Clear Coverage Online Authorizations Community Health Network of CT, Inc.

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1 Clear Coverage Online Authorizations Community Health Network of CT, Inc.

2 Overview Clear coverage is an online authorization tool which: Lowers authorization turn around time Improves workflow by decreasing administrative tasks Automates clinical evaluation processes 2

3 Clear Coverage Functionality Provides a web based hosted solution for authorization requests. Allows providers to search authorization request for up to 365 days. Enables providers to review eligibility of members in real time. Creates an authorization request. Allows view of only CMAP Providers Allows providers to attach the supporting clinical documentation to their authorization request. 3

4 Minimum Computer Requirements An Internet browser An Internet browser An Internet browser Adobe Reader An Internet browser Standard Screen Resolution An Internet browser Reliable High Speed Internet Access 4

5 5

6 Public Web Portal: Clear Coverage Inpatient Authorization Admission: Clear Coverage is a web-based decision tool that will give providers the ability to submit an Authorization Request/Prior Authorization electronically, at the point of care, and receive an immediate, realtime response to their request. Sign in or create an account here. 6

7 Log in Screen The Log in Screen for Clear Coverage CHNCT Help Desk:

8 Changing your password 8

9 Home Tab 9

10 Authorization Search 10

11 New Authorization 11

12 Patient Eligibility This eligibility lookup does not replace the DSS s AVES system, please continue to use the DSS s AVES system if a record of the transaction is required. 12

13 Administration 13

14 Authorization Request Overview Clear Coverage offers six steps to successful completion of an Authorization Request: Select the member Select the clinician (Admitting provider) Add the diagnosis (Up to four codes) Select the service (Inpatient) Select the service information (Admitting facility) Add additional notes/information 14

15 Step One Select the Member 15

16 Authorization Panes Clear Coverage Authorization Panes The pane on the left side of the screen allows the user to select the information required for the authorization. The pane on the right side of the screen displays all of the information selected. 16

17 Step Two Select the Clinician (Admitting Provider) 17

18 Default Inpatient Provider CT Medical Assistance Program 18

19 Step Three Add the Diagnosis Code (Up to Four) 19

20 Step Four Select the Service (Inpatient) 20

21 Step Five Select the Service Information (Admitting Facility) 21

22 Step Six Adding Notes or Attachments Use this section to provide: Facility contact information Campus where member is located Clinical documentation attachment Medical Recor Number Click here to attach documents 22

23 Clear Coverage Printing 23

24 Faxing from Clear Coverage From the Print tab, a selection is available for a Fax Coversheet. Cover sheet is member and authorization specific and cannot be used for other members or authorizations. 24

25 Home Tab 25

26 Clear Coverage An authorization number is generated as a reference number and is not an indication of approval. Providers can be notified of the approval status of their authorization request via letter, phone or web. 26

27 Questions before the live demonstration 27

28 Inpatient Authorization Process 28

29 Inpatient Authorization Process Admission notification may be submitted via web portal (Clear Coverage) as of April 1st, and/or phone, fax. If the provider chooses to use phone or fax: Phone: and follow prompts for authorization Fax: for initial notification Fax: for submission of clinical information 29

30 Clear Coverage is not used for the following Routine maternity deliveries. (Authorization not required) NICU babies at the facility of their birth. (Authorization not required) Newborns without an ID number transferred to another facility or readmitted should be faxed to CHNCT. (Authorization is required) Behavioral health admissions. Submit to CT Behavioral Health Partnership. (phone ) Elective admissions. Providers to submit requests via fax to CHNCT. Medicare Part A admissions. 30

31 Inpatient Authorization Process Notification must be submitted within 2 business days of admission. If clinical review is not submitted upon notification, it must be submitted within 2 business days or it will result in a denial. To accommodate holiday weekends, the system will allow for notification up to 5 days from the date of admission. Admission notification greater than 5 days from the date of admission cannot be entered into Clear Coverage. 31

32 CDH Authorization Process At this time, Chronic Disease Hospitals (CDH) may submit initial notification only into Clear Coverage. Continued stay review should be phoned or faxed to CHNCT. In the future, continued stay requests may be made through Clear Coverage. CDH facilities will be notified when this feature is available. 32

33 Determinations During this transition period, determination letters will continue to be mailed upon initial determination. Hospitals will be notified when determination letters are available in Clear Coverage. Authorization status may continue to be viewed in the HP portal. There is a one day lag in file transfer from Clear Coverage to the HP system. 33

34 Admission Dates Admission notification must include the admission date to be billed. If the admission date does not match what is billed, the claim will deny. Hospital must notify CHNCT for any correction of admission in order for the authorization to be cancelled and re-entered. 34

35 Retro Processes: Retro Eligible (Prepay) The following process applies when eligibility is granted retrospectively. These retro reviews are submitted by fax and are not in Clear Coverage: Notification must be submitted within 10 days of eligibility being granted. Notification must be submitted with Verification of Eligibility (VOE) and clinical information. Retro reviews will not be performed onsite. If authorization was given for a newborn, there is no need to re-submit once an ID is assigned. 35

36 Retro Processes: Special Retros The following process relates to failure to obtain authorization for emergency admissions. These special retro reviews are submitted by mail and are not in Clear Coverage: Submit a copy of the medical record and a check for $100 made out to: State of CT Department of Social Services Special retros submitted after 30 days must include a good cause exception. The number of special retros allowed is determined by DSS each State fiscal year. Retros will be completed within 60 days of receipt of the request. 36

37 Thank You 37

Community Health Network of CT, Inc.

PRPRE0024-0712 Clear Coverage Online Authorizations Outpatient Surgery Community Health Network of CT, Inc. A New Way to Request Authorizations As of July 31, 2012, there are now three options for requesting