Web Authorization Guide

Electronic Health Plans, Inc.

Web Authorization Guide

CONFIDENTIAL INFORMATION 1 Web Authorization Guide (2.0) (06/01/11)

Copyright © 2000-2011 by Electronic Health Plans, Inc. All rights reserved


Keeping your Account Secure You must be a registered user to access this website. This sign-in verification process is new and will provide a second level of security for our users. When you logon for the first time, you will be required to select a security question and provide an answer to your question. There are six security questions to choose from. This information will be used in the future to allow password retrieval without contacting our support team. Enter your contact information email address; select one security question from the drop-down list; provide an answer to your security question, then submit. This process is required once during initial account setup.

Login Process You are required to enter your pre-assigned username and password.

Offices with multiple Providers’ will need to identify Referring Provider at login.




Forgot Password & Password Recovery If you cannot remember your password, click on Forgot Password link and follow the instructions. You will be required to enter the username and email address associated with this account.

Security Question for Lost Passwords Enter your security question answer and click <Submit>.

Email Notification Your password will be sent to the email address on file.

Login Error If the email address does not match, or is not found, you will receive the error below. Please contact Provider Relations.




Authorization Form When the Authorization Form loads, you will notice that some of the text inputs are colored a pale yellow. You can use these boxes as search boxes.

Place your cursor over the Help Icon to get help for a specific item.

As you begin to type into the box, you will get a dropdown based on your input. You must type in at least three characters to get a result.



Continuing to type will narrow down your results.


Mouse-over results. As you mouse through the results, the corresponding fields will populate. Click to select a record.

If your search finds no results, you will see “no results found” in the search box. Click in the box to clear it or press and hold the Backspace key.

Once you have selected a patient, you can click on the Map quest button to view the patient’s location.




Diagnosis Code Search Diagnosis search boxes search by code or by text.

To clear a Diagnosis code, click the check box, then click the clear button, or you can click in the text box to clear it.




Refer To Search Refer To searches on the Doctor name or Facility name.

You can also search by specialty using the drop down menu

Choosing a specialty opens a pop up window.

Click a radio button to select a Physician or Facility.




Clicking a button populates the Refer To form with your selection.

After selecting a provider, click the Map quest button for a map and directions showing the route from patient to provider.

Procedure Code Search Search for the Procedure codes by number or text. Select desired quantity.




Mouse-over and click to select. Click in the textbox to clear.

Click the Add Service Code button to add a Service Code to the text box.

Click the Remove button to clear the Service Codes from the text box.

Add pertinent information to the Additional Medical Information box. Click on the Referral Requirements button for help and suggestions.

Note: You must include additional comments relevant to the Referral Request. For example, if the request is for Pre-Natal Care, you need to fill in the Expected Delivery Date, Last Menstrual Period, and the Hospital where the patient will deliver. Please provide as much information to support your request. If you leave the Authorization form before completing all fields, you will be prompted by this message.




Click on the Submit Form button to submit the Authorization Request. You will be prompted for missing or incomplete information.

You may receive notice that your request does not meet direct criteria and will be remarked as Routine.

Specialists will have the following two Referral options.

You will receive the message below after submitting form.

You will be asked to print a copy of the Authorization for the patient’s chart. Clicking OK will print the form and submit the Authorization Request. Clicking Cancel will submit the Authorization Request without printing.




After the Authorization Request has been successfully submitted, you will be asked if you would like to add an attachment. Attachments may be one of three formats, a Word document (.doc or .docx), a Photograph (.jpg) or a Portable Document Format (.pdf). You may upload 5 attachments at one time. There is no limit to the total number of attachments on each Authorization.

When uploading attachments is complete, you may utilize the Return to Request Button or navigate to any one of the tabs, Home, Authorization Form, Authorization History or Log Out.




Attachments can be also added to an Authorization Request through Authorization History. To do this a User must locate the desired Authorization Request. When the desired Authorization Request is located there will be an Attachment Button. If attachments currently exist, the button will state “Attachments” as seen in the example screen below.

If attachments do not currently exist, the button will state “Add Attachment” as seen in the sample screen below.

When attachments have been added to the Authorization Request, there are two methods to access the attachments through Authorization History. There is an Attachments Button at the top of the page. When this button is pressed, the User will be directed to the bottom of the page for Attached Documents. The second method for accessing the attachments is to simply scroll down to the bottom of the web page to the Attached Document section. Both results can be seen in the sample screen below.




If another attachment is required it can be added utilizing the Add another attachment Button under the Attached Documents section of the web page as seen in the sample screen below.

Authorization Requests attachment history can be also be reviewed under the Attached Documents section of the web page as seen in the sample screen below.

The Authorization History Page also includes a “Paperclip” icon indicating when an attachment has been added to an Authorization Request as seen in the sample screen print below.

Direct Referral Criteria: The following three tables represent service and diagnosis code combinations that are considered direct and are systematically accepted as such. Any request not meeting these criteria will be submitted as Routine. It is the discretion of the Utilization Management department to modify any web submitted referral. For Service Codes 99241-99245 ICD9 CODES GASTROENTEROLOGY 530-538, 560-574, 575.10-579.9 OB V22-V22.2 GYN V72.3-V72.32, 610-629.9 DIABETES SCREENING V77.1, 250-250.0, 250.5 CONJUNCTIVITIS 372-372.33 GLAUCOMA 365-365.9 RETINAL DETACHMENT 361-361.9 CHOLECYSTITIS 575-575.1 HERNIA-INCARCERATED 550.0-550.1, 551-552.9 TESTICULAR PAIN 608.2 ACTUE URINARY OBSTRUCTION 599.6,599.60, 599.69 FRACTURE CARE 800-829.1 & 733.1 And Service Codes




FAMILY PLANNING (ABORTIONS) 59840, 59841 DEPO PROVERA INJECTION X6051 OB ULTRASOUND 76801, 76805 RADIOLOGY 70030-70332 70360 71010-71130 72010-72120 72200-72220 73000-73140 73500-73660 74000-74022 74210-74220, 74240-74270 74400 76645 77052, 77055-77057

99384-99386 OB V22-V22.2 GYN V72.3-V72.32, 610-629.9

Note: Specialist may not request Direct Authorizations. Authorization History You may search Authorization History by Status and Request Date or by Patient Name. To search by Status, use the Auth Status drop down menu to choose the desired status and click on Search by Status/Request Date to view the Authorization History matching your request. To search by Request Date, enter the desired request date and click on Search by Status/Request Date to view the Authorization History matching your request. To search by Patient, you may enter the Patient’s Name, Patient’s DOB, Patient’s Health Plan ID or Patient’s CIN and click on Search by Patient Name to view the Authorization History matching your request.




Click the Referral Icon to view original authorization form. Click the Letter Icon View to see letter. Click the Attachment Icon to see the attachment(s).

o Authorization requests submitted within the last 60 days (including pregnancy related authorizations) will be accompanied by a letter and original authorization form.

o Authorization History type authorizations are requests completed within 61-120 days from submission date.

On the 61st day, expired referral letters are removed, leaving on the original authorization form.

o Pending Authorizations will show only the original authorization form until they are completed by UM.

o Faxed authorization requests will now appear in patient history. Click on Return to Search Results button to go back to History Page.

Modify Existing Authorization Requests: Completed Authorization requests can now be modified to add additional information to support the referral. You can only modify when the Modify Request button is present. Click to modify.




CONFIDENTIAL INFORMATION 16 Web Authorization Guide (2.0)

(06/01/11) Copyright © 2000-2011 by Electronic Health Plans, Inc. All rights reserved

Begin typing additional information. When complete, click <Submit Request>.