic Evaluation. See Appendix A for Templates and Examples of Documentation for Behavioral Assessments, Treatment Plan and Program Book Development.

4 Choose ASSESMENT/EVAL from the Document Description Drop down Menu.

5 Click Upload File


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1. A pop up window to Upload File window will appear.

2. Click Browse.

a. Search for the file/document you want to attach.

b. Double click on the file.

3. The pop up window will now list the file chosen.

4. Click Upload.

5. The attached file will be listed on the page.

a. If the wrong file was selected users can click the checkbox next to the

document, click Delete and Repeat steps 18-21.

6. Click the Next Button

a. If a document has not been attached, a warning message will pop-up to

confirm if you want to proceed without attaching a document. Click the OK

button to proceed.


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Step Action

6 *The Primary Diagnostic Category 1 is the main diagnosis (i.e F84.0)

7 Enter the partial Diagnosis Code 1 (see image below) or a brief Description and select the hyperlink above the text field.

System users can enter a partial diagnosis and then click on the hyperlink to view a filtered list of ICD-10 codes that match their search criteria.

Once a user clicks on the appropriate code in any of the pop-up windows, all other fields will populate.

8 System users then enter a Primary Medical Diagnostic category. Autism Service Providers can select None or Unknown from the Diagnostic Category. No Diagnosis Code or Description are needed if the selection is “None” or “Unknown”.

Step Action



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Step Action

10 Social Elements Impacting Diagnosis: To complete this section, simply click the check boxes for any of the factors that impact the member. It is okay to select more than one check box. At least 1 check box must be selected.

11 Users entering registration requests for Behavioral Assessments, Treatment Plan and Program Book Development must choose Other Psychosocial and Environmental Problems. When Other Psychological and Environmental Problems is selected, an open text field will open and require an entry. This text field should be used for the following:

1. Contact Name and Telephone Number of requestor. CT BHP ASD Clinical staff may have to outreach to the requestor directly for additional information. Please include phone extension, if applicable.

2. Requested level of care, time frame and units being requested (if not already outlined in the attached documentation).

3. For concurrent reviews: Which assessment tools are being utilized? Why now? What has driven the need for reassessment?

12 The next section is named “Functional Assessment”.

Users are not required to enter any information in this section as it is optional.

13 Click Next at bottom of page


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Key Step 5:

Entering Requested

Services

Once the Next button is clicked, the Requested Services Screen will display. The Requested Services Screen allows ASD providers to enter a listing of the services and modifiers that they are requesting in this registration.

Step Action

1 Click on the Click Here to Add or Modify Service Codes

Step Action

2 Choose the service or services that are being requested

H0031 is for ABA – Behavioral Assessments

H0032 is for APB – Treatment Plan/Program Book Development

3 Click Save

Step Action

4 ENTER 0 in the Visits/Units Column for each Service Requested – The Requested level of care, time frame and units being requested should be outlined in the attached ASD Registration Service Template with documentation.

5 Click Submit at bottom of screen.


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Key Step 6:

Submit Request and Confirm Submission

Once the Submit button is clicked, the submission screen will display. Behavioral Assessments, Treatment Plan and Program Book Development, requests will be pended to the CT BHP ASD Clinical Team for review.

Pended Requests

Step Action

1 Confirm submission of request. o Status will indicate ‘Pended’ at the top of the screen with a message indicating

that the request requires further review.

The Results screen provides a summary of information about the request as well as the CT BHP authorization number (U0######).

2 Print the request. Click the Print Authorization Result button to print a copy of the Results page. Click the Print Authorization Request button to print a copy of all the

screens/fields completed for the request, including the clinical screens and the Results page.

3 Download the request. Click the Download Authorization Request button to save a copy of the request

either in pdf format or xml.

NOTE: THIS WILL BE THE ONLY OPPORTUNITY FOR PROVIDERS TO DOWNLOAD and save/print a copy of the authorization request.

4 Exit the Request for Authorization function. Click the Return to Provider Home to exit the Request for Authorization function.

5 Users may proceed with another menu function on the ProviderConnect homepage or log out of the system.

NOTE: Autism Service Providers – Behavioral Assessments, Treatment Plan and Program Book Development

Approved requests for Behavioral Assessments will result in 3-month authorization for up to 10 units/hours.

Approved requests for Treatment Plan Development will result in a 90-day/1 unit authorization. (Re-registration allowed prior to the 90-day end date and based on medical necessity).

Approved requests for Program Book Development will result in a 3-month/3 unit authorization. (Re-registration allowed prior to the 90-day end date and based on medical necessity).


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Service Delivery, Observation & Direction and Autism Services Group Registration

Requests


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Completing a Registration Request for Service Delivery, Observation & Direction and Autism Services Group

Key Step 1:

Initiate a Request for Authorization

The first key step is to initiate the request for authorization function, which starts from the ProviderConnect Homepage. The function can also be initiated when the Member record is located first and then the Enter an Auth Request button is clicked.

What is Covered in this Module?

This module covers general functions within ProviderConnect as well as requests for Autism Service providers, which includes the following key functions: Registration of Service Delivery, Observation & Direction and Autism Services

Group

1. Click enter an Authorization Request link from either the left navigational or Home page of ProviderConnect.

2. Review the Disclaimer and click the Next Button.


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Completing a Registration Request for Service Delivery, Observation & Direction and Autism Services Group, cont.

3. Search for Member Record a. Enter Member’s Medicaid ID and Date of Birth b. Click Next

4. Click the Next button on the Member record to continue.

5. The Select Service screen will display

6. Locate and select the Service Address/Vendor.

NOTE: For Clinics and Group Practices – users should always ensure they are picking the correct vendor location for authorization of services. Group Practice users should ensure that they are selecting the appropriate address, followed by the correct licensure level for authorization requests (i.e – 123 Main St. – BCBA, 123 Main St. – LCSW).

7. Click the radio button next to the Service Address to select record. The record

selected will be attached to the request and authorization that will be created.

8. Click the Next button to continue. The Requested Service Header will display.


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Key Step 2: Complete Initial

Entry Request Screen

The second key step is to complete the initial entry screen of the request where the requested start date of the service is entered and the specific level of care and service is selected. Any field with an asterisk indicates that the field is required. 1. Enter the Requested Start Date (The Requested Start Date is the date for the

authorization to begin in order to cover requested services.)

For Concurrent Service Delivery Requests:

o Start date should be first date after expiration date of previous

authorization (For example: if today is 9/5/18 and authorization ends

for 9/14/18, requested start date should be 9/15/18.

o We request submissions 10 – 14 days prior to authorization

expiration date for time to review.

2. Select the Level of Service = Outpatient/ Community Based. (When the level

of service is selected, the screen will update with the required fields specific to

the level of service.)

3. Select the Type of Service = Mental Health

4. Select the Level of Care = Outpatient

5. Select the Type of Care = ABA Services

6. Attach a Document – NOTE: This function is included in the next

registration request screen. Users completing requests for

Behavioral Assessments, Treatment Plan and Program Book

Development should NOT attach documentation at this time

but in the registration request.

7. Click Next

8. Click OK on the pop up window that displays.


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Key Step 3:


For Service Delivery, Observation & Direction and Autism Services Group requests, the clinical screen workflow will display. This workflow consists of (2) screens. 1. ABA Services 2. Requested Services Below is information for completing each screen.

Key Step 3:


- Tips for Working through

the Clinical Screens

The screens will display in the order listed above when the Next button is clicked within each screen.

Requests are completed in order. All required fields are completed to move to the next screen.

Previous screens are accessed by clicking the Back button. However, you must click the Next button to proceed forward.

Within any clinical screen the request can be saved as a draft by clicking the Save Request as Draft button within the screen header.

IMPORTANT NOTE: Saving

Requests as Drafts

Once the clinical screens in ProviderConnect are accessed, providers have the ability to save a request as a draft in the event that they cannot complete it at the time the request was started. Users can click Save Request as Draft on the top right of the screen. Saved drafts can be viewed and opened by providers from the View Clinical Drafts screen accessible from the ProviderConnect homepage. (See pg 9.)


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Key Step 4:

Complete the Clinical Screens – ABA Services

Screen

The ABA Services screen is the only screen that will display. Much of the information is required for completion on this screen. Documentation of Primary Behavioral Condition is required. Provisional working condition and diagnosis should be documented if necessary. Documentation of secondary co-occurring behavioral conditions that affect or are a focus of treatment (mental health, substance use, personality, intellectual disability) is strongly recommended to support comprehensive care. Authorization (if applicable) does NOT guarantee payment of benefits for these services. Coverage is subject to all limits and exclusions outlined in the member’s plan and/or summary plan description including covered diagnoses.

Step Action

1 Are you requesting ABA Services for a member with a behavioral health diagnosis? Click Yes or No

2 If yes, complete the following…if no, move to Step 5

3 If previously submitted check the box for Already submitted.

4 Enter the Name of the Professional who gave the diagnosis, the Licensure Type of the Professional and the Date of the diagnostic assessment/diagnosis.

5 Attach a Document: This function is included at the bottom of the

ABA Services screen. Users completing requests for

Service Delivery, Observation & Direction, and Autism

Services Group should NOT attach documentation

at this time but at the bottom of the screen. (STEP 20)


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Step Action

6 *The Primary Diagnostic Category 1 is the main diagnosis (i.e F84.0)

7 Enter the partial Diagnosis Code 1 (see image below) or a brief Description and select the hyperlink above the text field.

System users can enter a partial diagnosis and then click on the hyperlink to view a filtered list of ICD-10 codes that match their search criteria.

Once a user clicks on the appropriate code in any of the pop-up windows, all other fields will populate.




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Step Action

10 Social Elements Impacting Diagnosis: To complete this section; simply click the check boxes for any of the factors that affect the member. It is okay to select more than one check box. For ASD Services, users must select Other Psychosocial and Environmental Problems (See next step)

11 NOTE: Users entering registration requests for Service Delivery, Observation & Direction and Autism Services Group must choose Other Psychosocial and Environmental Problems. When Other Psychological and Environmental Problems is selected, an open text field will open and require an entry. This text field should be used for the following:

4. Contact Name and Telephone Number of requestor. CT BHP ASD Clinical staff may have to outreach to the requestor directly for additional information. Please include phone extension, if applicable.

5. Requested level of care, time frame and units being requested (if not already outlined in the attached documentation)

12 The next section is named “Functional Assessment”.

Users are not required to enter any information in this section as it is optional.

13 Is member receiving other professional services? Click Yes or No

14 If yes…Check all Services that Apply

15 Is member taking any medication? Click Yes or No


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Completing a Registration Request for Service Delivery, Observation & Direction and Autism Services Group, cont

Step Action

16 If yes, list the name, dosage, side effects (if any) and whether the member is compliant in the Narrative Entry open text field.

17 Click the radio button for the appropriate rating for Current Impairments:

Danger to Self, Anxiety, Danger to Others, Psychosis/Hallucinations/Delusions Mood Disturbance (Depression or Mania) and Impulsive/Reckless/Aggressive Behavior

18 Click the radio button for the appropriate rating for Current Skills Impairments:

Cognitive/Pre-Academic Skills, Language/Communication Skills, Reduction of Interfering Behaviors, Safety Skills, Social Skills, Adaptive and Self-Help Skills, Play and Leisure Skills, Coping and tolerance Skills, Community Integration And Other (specify in report)

19 Please outline areas of progress since last review, as well as areas that need to be focus of future treatment. If there has been a lack of progress, gap in services, please indicate the actions to adjust or change treatment plan to address the lack of progress or barriers to progress. Include a summary of the Transitional/Discharge Plan and any additional resources or referrals that are needed for the member or their family.

20 Attach a Document - Service Delivery, Observation & Direction and Autism Services Group require additional documentation.

Attached documentation should NOT be a copy of the Diagnostic Evaluation.

For Initial Service Delivery requests, after completing FBA/BIP, the reports must be attached to the request.

For Concurrent Service Delivery requests, progress reports (and updated BIP if applicable) must be attached for review.

ATTACHMENT SHOULD ALSO INCLUDE THE ASD REGISTRATION TEMPLATE WHICH INDICATES THE LEVELS OF CARE YOU ARE REQUESTING AND THE NUMBER OF UNITS.

21 Choose ASSESMENT/EVAL from the Document Description Drop down Menu.

22 Click Upload File


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ATTACHED DOCUMENTATION SHOULD ONLY INCLUDE INFORMATION

ON THE CLIENT FOR WHICH YOU ARE SEEKING AUTHORIZATION. ATTACHED DOCUMENTATION CANNOT CONTAIN ANY PERSONAL HEALTH INFORMATION FOR ANY OTHER CLIENT IN YOUR PRACTICE. CHECK ATTACHMENTS TO ENSURE THAT THE DOCUMENTATION IS SPECIFIC TO THIS CLIENT AND THIS CLIENT ONLY!

1. A pop up window to Upload File window will appear.

2. Click Browse.

a. Search for the file/document you want to attach.

b. Double click on the file.

3. The pop up window will now list the file chosen.

4. Click Upload.

5. The attached file will be listed on the page.

a. If the wrong file was selected users can click the checkbox next to the

document, click Delete and Repeat steps 18-21.

6. Click the Next Button

a. If a document has not been attached, a warning message will pop-up to

confirm if you want to proceed without attaching a document. Click the OK

button to proceed.


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Key Step 5:

Entering Requested

Services

Once the Next button is clicked, the Requested Services Screen will display.

The Requested Services Screen allows ASD providers to enter a listing of the services and modifiers that they are requesting in this registration.

Step Action

1 Click on the Click Here to Add or Modify Service Codes

Step Action

2 In the Pop Up Window Choose the service or services that are being requested

H0046 is for AOD – 10% or more of Service Delivery by Technician

H2014 is for ABB - Service Delivery by Clinician which includes: NOTE: THIS SERVICE ALSO INCLUDES THE FOLLOWING ADDITIONAL CODES THAT ARE UTILIZED AT THE TIME OF BILLING: 97153 (Adaptive behavior treatment by protocol, administered by a technician under the direction of a physician or other qualified healthcare professional, face-to-face with one patient)

0372T is for ASG – Group Intervention NOTE: UNTIL SYSTEM UPDATES ARE COMPLETED WITH UPDATED CPT CODE – PLEASE DO NOT SELECT 0372T – Requested Group Intervention level of care, timeframe and units requested should in the attached template of ASD Registered Service Requests with documentation.

3 Click Save


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Step Action

4 ENTER 0 in the Visits/Units Column for each Service Requested – The Requested level of care, timeframe and units requested should in the attached template of ASD Registered Service Requests with documentation.

Step Action

5 Click Submit at bottom of screen.


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Key Step 6:

Submit Request and Confirm Submission

Once the Submit button is clicked, the submission screen will display. Service Delivery, Observation & Direction and Autism Services Group, requests will be pended to the CT BHP ASD Clinical Team for review.

Pended Requests

Step Action

1 Confirm submission of request. o Status will indicate ‘Pended’ at the top of the screen with a message indicating

that the request requires further review.

The Results screen provides a summary of information about the request as well as the CT BHP authorization number (U0######).

2 Print the request. Click the Print Authorization Result button to print a copy of the Results page. Click the Print Authorization Request button to print a copy of all the

screens/fields completed for the request, including the clinical screens and the Results page.

3 Download the request. Click the Download Authorization Request button to save a copy of the request

either in pdf format or xml.

NOTE: THIS WILL BE THE ONLY OPPORTUNITY FOR PROVIDERS TO DOWNLOAD and save/print a copy of the authorization request.

4 Exit the Request for Authorization function. Click the Return to Provider Home to exit the Request for Authorization function.

5 Users may proceed with another menu function on the ProviderConnect homepage or log out of the system.


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Viewing and Printing Authorization(s) in the ProviderConnect System


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Viewing and Printing Authorization(s) in the ProviderConnect System

Key Step 1:

Viewing Authorization Inofrmation in

ProviderConnect

The ProviderConnect application allows users to view authorization details and print authorization letters for any completed authorization request. These functions can be initiated though the Authorization Listing on the Home page or . Below are the key actions for completing these functions

Option 1: Using the “Authorization Listing” Function: 1) Once logged into the ProviderConnect homepage, click on the “Authorization Listing”

link.


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Viewing and Printing Authorizations, cont.

2) Enter “CT” (in capitals) followed by the Member’s Medicaid ID (i.e. CT005555555) in the “Member ID” field if searching for a specific member’s authorization.

a. To view all of the authorizations for your facility practice, do not enter the Member ID and proceed to the next step.

3) Then, click “View All” or “Search” to view the client’s authorization(s). 4) The “Authorization Search Results” screen will appear. Click on the blue hyperlink for

the authorization that you would like to view.


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5) The “Auth Summary” screen will now be visible. On this screen, information such as Member ID, Name, Authorization #, Authorization Status, and Admit Date can be viewed.

TIP: Please note that when searching all Authorizations, the search results header allows

users to sort the results by clicking on the desired category. Click on the header title (i.e. Auth#, Member ID, Member Name, etc) once for descending results & click twice for ascending. We recommend that users sort by either Member Name or Service (LOC)

Only 50-100 results will be visible at a time. Users can click Next to view the Next 50-100 authorization lines.


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6) By clicking on the “Auth Details” Tab, it is possible to view the Submission Date, Type of Treatment, Dates of Service, Visits Requested/Approved, Units Already Used, and Status. Also, by clicking on the “Authorization Letter” icon, a PDF of the authorization letter can be viewed.

Option 2: Through the “Specific Member Search” Function: 1. Once logged into the ProviderConnect homepage, click on the “Specific Member

Search” link.


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2. On the “Eligibility and Benefits Search” page, enter the “Member ID” and the “Date of Birth”, then click “Search”.

3. The next screen shows the demographics information for the member along the top of the page. Click on the “View Member Auths” button.


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4. Once the “View Member Auths” button is clicked, the screen will drop down to display additional information. Click the “Search” button.

5. The “Authorization Search Results” screen will appear. Click on the blue hyperlink for the authorization that you would like to view.


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6. The “Auth Summary” screen will now be visible. On this screen, information such as Member ID, Name, Authorization #, Authorization Status, and Admit Date can be viewed.

7) By clicking on the “Auth Details Tab”, it is possible to view the Submission Date, Type of Treatment, Dates of Service, Visits Requested/Approved, Units Already Used, and Status. Also, by clicking on the “Authorization Letter” icon, a PDF of the authorization can be viewed.


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Completing Discharge Information for ASD Services


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Completing Discharge Information for ASD Services

Key Step 1: Navigating to the

Discharge Information Page

ASD Providers will enter discharge information on client’s that are no longer receiving behavioral health services by utilizing the Discharge function on the client’s authorization summary page.The first key step is to search for the client’s existing authorization, which can be initiated when the Specific Member Search button is clicked.

NOTE: Discharge summaries do not allow attachments of discharge summaries. ASD Providers should still still email the Beacon Clinical Care Manager to let them know you have discharged (and if a new provider is needed) AND keep a record of the summary in your chart for chart reviews

1. Click Specific Member Search from the navigational bar or Find a Specific Member on the Home page

2. Enter values for the Member ID and Date of Birth a. Note: The As of Date (MBR Eligibility Date) will auto-populate with

today’s date. To search a previous eligibility date, users can enter a previous date.

3. Click Search


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Completing Discharge Information for ASD Services, cont.

4. Click View Member Auths 5. Once the screen expands, Click Search

6. Click the Authorization Link on the Authorization you are requesting

additional units for.

7. On the Authorization Summary page, click Complete Discharge

Review


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Key Step 6:

Complete the Discharge

Information Screen

The Discharge Information screen provides essential information about the client’s discharge from services.

Step Action

1 Enter the *Actual Discharge Date (mmddyyyy)

2 The Primary BH Diagnosis, Primary Medical Diagnosis and the Social Elements Impacting Diagnosis will be auto-completed based on your previous authorization

Step Action

3 Under the Functional Assessment Section: Click the radio button for Discharge Condition:

Improved, No Change, Worse or Unknown Click the radio button for Type of Discharge:

Planned or Unplanned

4 Select (1) item for Discharge Reason

No further treatment indicated = Successful discharge

Member dropped out = Family does not want ABA services

Medication Management follow up only

Transfer to more intensive Level of Care = Residential

Referral to other outpatient service(s) = Parent/Family request other

provider

Member no longer eligible or moved = Member aged out of HUSKY, Switched to HUSKY B, Moved out of state or within state and you are unable to continue treatment

Other = When provider reaches impasse with family and discharge needed and choose other


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Step Action

5 Click the radio button for the appropriate rating for Current Risks:

MEMBER’S RISK TO SELF *

MEMBER’S RISK TO OTHERS *

Complete additional required information when the rating is a ‘2’ or ‘3’ (i.e. Ideation, Intent, Plan, Means, Current Serious Attempts, etc)

6 Click the radio button for the appropriate rating for Current Impairments:

MOOD DISTURBANCES (DEPRESSION OR MANIA)*

WEIGHT LOSS ASSOCIATED WITH AN EATING DISORDER*

Complete additional required information when the rating is a ‘2’ or ‘3’ (A sub-section will expand to display the fields that need to be completed)

ANXIETY*

MEDICAL/PHYSICAL CONDITIONS*

PSYCHOSIS/HALLUCINATIONS/DELUSIONS*

SUBSTANCE ABUSE/DEPENDENCE*

THINKING/COGNITION/MEMORY/CONCENTRATION PROBLEMS*

JOB/SCHOOL PERFORMANCE PROBLEMS*

IMPULSIVE/RECKLESS/AGGRESSIVE BEHAVIOR*

SOCIAL FUNCTIONING/RELATIONSHIPS/MARITAL/FAMILY PROBLEMS*

ACTIVITIES OF DAILY LIVING PROBLEMS*

LEGAL*

7 Click the radio button for the appropriate rating for

ABILITY TO SELF-ADMINISTER MEDS W/O ASSISTANCE OR SUPERVISION*

ABILITY OF FAMILY/NATURAL SUPPORTS.OTHER TO SUPERVISE MEDICATIONS*

8 Check all applicable options for Notified of Discharge*

If choice is “Other” indicate notifications in the specify text box.

9 Click the Save Discharge Information button. The Determination Status screen will display next indicating that Discharge has

been completed.

10 Print the request. Users can Click the Print Discharge Result button to print a copy of the Results

page.

11 Exit the Discharge Completed page. Click the ProviderConnect Home to exit the Discharge Information Screen and

return to the Home Page.

PLEASE NOTE: Discharge summaries do not allow attachments of discharge summaries. ASD Providers should still still email the Beacon Clinical Care Manager to let them know you have discharged (and if a new provider is needed) AND keep a record of the summary in your chart for chart reviews


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Appendix A: Documentation Templates Behavioral Assessments, Treatment Plan and

Program Book Development


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HAPPY KIDS AND FAMILIES ORGANIZATION 123 Play Street Wonderful, CT 860-999-9999

Member Name Wonder Kid

Member DOB __________ Member ID _________

DATE OF REQUEST __________

Name of clinician and license (LCSW; BCBA; Ph.D)

Statement of purpose and what assessment tools you will be using during the

assessment process

Date range

Signature


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HAPPY KIDS AND FAMILIES ORGANIZATION 123 Play Street Wonderful, CT 860-999-9999

Member Name Super Child

Member DOB 11/13/1999 Member ID : 001234555

DATE OF REQUEST 8/1/18

Name of clinician and license (LCSW; BCBA; Ph.D)

Clinical rationale for need at this time and date range needed. For Example: Super Child has

made significant behavioral growth and mastered several skill acquisition targets, which is

driving the need for updated treatment planning and program creation.


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ABC ASD Group Practice 123 High Street Hometown, CT 860-555-5555

Name of Client DOB Address Clinician Overseeing Case

Anita Services 05/05/2014 123 Service Way Nice, CT 00000

Oh Susana, BCBA

Background Information:

Anita has a current diagnosis of Autism given by Dr. Diagnosis on March 3th, 2016.

Anita has had a history of significant behavioral concerns that include, but are not limited to, noncompliance, limited attending, repetitive behaviors, and aggression on a daily basis.

Anita demonstrates a history of aggression across all settings that includes, but is not limited to pushing, pulling hair, and pinching.

Anita demonstrates a history of noncompliant behaviors, and has difficulty following more than a one-step direction.

Anita demonstrates repetitive behaviors such as hand flapping when excited or bored.

Anita communicates using one word phrases

Anita demonstrates limited social skills that included, but are not limited to eye contact, shared enjoyment, imitation, joint attention, functional play, and restricted and repetitive play behaviors based on results from a recent ADOS.

Proposed Date of Completion: January 16th, 2018


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Concurrent Review Request Template

ABC ASD Group Practice 123 High Street Hometown, CT 860-555-5555

Name of Client DOB Address Clinician Overseeing Case

Anita Services 05/05/2015 123 Service Way Nice, CT 00000

Oh Susana, BCBA

Background Information:

Anita has been receiving services since January 18th, 2018

Services have been delivered by a technician for 10 hours per week, with 1 hour Observation & Direction by BCBA, and 1 hour per week direct by BCBA.

Documents

ProviderConnect Registered Services Autism Service ...Completing a Registration Request for Behavioral Assessments, Treatment Plan and Program Book Development, cont. Key Step 3: Complete