Overview of Services WA State Physical Therapy Association Teresa - - PowerPoint PPT Presentation
OneHealthPort Overview of Services WA State Physical Therapy Association Teresa Davis, RN, Director of Market Development Kerry Tye, Senior VP Business Operations & Marketing May 11, 2017 Created by and for the local healthcare community,
1 Created by and for the local healthcare community, OneHealthPort solves information exchange and workflow problems shared across healthcare organizations.
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– Lead Organization
– Lead Organization
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– Assigned by your organization’s SSO Administrator
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connections
to route messages
standard data
C-CDA Response to API Query from/to EHR
Push
EHR pushes C-CDA to CDR View only use of the CDR using Portal Sponsor bulk loads claims and eligibility data Sponsor and other authorized parties can access reports and/or data
Clinics Clinics Providers Providers Hospitals Hospitals Authorized Party
Clinical Organization EHRs push C-CDA to CDR after each sponsored patient
reached, Clinical Organizations can draw C-CDA from CDR into their EHR through the HIE, or view CDR through secure portal.
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– Contracted with Managed Medicaid Care Organizations to provide care for patients covered under Apple Health plans – Use a certified electronic health record system (EHR) system – Received Meaningful Use incentive payments – Behavioral health and substance use disorder providers will begin participation in second phase of the CDR initiative later in 2017
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– When obtaining a pre-auth is extremely difficult
– Standard Notification timeframes for responding to pre-auth requests
corresponding timeframes
– Outlines requirements for payers to provide browser capabilities to access pre-authorization and admission notification information
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Provider Administered Medication
– Identify excluded benefits – Updated status information – Supporting document requirements for new requests and renewal or extension of services
Worksheet: Provider Requested Priority for Implementation of BPR-Browser Capability Related Enhancement BPR Enhancement BPR Page# Priority Rank 1 -11
Identify excluded benefits Use unlisted codes to look up investigational/ experimental services 9 1 (17) 1 p thi Link to supporting documentation requirements, for New requests Renewal or extension of current services (if different than new request) Unlisted codes 9-10 2 (24) Updated status information 14-15 3 (24) 1 p a 10 Include information about ‘Provider Administered Medications’ and ‘Provider Administration of Medications’ on web site, similar to other medical services Lookup Specialty Pharmacy Status Information 3-4, 6 8 9 14-15 4 (31) A n prov – “specialty” Identify when coverage for a service is dependent upon clinical requirement for previously tried services or diagnostic tests 10 5 (33) Identify services that require a medical review, separate from pre-auth Able to request a pre-service authorization review of these services 9, 10 10 6 (34) For questions about supporting clinical information – provide check list selection of answers and/or allow for complete entry
13 7 (36) Br where ‘High” ranking than “ ” Identify any ‘professional restrictions’ associated with a service On auth request form, include question(s) about these restrictions with check list of responses for which authorization will be considered. 9, 10 13 8 (42) Eliminate requirement for provider signature for an authorization request 13 9 (47) When multiple authorization for the same service are required, allow for requesting them at the same time 13 10 (49) Identify ‘specialty’ Pharmacy related information associated with ‘Provider Administered Medications’ 9 11 (57) Priority Legend: (xx) – sum of all rankings for the enhancement, with lower number having a higher prior Critical Essential High
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www.onehealthport.com/workflow-navigator
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Select from either Pre-Service Processing or Admission Notification
Participating Health Plans Asuris Northwest Health Commercial Asuris Northwest Health Medicare Advantage Cigna Community Health Plan of Washington Kaiser Permanente – Washington Region (formerly GHC) Labor & Industries LifeWise LifeWise Health Plan of Oregon LifeWise Health Plan of Washington Premera Blue Cross Premera Blue Cross Blue Shield of Alaska Regence Commercial Regence Federal Employee Program Regence Medicare Advantage Regence Uniform Medical Plan
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(if Liability is not uploaded then it doesn’t show in Audit)
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agencies from being sued without its consent. The doctrine stems from the ancient English principle that the monarch can do no wrong. NOTE: If you don’t have a Sovereign immunity document, the answer is most likely NO
credentialing). If so, the answer is YES
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application, you can add Practice Location from the Manage Practice page - if completed, then select YES
individual provider (and not add from the Manage Practice page), please select NO
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have the most issues with Chrome, if that’s the case, we recommend Firefox
than 2 or so months (please use the Gap section for any gap in coverage)
Documents = Application Documents is for use by Washington State
ALL fields
information or use Covering Colleagues
– Provider signatures cannot be scribble - it has to be somewhat readable
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Kerry Tye Senior VP Business Operations & Marketing Phone: 1.206.624.3128 x 119 Email: ktye@onehealthport.com Teresa Davis, RN Director of Market Development Phone: 1.206.624.3128 x 152 Email: tdavis@onehealthport.com Robert Alexander Provider Relations Manager 213.607.3635 robert.alexander@medversant.com Medversant Technologies, LLC Stephanie Cole Provider Experience 425-918-4830 Stephanie.Cole@Premera.com Premera Blue Cross