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, OneHealthPort solves information exchange and workflow problems shared across healthcare organizations. 1

Agenda • Single Sign-On (SSO) Update • Health Information Exchange (HIE) • Clinical Data Repository (CDR) • Pre-Authorization/Pre-Service • Credentialing Update • Q&A • Introduce Premera 2

OneHealthPort Who We Are What We Do • Single-Sign-On Created in 2002, by and for the local healthcare • Admin Simp community, OneHealthPort – Lead Organization solves information exchange • Credentialing Data Collection and workflow problems • WA Healthcare Forum shared across healthcare organizations • Health Information Exchange – Lead Organization 3

Single Sign-On Reminder: Monthly Webcasts 4

Single Sign-On (SSO) Activity • SSO started in 2003 • Total Transactions in 2016 = 20,000,000! • As of 12/31/2016: – Total Organizations = 70,000 – Active Subscribers = 102,000 5

OneHealthPort’s Home Page 6

SSO Login Page 7

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CDR Access • Testing in the clinical portal is accessed with a “Test Role Only” – Assigned by your organization’s SSO Administrator • Once testing is complete other roles are assigned by your Administrator 9

Health Information Exchange (HIE) & Clinical Data Repository (CDR) 10

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Clinical Data Repository Clinical Data Repository Initiative Sponsors Sponsor use for CDR service • Washington State – Aggregate data for specific patient populations Health Care Authority – Work with specific provider (Medicaid) contributors to provide data • Physicians of – Used to create longitudinal Southwest Washington health record for patients (Managed Medicare) – Accumulate data for managing • More in the future contractual obligations and performing analytics 12

C-CDA Exchange with the CDR Sponsor bulk loads claims and eligibility data • Authenticate EHR pushes C-CDA connections to CDR • Use Provider Directory Providers to route messages • Facilitate exchange of Clinics standard data • Host API/web services • API Directory Push • Standards Propagation Hospitals View only use of the CDR using Portal Authorized Party Clinical Organization EHRs push C-CDA to CDR after each sponsored patient encounter. After a critical mass of data is Providers reached, Clinical Organizations can draw C-CDA Response Clinics C-CDA from CDR into their EHR through Sponsor and other to API Query the HIE, or view CDR through secure authorized parties from/to EHR portal. can access reports and/or data Hospitals 13

Who Should Participate? Provider organizations that meet the criteria below are required to submit C-CDAs – 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 • For specific questions about provider participation requirements contact the HCA at healthit@hca.wa.gov Enter CDR in the subject line of the email to route your question to the Link4Health team 14

CDR Questions Health Care Authority CDR Initiative • Visit HCA website for general CDR information: www.HealthIT.wa.gov • General questions about CDR participation requirements email HCA Health IT team at HealthIT@hca.wa.gov (Put “CDR” in the subject line) • Get started with HCA CDR participation: http://www.onehealthport.com/hca-cdr Physicians of Southwest Washington CDR Initiative • Get started with PSW CDR participation: http://www.onehealthport.com/psw-cdr 15 15

Pre-Authorization/Pre-Service 16

Pre-Auth Best Practice Recommendations (BPRs) • Extenuating Circumstances • Payer Websites – When obtaining a pre-auth is – Outlines requirements for payers extremely difficult to provide browser capabilities to access pre-authorization and o Unable to Know admission notification o Not Enough Time information • Timeliness – Standard Notification timeframes for responding to pre-auth requests • Defines type of requests and corresponding timeframes • Meets or exceeds NCQA standards 17

Payer Website Enhancements Provider Requested Priority Worksheet: Provider Requested Priority for Implementation of BPR-Browser Capability Related Enhancement BPR Priority • 11 Requested Enhancements BPR Enhancement Page# Rank 1 -11  Identify excluded benefits 9 1 p  Use unlisted codes to look up investigational/ experimental 1 (17) thi services – Identify excluded benefits Link to supporting documentation requirements, for 9-10  New requests 2 (24)  Renewal or extension of current services (if different than new request) – Updated status information  Unlisted codes Updated status information 14-15 3 (24) 1 p a 10 Include information about ‘Provider Administered Medications’ 3-4, 6 A n – Supporting document and ‘Provider Administration of Medications’ on web site, similar prov to other medical services 4 (31) –  Lookup “specialty” 8  Specialty Pharmacy requirements for new requests and 9  Status Information Provider 14-15 Identify when coverage for a service is dependent upon clinical 10 5 (33) renewal or extension of services Administered requirement for previously tried services or diagnostic tests  Identify services that require a medical review, separate 9, 10 from pre-auth 6 (34) Medication 10  Able to request a pre-service authorization review of these services For questions about supporting clinical information – provide 13 7 (36) Br check list selection of answers and/or allow for complete entry where of information ‘High” ranking than “ ”  Identify any ‘professional restrictions’ associated with a 9, 10 8 (42) service  13 On auth request form, include question(s) about these restrictions with check list of responses for which authorization will be considered. Eliminate requirement for provider signature for an 13 9 (47) authorization request When multiple authorization for the same service are required, 13 10 (49) allow for requesting them at the same time Identify ‘specialty’ Pharmacy related information associated 9 11 (57) with ‘Provider Administered Medications’ Priority Legend:  (xx) – sum of all rankings for the enhancement, with lower number having a higher prior  Critical Essential High 18

Best Practice Recommendations (BPR) Online BPR Search Tool Under AdminSimp • Search by Category: Claims Edits, HIPAA Transactions, Prospective Review for Medical and Pharmacy 19

Workflow Navigator Pre-Service Search Tool Demo 20

Workflow Navigator www.onehealthport.com/workflow-navigator 21

Workflow Navigator 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 Select from either Pre-Service Processing or Admission Notification 22

Premera Blue Cross – Visits & Procedures 23

Premera Blue Cross – View Medical Policies 24

Premera Blue Cross – Check Status of Request 25

Workflow Navigator – Carved Out Service 26

Workflow Navigator – Carved Out Service 27

Workflow Navigator – Carved Out Service 28

Pre-Auth – Ongoing Efforts • Validation – Observe provider workflow as they navigate through different sites • Meetings with Payers – Provide feedback from validation findings and what we learn during Lunch & Learns • Host Payer Webcasts – Payers highlight pre-auth tools on their website and allow time for Q&A 29

Credentialing 30

Legislative Update – Credentialing • A new law passed requiring providers and credentialing entities to use ProviderSource • Effective 6/1/18 • Delegated entities are exempt 31

Physical Therapist Provider Source sections that cause the most confusion 32

Documents Page Overview • Manage Documents • Application Documents 33

Other IDs and Certifications • This section is payer specific • If you answer YES, then you need to upload to Manage Documents 34

Other IDs and Certifications • Certification Type: If you respond YES, then complete the below 35

Application Document Audit • Required documents for every payer (if Liability is not uploaded then it doesn’t show in Audit) 36