ProviderConnect User Manual — CT BHP
Contents
1. oa Updated 9 1 2015 CT BHP ProviderConnect User Manual Reg Completing Concurrent Requests for Registered Services continued 8 Click the Process Continuing Care Concurrent Request tab to complete the Concurrent Request sagos ron agate Servis Hader ani sec tic Kdei aen b annro craves watts ea C aoe Com Key Step 3 The Type of Services screen is the first screen that will display after the Initial Entry Complete the screen Clinical Screens 36 ORF2 The same screens are completed for initial and concurrent requests However as noted any data that is not expected to be updated for a concurrent request will auto populate from the initial or last request The pre populated fields can be overwritten with new data 1 Type of Services Screen Displays Click the Next button 2 The Diagnosis screen will display next Update any Behavioral or Medical Diagnosis if applicable Click the Next button 3 The Current Risks and Impairments screen will display next The Current Risks and Impairments fields will need to be completed to move onto the next screen Click the Next button a The Special Population screen will display next Update Fields if applicable Click the Next button 5 The Treatment Plan screen will display next The Treatment Plan fields and the Re Registration Only fields will ne2. Sibiltv and Benetts Bave Referrals Enta snaci Mamer Review Referrals tor or Baview Authorization Feguest view My Recent Authorization Letters wina Jrfomanon Enter an Aharon Eege Enteraed view Clinical Drafts 2 Review the Disclaimer and click the Next Button Disclaimer Please note that Valuetptions recognizes only fully recognize of retain data for partially completed requesta pon full completion of the Enter an Authoreation Request pi notthcatien that vour requast nas bean raceived by ValuaOabons 19 Updated 9 1 2015 ss senice BE Completing Initial Requests for Registered Services continued CT BHP ProviderConnect User Manual Re 3 Search for Member Record by entering the Member s Medicaid ID and Date of Birth Then click Search eee ee ee eee tember ID fernp00700050 eve spacer or dores koata of ith 1151895 camaorern As of Date oezo eoor 4 Click the Next button on the Member record to continue ea Member Narna waansin mooney Date of Birth o17ass1995 Gender 5 The Select Service screen will display 20 Updated 9 1 2015 xs Services BE Completing Initial Requests for Registered Services continued CT BHP ProviderConnect User Manual Re 6 Locate and select the Service Address Vendor Click the radio button next to the Service Address to select record Th
3. cont authorisation Letters ar Bad Traskdnu Information Authoreation Request FRAO ical Drafts 10 Updated 9 1 2015 ss Services BE Completing Requests for Outpatient Evaluations continued CT BHP ProviderConnect User Manual Regis 2 _Review the Disclaimer and click the Next Button Please note that Valueoptions recognizes only fully completed recognize ar retain data for partially completed requests Upon f notfcatien that your request haz Bean faccived by WaluaOat anc mitted raquasts as formal requests for authori ilaton oF the Enter an Authors 3 Search for Member Record by entering the Member s Medicaid ID and Date of Birth both fields are required Then click Search Eligibility amp Benefits Search Required fields are denoted by an asterisk adjacent to the label Verify a patient s eligibility and benefits information by entering search criteria below Member ID DOXXXXXXX No spaces or dashes Last Name First Name or T Date will prepopulate to today Date of Birth 01012006 mmovyvvy DO NOT EDIT As of Date 03142014 IDDYYYY Caer Co 4 Click the Next button on the Member record to continue Hamba Member Ib TEMPoea7onese Date of Birth oiris ruus Alternate Address Marital status Home Phone Werk Phone Relation hir 2 11 Updated 9 1 2015 CT BHP ProviderConnect User Manual
4. WITHIN THE PAST 12 MOS HAS THE CHILD YOUTH BEEN ARRESTED WITHIN THE PAST 12 MOS HAS THE CHILD YOUTH BEEN SUSPENDED EXPELLED DURING 90 DAYS PRIOR TO THIS REQUEST FOR RE AUTHORIZATION HAS MEMBER BEEN ENROLLED IN SCHOOL IF MEMBER IS ENROLLED IN SCHOOL HAS MEMBER BEEN SUSPENDED FROM SCHOOL IF MEMBER IS ENROLLED IN SCHOOL DOES MEMBER HAVE UNEXCUSED ATTENDANCE PROBLEMS MEMBER S BEAVIOR RESULTED IN NEW LEGAL PROBLEMS ANY NEW LEGAL CHARGES BROUGH AGAINST MEMBER FAMILY MEMBER BEEN INVOLVED IN ANY PEER SUPPORT ACTIVITIES MEMBER BEEN ACTIVELY INVOLVED IN ANY ORGANIZED RECREATIONAL ACTIVITIES DOES THE CHILD S CARE PLAN INCLUDE A GOAL OF INVOLVEMENT IN ORGANIZED RECREATIONAL ACTIVITIES DURING THE PAST 3 MONTHS HAVE YOU COMMUNICATED WITH ANY OF THE FOLLOWING REGARDING CARE AND TREATMENT OF MEMBER SCHOOL DCF PROBATION PAROLE Complete the Methadone Maintenance section if expanded Ata minimum the following fields are required for initial requests IS THE MEMBER CURRENTLY MAINTAINED ON METHADONE o If yes how long has the member received Methadone Services o If no what has been the duration of the member s opioid use WHAT OTHER SERVICES ARE INCLUDED IN THE TREATMENT PLAN WHAT IS THE ULTIMATE TREATMENT GOAL 31 Updated 9 1 2015 er Manual Reg 3 Complete the Ambulatory Detox section if expanded At a minimum the following fi
5. is selected in the drop down then an Assessment Score must be entered into the corresponding field as well 3 Tf an Assessment Measure is not listed in the dropdown Other can be selected 4 1f Other is selected an open text box will appear Please enter the Other test and the Assessment score of that test A Select the appropriate Assessment Measure from the drop down menu and enter the Assessment Score be sndion HPA B Users can select from the following assessment measures If you are using a ifferent assessment measure then select Other from the drop down menu Below is a Key for the Assessment Measure List CDC HRQL Center for Disease Control Health Related Quality of Life e CGAS Children s Global Assessment Scale FAST Functional Assessment Staging Test GAF Global Assessment of Functioning OMFAQ Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire e SF12 Quality of Life Assessment Using the Short Form 12 Questions SF36 Quality of Life Assessment Using the Short Form 36 Questions WHO DAS World Health Organization Disability Assessment Schedule 17 Updated 9 1 2015 CT BHP ProviderConnect User Manual Completing Requests for Outpatient Evaluations continued Key Step 4 Once the Submit button is clicked from the final clinical screen the submission Submit R
6. TBI MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE NERVOUS SYSTEM CHRONIC PAIN OTHER NERVOUS SYSTEM MIGRAINE EPILEPSY STROKE NERVOUS SYSTEM MULTIPLE SCLEROSIS NERVOUS SYSTEM OTHER NERVOUS SYSTEM PARKINSONS EPS PERINATAL PERIOD PREGNANCY CHILDBIRTH AND THE PUERPERIUM RESPIRATORY SYSTEM COPD ASTHMA EMPHYSEMA RESPIRATORY SYSTEM OTHER SKIN amp SUBCUTANEOUS TISSUE SyMPTOMS SIGNS amp ABNORMAL CLINICAL LAB NONE ii 26 Updated 9 1 2015 Completing Initial Requests for Registered Services continued A Partial Description We suggest for those system users that are new or unfamiliar to the ICD 10 Medical Diagnoses to first enter a partial description of the medical condition then click the Description hyperlink Primary Medical Diagnosis Primary medical diagnosis is required Select primary medical diagnostic category from dropdown or select medical agnosis Diagnostic Category 1 SELECT Diagnosis Code 1 B A partial description will bring up a pop up window where users can view a filtered list of those descriptions that match their search criteria crose winpow C Once a user clicks on the appropriate code in the pop up window all other fields will populate Primary Medical Diagnosis Primary mecca dlagrass is required Select primary medica diagnostic category from dropdown or select medical diagnosis code and descritor Diagnesic Ca
7. Complete required information about the member s treatment plan THE TREATMENT PLAN WAS DEVELOPED WITH THE MEMBER OR HIS HER GUARDIAN AND HAS MEASURABLE TIME LIMITED GOALS DOES A DOCUMENTED GOAL ORIENTED TREATMENT PLAN EXIST ANTICIPATED TARGET DATE FOR ACHIEVEMENT OR CURRENT TREATMENT PLAN GOALS 5 Click Next button The Psychotropic Medications screen will display next The medication fields are not required but should be completed if applicable 6 Click Next 32 Updated 9 1 2015 CT BHP ProviderConnect User Manual Registered Services Completing Initial Requests for Registered Services continued Key Step 9 Submit Request and Confirm Submission Once the Next button is clicked from the final clinical screen the submission screens will display The specific screens that display vary depending on if the request is approved or pended For the Outpatient Services new requests will most likely auto approve meaning that the requested authorization will be an automatically approved authorization For auto approved requests two screens display the Accept Reject screen and the Confirmation screen If the request is pended for some reason only one screen will display the Confirmation screen Below is information for submitting request for both auto approved and pended requests Auto Approved Requests Step Action 1 CT BHP providers should always click the Accept Button o
8. care within your agency practice thus removing this registration from your access standards Select the REFERRAL SOURCE Enter the date of the FIRST PHONE OR WALK IN CONTACT WITH MEMBER OR PARENT GUARDIAN and select the method for the FIRST CONTACT WAS Select the REFERRAL TYPE If the Referral Type is Routine or Urgent then complete the conditionally required fields for Routine or Urgent referrals o DATE OF FIRST APPOINTMENT OFFERED TO MEMBER o DATE OF FIRST APPOINTMENT ACCEPTED BY MEMBER o DATE OF FIRST FACE TO FACE CLINICAL EVALUATION Ifthe Referral Type is Emergent then complete the conditionally required fields for Emergent referrals o DATE AND TIME PRESENTED AT THE CLINIC Time must be entered as military time ie 2 00pm 1400 and 2 am 0200 o DATE AND TIME OF CLINICAL EVALUATION Time must be entered as military time i e 2 00pm 1400 and 2 am 0200 Click the Next button _ The Diagnosis screen will display next Updated 9 1 2015 CT BHP lerConnect User Manual Reg Completing Initial Requests for Registered Services continued Key Step 5 The Level of Diagnosis screen is the first screen that will display after the Initial Entry Complete the screen Much of the information is required for completion of this screen Clinical Screens jia aa q Documentation of Primary Behavioral Condition is required Provisional working Diagnosis condition and diagnosis should
9. fields A sub section will expand to display the fields that need to be completed WEIGHT LOSS ASSOCIATED WITH AN EATING DISORDER SUBSTANCE ABUSE DEPENDENCE LEGAL Complete additional required information when the LEGAL impairment rating is a T 2 or 3 A sub section will expand to display the fields that need to be completed Indicate Yes No or Not Assessed for DOES MEMBER HAVE CO OCCURRING MENTAL HEALTH AND SUBSTANCE ABUSE CONDITIONS Click the Next button _ The Special Population screen will display next Updated 9 1 2015 CT BHP ProviderConnect User Manual Registered Services a Completing Initial Requests for Registered Services continued Key Step 6 The Special Populations screen captures information specific to the following types Complete the of members Clinical Screens Members Age 0 18 ORF2 Special Methadone Maintenance Populations Screen Ambulatory Detox If the member is not any of the types listed then this screen can be skipped If the member is one or more of those types the sections that must be completed will be automatically expanded to display the fields that must be completed Below are the key actions for completing this step Any field with an asterisk indicates that the field is required Complete the Member s Age 0 18 section if expanded SED SERIOUSLY SEVERELY EMOTIONALLY DISTURBED CO OCCURING DISORDER LIVING SITUATION
10. providers to complete requests for Outpatient Evaluations using an easy to follow workflow For Outpatient Evaluations only the Primary Behavioral Diagnosis Code is required for completion Most requests will auto approve unless the request does not pass the system validations KeySteps The key steps for creating requests for Outpatient Evaluation authorizations include 1 Initiate a Request for Authorization 2 Complete the initial entry request screen 3 Complete the clinical screens Outpatient Treatment Request 1 ORF1 4 Submit Request and confirm submission Details about each key step follow Key Step 1 The first key step is to initiate the request for authorization function which starts from Initiate a Request the ProviderConnect Homepage The function can also be initiated when the for Authorization Member record is located first and then the Enter an Authorization 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 the Enter an Authorization Request link from either the left navigational or Home page of ProviderConnect Welcome Thank vou for using ValueOptions ProviderConnect OUR MESSAGE CENTER anno ae Your Recent Inquiries box iz empty ee ge WHAT DO vou WANT TO Da TODAY Eininn and nenets Beview paferals gt Baviow Raferrals Entar or review Authorization w sr Mew my
11. CT BHP ProviderComect User Manual Registered Services BA ProviderConnect Registered Services User Manual 1 Updated 9 1 2015 CT BHP ProviderConnect User Manual Re Table of Contents n Introduction Accessing ProviderConnect ProviderConnect Basics Features Completing Requests for Outpatient Evaluations Completing Initial Requests for Registered Services Completing Concurrent Requests for Registered Services Updated 9 1 2015 Introduction Introduction What is Covered in this Module Training Objectives CT BHP ProviderConnect User Manual 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 Outpatient evaluations Obtaining authorizations for CT BHP Registered Services Outpatient Methadone Maintenance Ambulatory Detoxification and Home Based services Submitting requests for Psychological Testing services This module covers general functions within ProviderConnect as well as requests for Outpatient evaluations and services which includes the following key functions Registering Outpatient Evaluations This process focuses on completing a registration authorization for an Outpatient evaluation Registering Initial Outpatient Services This pr
12. HP ProviderConnect User Manual Completing Concurrent Requests for Registered Services Overview Concurrent Outpatient Services Validations and Checks Concurrent Check Key Steps Key Step 1 Initiate a Request for Authorization 34 Creating a Concurrent request in ProviderConnect follows the same process as completing a new request but with some variations within each step This is because ProviderConnect will automatically determine when a request is initial or concurrent by checking for existing authorizations on file for the same member provider and other matching criteria If the system finds an existing authorization that matches the criteria and the request is determined to be concurrent then the system will Pre populate some information from the last request into fields in the new concurrent request The pre populated fields can be overwritten with new data Require additional information The same screens are completed for initial and concurrent requests however any data that is not expected to be updated for a concurrent request will auto populate from the initial or last request When completing concurrent requests for Outpatient Services there are system checks that are completed at the beginning of the request specific to this type of request The purpose of these checks is to enforce established rules for concurrent Outpatient services authorizations When the level of service is Outpatie
13. PILEPSY STROKE NERVOUS SYSTEM PARKINSONS EPS PERINATAL PERIOD RESPIRATORY SYSTEM OTHER SKIN amp SUBCUTANEOUS TISSUE levmeToms SIGNS amp ABNORMAL CLINTCAL LAB it A Partial Description We suggest for those system users that are new or unfamiliar to the ICD 10 Medical Diagnoses to first enter a partial description of the medical condition then click the Description hyperlink Primary Medical Diagnosis Primary medical diagnosis is required Select pri rory from dropdown or select medical diagno Diagnostic Category 1 SELECT B A partial description will bring up a pop up window where users can view a filtered list of those descriptions that match their search criteria 15 Updated 9 1 2015 CT BHP ProviderConnect User Manual eT CIRCULATORY SYSTEM no ESSENTIAL PRIMARY HYPERTENSION pei CIRCULATORY SYSTEM m2 HYPERTENSIVE CHRONIC KIDNEY DISEASE pees o ia EENS A AAI RARE peau CIRCULATORY SYSTEM w HYPERTENSIVE HEART DISEASE aes C Once a user clicks on the appropriate code in the pop up window all other fields will populate Primary Medical Diagnosis Primary medial degrassi required eect primary medical diagnostic category from dropdonn er sect medical diagnosis code and descrition Diagnose atgory 1 DaorassCodet Descrifion CIRCULATORY SYSTEM HYPERTENSION ho Essential primary hypertension There is additionally
14. Registered Services ii Completing Requests for Outpatient Evaluations continued 5 The Select Service Address screen will display 6 Locate and select the Service Address Click the radio button next to the Service Address to select a record The record that is selected will be attached to the request and authorization that will be created 7 Click the Next button to continue The Requested Service Header will display Vendor First Name Paid Ta Vendor 10 Pay To ress vois TAP POWDER SODEMIERPRSEDR OTF SIDEMERERSEDE OT SED ROCKY HL CT 0067 3913 ROOK HL CT 08067 913 TIPRO voso TEP PODER SIDETERORSER SIDETEPRSEDR SED SE ROCKHILL CT 060673913 ROCKY HL CT 080673913 12 Updated 9 1 2015 CT BHP ProviderConnect User Manual Completing Requests for Outpatient Evaluations continued 13 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 that is being requested 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 1 Enter the Requested Start Date The Requested Start Date is the date for the authorization
15. YCHOTIC DISORDERS SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS SCHIZOPHRENIA SPECTRUM AND 29 UNSPECIFIED SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDER OTHER PSYCHOTIC DISORDERS 25 Updated 9 1 2015 CT BHP Provide nnect User Manual Re Completing Initial Requests for Registered Services continued Behavioral Diagnoses Primary Behavioral Dizanosis Diagnostic Category 1 Disgnoss Code1 Description SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORI F20 9 Schizophrenia Step Action 5 System users may choose to first select a Medical Diagnostic category and then utilize the Diagnosis Code and or Description field hyperlinks to locate the appropriate Medical Diagnosis 6 System users can enter a partial medical diagnosis and then click on the hyperlink to view a filtered list of those codes that match their search criteria 7 If there is No Medical Diagnosis or it is Unknown please select one of the options under the Diagnostic Category No Diagnosis Code or Description are needed if the selection is None or Unknown Freeones perean Daana Code Descution GENITOURINARY SYSTEM KIDNEY GENITOURINARY SYSTEM OTHER INFECTIOUS amp PARASITIC HIV INFECTIOUS amp PARASITIC OTHER INJURY POISONING amp OTHER EFFECTS OF EXT CAUSES OTHER INJURY POISONING amp OTHER EFFECTS OF EXT CAUSES
16. an open text field for other specific medical conditions You can then enter information such as Behavioral Health Rule Outs and In Remissions and other specific Medical Conditions other specife medics conditions 28 of 2000 The next section has been named Social Elements Impacting Diagnosis Additionally the Housing Problems checkbox has been divided into Housing Problems Not Homelessness and Homelessness 1 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 Tf there are no social elements impacting the member select the None checkbox if social elements have not been assessed yet select the Unknown checkbox 4 If Other Psychosocial and Environmental Problems is selected an open text field will open and require you to enter what the other is a 16 Updated 9 1 2015 Social Elements Impacting Diagnosis chests hy The next section is named Functional Assessment and will allow users to enter up to 2 different assessment measures and scores While 2 assessments can be entered users are not required to enter any information in this section as it is optional 1 To complete this section simply click the dropdown for the Assessment Measure 2 If an Assessment Measure
17. ations continued Key Step 3 Documentation of Primary Behavioral Condition is required Provisional working Complete the condition and diagnosis should be documented if necessary Documentation of ORF1 Clinical secondary co occurring behavioral conditions that impact or are a focus of Screens 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 members 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 required Step Action 1 The Primary Diagnostic Category 1 is the main diagnosis and should be the reason for the members decompensation to Inpatient Care 2 Enter the Diagnosis Code 1 or a brief Description and select the hyperlink Behavioral Diagnoses bein sehr eons A Diagnose category 1 SELECT Step Action 3 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 4 Once a user clicks on the appropriate code in any of the pop up windows all other fields will populate Behavioral Diagnoses Primary Behavioral Diagnosis Od D
18. 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 members 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 required Step Action 1 The Primary Diagnostic Category 1 is the main diagnosis and should be the reason for the members decompensation to Inpatient Care 2 Enter the Diagnosis Code 1 or a brief Description and select the hyperlink Behavioral Diagnoses ser Be rere it Disenasie Category 1 Tiemen adel Dexcristor SELECT rza Step ction 3 System users can enter a partial diagnosis and then click on the hyperlink to view a filtered list of those ICD 10 codes that match their search criteria 4 Once a user clicks on the appropriate code in any of the pop up windows all other fields will populate Behavioral Diagnoses Primary Behavioral Diagnosis 4 Diagnostic Category 1 Diagnosis Code 1 SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORE SCHIZOPHRENIA SPECTRUM AND OTHER PS
19. d Psychological Testing services b Substance Abuse should be chosen for SA Intensive Outpatient Outpatient Methadone Maintenance and Ambulatory Detoxification Services 11 Select the Level of Care Outpatient 12 Select the Type of Care Requested level of care amp provider type of the service ie Intensive Outpatient Comm Mant Hith Ctr Intensive Outpatient Fed Qualified Hith Ctr Extended Day Treatment Fed Qual Health Center Extended Day Treatment Comm Mntl Health Clinic Outpatient Comm Mnt Hith Ctr Outpatient Office Psych Testing Office Home Based Services MDFT individual Clinic 13 Attach a document CT BHP registered services do not require attached documents users can proceed to step 7 14 Click the Next button saging ouc 15 A warning message will pop up to confirm if you want to proceed without attaching a document Click the OK button to proceed 2 SENDS aaps astei stener tiayan esl caem erantsia esaeas daet e aace eat MEOE aaee Updated 9 1 2015 Completing Initial Requests for Registered Services continued CT BHP ProviderConnect User Manual Key Step 3 For Outpatient Services requests the clinical screens for the Outpatient Request Complete the Form 2 ORF2 workflow will display This workflow consists of six 6 clinical Clinical Screens screens The amount of infor
20. e record that is selected will be attached to the request and authorization that will be created 7 Click the Next button to continue The Requested Service Header will then display Staging c egw Serten Hinder seit autora Attach a Document a 5 2 Updated 9 1 2015 CT BHP ProviderConnect User Manual Regis Completing Initial Requests for Registered Services continued 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 8 Enter the Requested Start Date The Requested Start Date is the date for the authorization to begin in order to cover all requested services 9 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 10 Select the Type of Service a Mental Health should be chosen for MH Intensive Outpatient Extended Day Treatment Outpatient Home Based an
21. ed Services continued Key Step 4 Complete the Clinical Screens ORF2 Type of Services Screen Step 1 The Type of Services screen is the first screen that will display after the Initial Entry screen Much of the information is required for completion on this screen Below are the key actions for completing this step Any field with an asterisk indicates that the field is required Action Enter the CONTACT NAME and PHONE NUMBER of the individual the CT BHP should contact if more information is needed by a ValueOptions clinician n Enter the MEMBER S GUARDIAN if needed Complete the required questions IS THIS A NEW REGISTRATION FOR A CLIENT ALREADY IN OUTPATIENT TREATMENT WITHIN YOUR AGENCY PRACTICE o NOTE TO ECC PROVIDERS This field has been updated This field now is inquiring if this registration is for a client ALREADY IN outpatient treatment with your facility Ifa client has recently become HUSKY eligible but has already been previously receiving services through your agency practice ECC users should select YES thus removing this registration from your access standards Ifthe client is HUSKY eligible and is a new admission to your facility ECC users should select NO IS MEMBER STEPPING DOWN TO OUTPATIENT FROM A HIGHER LEVEL OF CARE WITHIN YOUR AGENCY PRACTICE o NOTE TO ECC PROVIDERS Users should select YES if a member is stepping down from a higher level of
22. ed to be completed to move onto the next screen Indicate Degree of Progress from previous registration Treatment Modalities to be used w this request Family Individual Group Medication Management and Frequency Click the Next button 6 The Psychotropic Medications screen will display next Update Fields if applicable Click the Next button 7 Submit Request Updated 9 1 2015
23. efits Search Required fields are denoted by an asterisk adjacent to the label Verify a patient s eligibility and benefits information by entering search criteria H First Name Jar ot oi Nanna srr esr bake TATE T puroa rrr Updated 9 1 2015 CT BHP ProviderConnect User Manual Registered Services si ProviderConnect Basics continued Review Members record details Demographics Displays basic member information i e address phone etc Enrollment History Displays active and expired enrollment records for member COB Coordination of Benefits Display information on other insurance policies Additional Information Displays claims mailing address for the member OAR go Demographics Enrulinent History GOB Additional Information Member eligibility does nct guarantee payment Eligibility is as of today s date and is provided by our cients View Member Auths Displays Member specific authorizations Enter an Authorization Initiates the Request for Services process View Clinical Drafts Display member specific Clinical Drafts 0 View Referrals For Residential Group Home Providers Only geen Tome FN Work Phone Relationship 1 Gender M Male View Member Auths iew Referrals 8 Updated 9 1 2015 CT BHP ProviderConnect User Manual Re istered Services i Features Saving Requests While working with re
24. elds are required for completion for initial requests FROM WHAT SUBSTANCE IS THE MEMBER IN NEED OF DETOXIFICATION HAS THE MEMBER HAD PREVIOUS DETOX IN ANY SETTING IN THE PAST YEAR o If yes number of detoxes in the past year WHAT IS THE IDENTIFIED DISCHARGE PLAN 5 Click the Next button The Treatment Plan screen will display next Key Step 7 The Treatment Plan screen captures information specific to the member s plan for Complete the treatment while they are receiving services from the provider Clinical Screens ORF2 Note The Re registration section can be skipped for initial requests This section is Treatment Plan Treatment HAR Only required for concurrent requests Below are the key actions for completing this step Any field with an asterisk indicates that the field is required Step Action Indicate Yes or No for IS PSYCHIATRIC MEDICATION EVALUATION OR MEDICATION MANAGEMENT VISIT INDICATED 2 Indicate Ves or No for HAVE YOU PROVIDED INFORMATION REGARDING PEER SUPPORT OR SELF HELP OPTIONS 3 Indicate Ves or No for DO FAMILY MEMBERS OR SIGNIFICANT OTHERS ACTIVELY PARTICIPATE IN THE MEMBER S TREATMENT AND RECOVERY If Yes is selected complete the follow up question IF YES ARE ANY OF THE FAMILY MEMBERS SIGNIFICANT OTHERS RECEIVING THEIR OWN MH OR SA TREATMENT 3 Select valid options to indicate the consent obtained for contact with SCHOOL MEDICAL PROVIDER and PREVIOUS BEHAVIORAL HEALTH TREATMENT PROVIDER 4
25. equest screens will display The specific screens that display vary depending on if the and Confirm request is approved or pended Submission For the Outpatient Evaluations the request will most likely auto approve meaning that the requested registration will be an approved authorization 1 For approved request the status would indicate Approved at the top of the screen 2 Lastly you have the options to either Print the Authorization Result Print the Authorization Request Download the Authorization Request or Return to Provider Home SV Pnowipenconnecr ny 18 Updated 9 1 2015 CT BHP ProviderConnect User Manual Re Completing Initial Requests for Registered Services Key Step 1 The first key step is to initiate the request for authorization function which starts from Initiate a Request the ProviderConnect Homepage The function can also be initiated when the for Authorization Member record is located first and then the Enter an Authorization 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 gaging cone nari Welcome Thank you for using ValueOptions ProviderConnect ic Member soarch YOUR MESSAGE CENTER
26. es While 2 assessments can be entered users are not required to enter any information in this section as it is optional Step Action 1 To complete this section simply click the dropdown for the Assessment Measure 2 If an Assessment Measure is selected in the drop down then an Assessment Score must be entered into the corresponding field as well 3 If an Assessment Measure is not listed in the dropdown Other can be selected 4 Tf Other is selected an open text box will appear Please enter the Other test and the Assessment score of that test Updated 9 1 2015 er Manual Reg Completing Initial Requests for Registered Services continued A Select the appropriate Assessment Measure from the drop down menu and enter the Assessment Score SELECT gt assesment Score 78 a SELECT Coc HRGOL Fas a OTHER naa SP12 536 WHO Das B Users can select from the following assessment measures If you are using a different assessment measure then select Other from the drop down menu Below is a Key for the Assessment Measure List CDC HRQL Center for Disease Control Health Related Quality of Life e CGAS Children s Global Assessment Scale FAST Functional Assessment Staging Test GAF Global Assessment of Functioning Questionnaire e SF12 Quality of Life Assessment Using the Short Form 12 Question
27. h will save the record when clicked As a saved record it is only available within ProviderConnect and is not available to access in CareConnect Submit A Submit button is available on some screens which will submit the record when clicked Text Boxes Member s Guardian John Smith Any open text box indicates that free form text can be entered into the box Updated 9 1 2015 CT BHP ProviderConnect User Manual Regi 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 Connecticut Behavioral Health Partnership 3 Under the forms section click on the Online Services Account Request Form hyperlink Forms we 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 ctbhp valueoptions com 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 sd Services BE Updated 9 1 2015 CT BHP ProviderConnect User Manual Accessing ProviderConnect co
28. iagnostic Category 1 Dagnosis Code TOENE SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORE v phrenia code Description SCHIZOPHRENIA SPECTRUM AND E SPCEIFIED SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC OTHER PSYCHOTIC DISORDERS SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS B UNSPECIFIED SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDER 14 Updated 9 1 2015 CT BHP ProviderConnect User Manual Registered Services Step Action System users may choose to first select a Medical Diagnostic category and then utilize the Diagnosis Code and or Description field hyperlinks to locate the appropriate Medical Diagnosis 6 System users can enter a partial medical diagnosis and then click on the hyperlink to view a filtered list of those codes that match their search criteria 7 Tf there is no medical diagnosis or it is unknown please select one of the options under the Diagnostic Category No Diagnosis Code or Description are needed if the selection is None or Unknown Primary Medical Diagnoses primary medical daor Diegnostie catagory 2 bonus code 2 pascietion SELECT INFECTIOUS amp PARASITIC HIV INFECTIOUS amp PARASITIC OTHER MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE NERVOUS SYSTEM CHRONIC PAIN OTHER NERVOUS SYSTEM MIGRAINE E
29. mation collected within each screen varies and not all ORF fields are required Type of Services Diagnosis Current Risks Special Population Treatment Plan Psychotropic Medications Ppl Py po Below is information for completing each screen KeyStep 3 The screens will display in the order listed above when the Next button is clicked Complete the within each screen Clinical Screens Requests must be completed in order All required fields must be completed to Sones eee move to the next screen tle Cinteat Previous screens can be accessed by clicking the Back button However you Sorin 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 staging mel nota wen roams eget ae RR IMPORTANT Once the clinical Requests as ProviderConnect have Drafts been accessed Topic providers have the nans 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 Save Request as Draft 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 11 23 Updated 9 1 2015 CT BHP ProviderConnect User Manual Reg Completing Initial Requests for Register
30. n the confirm submission screen o When the Accept button is clicked the request will auto approve and an authorization will be created with the indicated number of visits approved o CT BHP users should not click the Reject button If a user clicks Reject the request will NOT be approved Rather it will be pended to the CT BHP clinical staff delaying authorization and billing 2 Confirm submission of request The Results screen will display once the Accept button is clicked on the previous screen o For approved requests the status would indicate Approved at the top of the screen o For pended requests Psychological testing Ambulatory Detox concurrent reviews the status would 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 3 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 screensifields completed for the request including the clinical screens and the Results page 4 Download the request Click the Download Authorization Request button to save a copy of the request either in pdf format or xml Exit the Request for Authorization function _ Click the Return to Provider Home to exit the Request for Authorization function Updated 9 1 2015 CT B
31. nect screens should only be used when navigating to the previous screen Do not use the back button on your Internet browser Calendar Icon For date fields a pop up calendar can be accessed by clicking the calendar icon When the calendar opens click the date desired and the date field will automatically update with the selected date Cancel Button A Cancel button is available within some screens to allow a user to exit from the function Any data items with checkboxes next to them indicate Checkboxes Eok that more than one data item can be selected for that MEE field Click inside of the box to select the value Expand Collapse Any title with an arrow gt to the left of the title Narrative Entry indicates that it is a section that can be expanded to display fields or information Click on the title to expand or collapse the section Hyperlinked Any underlined codes that are input options for a field Codes 301 3 will populate the field when clicked Hyperlinked ki Any underlined field title will open screens help text a Field Titles kosm list of codes etc when clicked Radio buttons Ove One O Unknown Any data items with radio buttons next to them indicate that only one data item can be selected for that field Click inside of the circle to select the value Save Request as Draft A Save Request as Draft button is available on the Request for Services screens whic
32. nt Community Based a request will be determined as concurrent based on the Concurrent Review Check parameters set up for CT BHP In general there are three types of checks for determining if a review should be concurrent See below for details on each type of check The specific rules may vary depending on the Level of Care and Type of Care The key steps for creating concurrent requests for Outpatient Services include 1 Initiate a Request for Authorization 2 Complete the initial entry request screen 3 Update the clinical screens ORF2 4 Submit Request and confirm submission 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 Follow from Step 1 on Page 16 Updated 9 1 2015 CT BHP ProviderConnect User Manual Regi Completing Concurrent Requests for Registered Services continued Key Step 2 Complete Initial 35 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 reques
33. ntinued Overview The ProviderConnect web application can be found on the CT BHP website 1 Go to www CTBHP com 2 Click on For Providers Connecticut Behavioral Health Partnership Connecticut BHP a Connecticut BHP i 3 New Users without an ID refer to page 6 otherwise 4 Enter User ID and Password 5 Click Log In 6 Accept the User Agreement to proceed to the home page 6 Updated 9 1 2015 CT BHP ProviderConnect User Manual Re ProviderConnect Basics Searching for and Viewing Member Records One function that is used often 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 Staging Welcome THE HARTFORD DISPENSARY Thank you for using Valul patie ranba beara Enter an authorization Request YOUR MESSAGE CENTER Rea Recent Inquires Responded ta by ValueGetions Bed Tracking araman Ean WHAT DO YOU WANTTO DO TODAY ii ar sis Enda Specie emer 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 Eligibility amp Ben
34. ocess focuses on completing a registration authorization for an initial outpatient service Registering Concurrent Outpatient Services This process focuses on completing a registration authorization request for a concurrent Outpatient service 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 an Outpatient Evaluation authorization Complete a request for an Initial Outpatient service authorization Complete a request for a Concurrent Outpatient service authorization Updated 9 1 2015 CT BHP Provider Introduction continued snnect User Manual Re Navigation Throughout the ProviderConnect screens navigation features are available to make Features it easier to move through the fields and screens Below are a few basic features available Feature Breadcrumbs What Looks Like Description Tabs with titles of each request screen will display on all of the request screens to show progress through the process Asterisk Level of Service Any field with an asterisk next to it indicates that the field is required and a data item must be entered or selected in order to complete the request Conditionally required fields will not have asterisks Back Button A Back button is available on most ProviderConnect screens to help navigate to previous screens The Back button on the ProviderCon
35. quests for authorizations in ProviderConnect providers have as Drafts 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 Review Referrals mor Bod rackina WHAT DO YOU WANT TO DO TODAY Blinn and benefits a adaini Enter or Review Authorization Requests Enter an Authorization Resuest Rovio an Authorization Vow Clinical Drafts 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 View Clinical Drafts Please select the Provider T0 belos to vin and dick the Search Drafts button to vies Saved and Exped Cal Reese or Saved and Ex Plans for a deen provider rode 0 m Saved Clinical Request Drafts essed request dati actemesealy expe 20 doy ser the Il Savad Date Sot smelo ea Dante od eed seake Led Coe onsite athorod i eed Ste GEER NOONE O O e Sgp Tome FST i When a record is saved as a draft it is NOT available for CT BHP clinical staff to review 9 Updated 9 1 2015 CT BHP ProviderConnect User Manual Completing Requests for Outpatient Evaluations Overview ProviderConnect provides the ability for
36. s SF36 Quality of Life Assessment Using the Short Form 36 Questions WHO DAS World Health Organization Disability Assessment Schedule e OMFAQ Older Americans Resources and Services Multidimensional Functional Assessment Key Step 5 The Current Risks screen captures a snapshot of the member s current mental Complete the status by allowing providers to complete ratings for the member s risk to self and risk Clinical Screens to others and twelve 12 different impairments orea Surrent Below are the key actions for completing this step Any field with an asterisk Risks Screen indicates that the field is required Step Action 1 Click the radio button for the appropriate rating for Current Risks MEMBER S RISK TO SELF MEMBER S RISK TO OTHERS 2 Updated 9 1 2015 CT BHP ProviderConneet User Manual Registered Services BA Click the radio button for the appropriate rating for Current Impairments MOOD DISTURBANCES DEPRESSION OR MANIA WEIGHT LOSS ASSOCIATED WITH AN EATING DISORDER 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 Complete additional required information when the rating is a 2 or 3 for the following
37. t 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 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 c Mental Health should be chosen for MH Intensive Outpatient Extended Day Treatment Outpatient Home Based and Psychological Testing services d Substance Abuse should be chosen for SA Intensive Outpatient SA Outpatient Methadone Maintenance and Ambulatory Detoxification Services Select the Level of Care Outpatient 5 Select the Type of Care Requested level of care amp provider type of the service i e Outpatient Community Mental Health Center Home Based Services MDFT Individual Clinic NOTE The Type of Service and the Type of Care MUST match the selections made on the initial registration for the request to be considered a concurrent review 6 Attach a document CT BHP registered services do not require attached documents users can proceed to step 7 7 Click the Next Button Warning message will pop up to confirm if you want to proceed without attaching a document Click the OK button to proceed a Staging Ss Eze
38. tegory 1 CIRCULATORY SYSTEM HYPERTENSION DaarossCode1 Dacton p o Essential primary hypertension There is additionally an open text field for other specific medical conditions You can then enter information such as Behavioral Health Rule Outs and In Remissions and other specific Medical Conditions Other spectic medical conditions 28 of 2000 ANY HISTORY AND IN REMISSION Updated 9 1 2015 Manual Re Completing Initial Requests for Registered Services continued The next section has been named Social Elements Impacting Diagnosis Additionally the Housing Problems checkbox has been divided into Housing Problems Not Homelessness and Homelessness 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 If there are no social elements impacting the member select the None checkbox If social elements have not been assessed yet select the Unknown checkbox 4 If Other Psychosocial and Environmental Problems is selected an open text field will open and require you to enter what the other is n a Social Elements Impacting Diagnosis Casal tat The next section is named Functional Assessment and will allow users to enter up to 2 different assessment measures and scor
39. to begin in order to cover all requested services Please note The Requested Start Date will prepopulate to today Dates of service prior to today will require you to update the field 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 Select the Type of Service Mental Health Select the Level of Care jutpatient 5 Select the Type of Care Outpatient Evaluation Outpatient Services pp NY PROVIDERCONNECT Requested Services Header fale marked vith an arc 1 re regured Nate Diable pop p Bacher aetna to ve al epee nk perene uaa D ees Tae panied memanen l ourearienr s OUTPATIENT EVALUATION OUTPATIENT SERVICES e 6 Attach a document CT BHP registered services do not require attached documents users can proceed to step 7 7 Click the Next Button A warning message will pop up to confirm if you want to proceed without attaching a document Click the OK button to proceed Microsoft Internet Explorer apn You have ner azached a domurer och Reuss Haste eh CANCE to return ta the screen ta attach adcurane cr dek OK te proceed wth your request Wsthout chs doaument Updated 9 1 2015 CT BHP ProviderConnect User Manual Registered Services a Completing Requests for Outpatient Evalu
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