CT BHP ProviderConnect Outpatient Requests...Inpatient facilities are expected to update their bed availability information twice daily by using the following process: 1. Select the

CT BHP ProviderConnect User Manual – Higher Levels of Care

1 Updated June 2019

CT BHP ProviderConnect User Manual

Higher Levels of Care


2 Updated June 2019

Table of Contents

Introduction ......................................................................................................................... 3

Obtaining Id and Password ................................................................................................ 4

Logging In ........................................................................................................................... 5

Updating Inpatient Bed Tracking Information ....................................................................... 6

Searching for Available Inpatient Beds in ProviderConnect ................................................. 8

Completing Inpatient/HLOC Initial Authorization Requests ................................................ 10

Completing Concurrent Requests for Higher Levels of Care ............................................. 24


3 Updated June 2019

Introduction The ProviderConnect application provides a variety of self-service functions to help providers access and view information about members and authorizations as well as complete requests for higher level of care service authorizations and monitor inpatient bed availability.

What is covered in this manual? This module covers general functions within ProviderConnect as well as the Initial and Concurrent Review processes for Adult Group Home authorizations. As a result of this training module, you will be able to:

Log into ProviderConnect

Update inpatient bed tracking information

Search for available inpatient beds

Enter initial and concurrent Inpatient/Higher Level of Care authorizations


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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.

3. Under the Templates section, click on the ‘Online Services Account Request Form’ hyperlink.

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 [email protected]

5. User ID’s and passwords are created within 1-2 business days from date of receipt. 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 877-552-8247 or email us: [email protected].

http://www.ctbhp.com/

mailto:[email protected]

mailto:[email protected]


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Logging In

1. Go to www.CTBHP.com 2. Click on For Providers

3. Click Log In

4. Enter User ID and Password.

5. Click Log In

6. Accept the User Agreement to proceed to the home page.

http://www.ctbhp.com/


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Updating Inpatient Bed Tracking Information

Inpatient facilities are expected to update their bed availability information twice daily by using the following process: 1. Select the Enter Bed Tracking Information link from either the left navigational menu or the middle

of the ProviderConnect homepage.

2. On the following screen, select the appropriate vendor that you would like to update bed availability for by clicking on the radio button in the Capture column.

3. On the following screen, click on the link for “Behavioral Health Partners {KIDCARE}” link.


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4. After clicking on the previous link, a listing of the types of beds that have been set up for that

vendor/service location will then display so the information can be updated. ProviderConnect users can update the following details:

Date of most recent update (should auto-populate with current date)

Total number of available beds/openings

Total female beds/openings

Total male beds/openings

Total female flex beds/openings

Total male flex beds/openings

Once the information has been updated, click the Update button.


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Searching for Available Inpatient Beds in ProviderConnect ProviderConnect users can search for available inpatient beds using the following process: 1. Select the Search Beds/Opening link from either the left navigational menu or the middle of the

ProviderConnect homepage.

2. On the Search Available Beds/Openings page, ProviderConnect users can specify which type of beds they are requesting by utilizing the following fields:

Level of care

Type of care

Type of service

Age

Female bed

Male beds

Projected female beds without match

Projected male beds without match

All

Cultural/Language

Specialty needs

Zip Code

Distance from zip code


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3. Once users enter their search criteria and click the Search button, the matching search results will

appear on the next page.

Notes about Searching for Available Beds:

Providers can only select one Cultural/Language and one Specialty Needs per search. If the

facilities have other languages and specialty needs, these will also display along with what was

selected.

The ProviderConnect Bed/Openings Search Results screen will display up to 150 records and

display a message to the user when only the first 150 records are being displayed to the user.

Projected Female/Male Beds Without Match refers to beds that will become available within the

next 30 days that have not yet been reserved for another member. Projected matches will not

return results for any level of care except Residential or Group Home.


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Completing Inpatient/HLOC Initial Authorization Requests

Key Step 1: Initiate Authorization Request

1. Click Enter an Authorization/Notification Request link from either the left navigational or Home

page of ProviderConnect

2. Review the Disclaimer and click the Next Button.

3. Search for Member Record by only entering the Member’s Medicaid ID and Date of Birth (both fields are required). Then click Search.

4. Click the Next button on the Member record to continue.

5. If this registration request is for a member that does not have a previous authorization with your

practice, proceed to Step 9.



6. If this registration request is for a member that has an existing authorization with your practice, the Prior Authorization Listing for Concurrent Review Page will appear.

7. The Prior Authorization Listing for Concurrent Review Page will display any authorizations the member has with your practice.

To enter an initial registration for a service that has not been authorized, click the Process Initial Review button and Proceed to Step 8, or;

To complete a concurrent review of a current authorization, select the appropriate authorization that is listed and Click Process Concurrent Review button and proceed to Key Step 2: Requested Services Page – Page 8.

8. The Select Service Address Screen will appear.

9. Locate and select the Service Address: Click the radio button next to the appropriate Service

Address location.



10. Click the Next button to continue

11. The Requested Services Header Page will display.

Key Step 2: Requested Services Page

The second key step is to complete the requested start date of the service and the specific level of care that is being requested. 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.

1. Enter the Requested Start Date (The Requested Start Date is the date for the authorization to begin in order to cover all requested services). NOTE: The Requested Start Date will prepopulate. Dates of service prior to today will require you to update the field.

2. Select the Level of Service = INPATIENT/HLOC. (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 = Mental Health or Substance Use

4. Select the Level of Care = INPATIENT, PARTIAL HOSP, 23 HOUR OBS

1) Select the Type of Care

Note: (Inpatient – IP Psych Facility – Natchaug Hospital Only)

Note: For Inpatient Detox, Type of Service =Substance Use, Level of Care=Inpatient,

Type of Care=Inpatient Detox

Note: For Partial Hospital, Type of Service =MH or SA, Level of Care= Partial Hospital,

Type of Care= Partial Hospital (PHP)

5. Enter the Admit Date (MMDDYYYY)-ADMIT DATE MUST MATCH REQUESTED START DATE

6. Answer Yes or No for Has Member Been Admitted to Your Facility field.

7. If the Admit Time field is not auto-populated, users should enter 00:00 (military time).

Providers with more than one provider type-specialty at the same address location, will have more than one service address listing. Users should select the appropriate address for the authorization being obtained. Example: ABC Hospital

1. 123 Main St – OTP for Outpatient Services or 123 Main St - INP for Inpatient Services

ABC – Group Practice 2. 123 Main St – LCSW for LCSW group or 123 Main St – MD for Psychiatrist Group or 123 Main St –

BCBA for BCBA Group.



8. To attach a document (CT BHP Inpatient/HLOC registered services do not require attached documents but a Release of Information (ROI) can be attached if one was obtained)

a. Indicate Yes or No for DOES THIS DOCUMENT CONTAIN CLINICAL INFORMATION ABOUT THE MEMBER?

b. Choose ADDITIONAL CLINICAL or ASSESMENT/EVAL from the Document Description Drop down Menu.

c. Click Upload File.

9. A pop up window to Upload File window will appear.

10. Click Browse.

11. Search for the file/document you want to attach.

12. Double click on the file.

13. The pop up window will now list the file chosen.

14. Click Upload.



15. The attached file will be listed on the page.

16. If the wrong file was selected users can click the checkbox next to the document, click Delete and Repeat steps 9-15.

17. Click the Next Button

Key Step 3: Completing Clinical Screens For initial inpatient service requests, there are two (2) clinical screens (Please note that the third tab additional MTPPR information is only for Residential & GH providers). The amount of information collected within each screen varies and not all fields are required.

Level of Care/ Diagnosis

Clinical Presentation/ Medication/ Treatment

Additional MTPPR Information (Not Required)

1. Enter the CALLING PROVIDER/FACILITY open text field.

If Member’s LMHA is involved, Select LMHA from the dropdown

2. Enter the Aftercare Follow-up contact information for the member – Please provide at least one method for contacting member for follow-up. If not available, please clarify reason.

Complete Phone #, if not available select box and enter reason why

3. Enter the Member’s email and then validate email to the right (not required) 4. Enter the Admitting Physician’s name and phone # 5. Enter the Attending Physician’s name and phone # 6. Enter the Preparer’s name and phone # 7. Enter the Utilization Review’s Contact name and phone #

8. Enter the Name of Place/Facility/Institution who referred member (please be specific)

9. Complete the IF CHILD, DCF LEGAL STATUS field drop down.

10. Primary Behavioral Diagnosis is required: The Primary Diagnostic Category 1 is the main diagnosis and should be the reason for the members decompensation to Adult Group Home Level of Care

Documentation of Primary Behavioral Condition is required. Provisional working condition and diagnosis should 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.

11. System users can either enter a partial diagnosis in the Diagnosis Code 1 box or enter partial

description of the diagnosis and then click on the hyperlink above the field to view a pop-up window/list of ICD-10 codes that match their search criteria.



12. Once a user clicks on the appropriate code in any of the pop-up windows, all other fields will populate.

13. The Primary Medical Diagnosis is required. The same process above can be utilized to select a Primary Medical Diagnosis Code and/or Description field with their corresponding hyperlink to locate the appropriate Medical Diagnosis.

NOTE: If there is no medical diagnosis or it is unknown, please select None or Unknown from the Diagnostic Category drop down list. A Diagnosis Code or Description is not required if the selection is “None” or “Unknown”.

14. 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.

15. Social Elements Impacting Diagnosis: 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 or if they have not been assessed yet, select the “None” or “Unknown” checkbox.

If Other Psychosocial and Environmental Problems is selected, an open text field will open and require you to enter what the other is.

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.

16. To complete this section, simply click the dropdown for the Assessment Measure

If an ‘Assessment Measure’ is selected in the drop down, then an ‘Assessment Score’ must be entered into the corresponding field as well.



If an Assessment Measure is not listed in the dropdown, “Other” can be selected. If “Other” is selected an open text box will appear. Please enter the “Other” test and the Assessment score of that test

17. Select the appropriate Assessment Measure from the drop down menu and enter the Assessment Score.

CDC HRQL = Center for Disease Control - Health-Related Quality of Life

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)

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

The next section is named “Medical Implications” and will ask users to answer (2) questions.

18. Are there comorbid medical conditions that impact the treatment of the diagnosed “MHSA” (Mental Health Substance Use) conditions? Yes, No, or Unknown

19. Is the member receiving appropriate medical care for the comorbid medical conditions? Yes, No. or Unknown

The next section is named “Metabolic Assessment Tool.” This section is not required.

20. To complete this section, simply enter the members weight (lbs.), height (feet/inches) & waist circumference (inches)

21. The BMI number will auto generate along with “Results of BMI indicate the member may be” & the “Recommendation”. The Results of the Metabolic Syndrome Assessment will also auto populate.

If BMI not assessed please indicate by selecting the check box



And if the BMI was not assessed, then please provide additional information on reason for not obtaining BMI or if recommendation is to follow-up, details around the follow-up when available in the open text field.

22. Select Next at the bottom of the page to move to the next Tab

The Clinical Presentation/Medication/Treatment screen captures a snapshot of the member’s current mental status by allowing providers to first enter the Symptomatology. The Narrative entry is required and is looking for the following information below:

23. Symptomatology: Please explain the reason for current admission (describe symptoms) and include the precipitant (what stressor or situation led to this decompensation). If this is a concurrent request, please describe the reason for the continued stay, including both the progress that has been made to date, and what symptoms still remain.

24. Below the Symptomatology is an abbreviated risks section Select the radio button for the following field:

Members Risk to Self- Please Indicate (1,2,3 or N/A) (Please note: By indicating 2 or 3 will open up a Danger to Self-Symptom Complex Box narrative in the primary Issues/Symptoms addressed in Treatment Area)

Members Risk to Others- Please Indicate (1,2,3 or N/A) (Please note: By indicating 2 or 3 will open up a Danger to Others-Symptom Complex Box narrative in the primary Issues/Symptoms addressed in Treatment Area)

Substance Use- Please Indicate (1,2,3 or N/A) (Please note: By indicating 2 or 3 will open up a Substance Use Symptom Complex Box narrative in the primary Issues/Symptoms addressed in Treatment Area)

Legal- Please Indicate (1,2,3 or N/A) (Please note: By indicating 1, 2 or 3 will open up a field which requires the user to indicate the following legal issue: Juvenile Justice, Parole, Probation or Other Court)

25. If Substance Use is Primary, complete the following, otherwise Proceed to Step 34

26. Select the radio button for Urine drug screen- Please Indicate (Yes, No or Unknown)

27. Select the radio button for the following fields: (*not required unless SA Primary)

28. Outcome of UDS- Please Indicate (Positive, Negative or Pending)

29. Enter the Date of Urine Drug Screen: (*not required unless SA Primary)



30. MMDDYYYY format or select the calendar button and select the date

31. Enter the COWS & CIWA: (*not required unless SA Primary)

COWS scale for Opiate Withdrawal: 5-12: mild 13-24: moderate 25-36: moderately severe >36: severe withdrawal

CIWA for ETOH withdrawal: < 8: no concern 9-15: mild to moderate concern 16+: needs aggressive intervention- potential delirium

32. Positive for: Check all that apply (*not required unless SA Primary)

Select Check boxes: Cannabis, Opiates, Cocaine, Amphetamines, Tricyclic Antidepressants, Phenylpropanolamine, Benzodiazepines, Barbiturates, Methamphetamine, PCP (phencyclidine, LSD (Lysergic acid diethylamide, Methadone or Other

33. *Enter the Blood Alcohol: if unknown, then select the checkbox N/A

The Primary Issues/Symptoms Addressed in Treatment Symptom complexes are utilized for gathering clinical information specific to the primary behavioral diagnosis and/or risk. At times more than one complex may be identified for completion. Providing all the requested information in the identified complex (es) will assist in completing the authorization process and determining medical necessity. If this is a concurrent request, please update the identified complexes with any new information for each complex based on the individual's current symptomatology

34. If Danger to Self-Symptom Complex is Required: Indicate the following:

PRESENTING PROBLEM (BEHAVIORAL DESCRIPTION OF ACUITY; DESCRIBE ANY ATTEMPT, RESCUE, SELF-RESCUE, LETHALITY, MEDICAL TREATMENT RECEIVED):

IDEATION:

PLAN:

INTENT:

MEANS:

BASELINE (INCLUDE ANY SUICIDALITY, PARASUICIDALITY OR SELF-INJURIOUS BEHAVIOR AT BASELINE):

DESCRIBE ANY HISTORY OF ATTEMPTS:

TREATMENT HISTORY:

ICM NEEDS (INCLUDING COMMUNITY, VO, CM, DM, ETC):

OTHER INFORMATION PERTINENT TO MEMBER'S HISTORY AND CURRENT TREATMENT REQUEST:

35. If Danger to Others-Symptom Complex is Required: Indicate the following:

PRESENTING PROBLEM (WHO IS THE INTENDED VICTIM? WHY DOES THE MEMBER WANT TO COMMIT HOMICIDE OR HARM?):



IDEATION:

PLAN:

INTENT:

MEANS:

HOW IS THIS REFLECTIVE OF MENTAL ILLNESS VERSUS MALADAPTIVE SOCIAL BEHAVIOR?

IS THERE A DUTY TO WARN?

WILL PROVIDER DO THE DUTY TO WARN? (NOTE, IF PROVIDER WILL NOT DO DUTY TO WARN SPEAK WITH YOUR SUPERVISOR):

BASELINE:

DESCRIBE ANY HISTORY OF VIOLENCE (INCLUDING IF MEMBER HAS EVER ATTEMPTED TO KILL OR INFLICT SERIOUS HARM):

LEGAL INVOLVEMENT (PAST OR PRESENT)?

TREATMENT HISTORY:

ICM NEEDS (INCLUDING COMMUNITY, VO, CM, DM, ETC)

OTHER INFORMATION PERTINENT TO MEMBER'S HISTORY AND CURRENT TREATMENT REQUEST

36. If Psychosis-Symptom Complex is Required: Indicate the following:

PRESENTING PROBLEM (BEHAVIORAL DESCRIPTION OF SYMPTOMATOLOGY):

DELUSIONS:

HALLUCINATIONS:

COMMAND HALLUCINATIONS:

THOUGHT DISORDER:

BASELINE:

FIRST EPISODE?

NEUROLOGICAL WORKUP NEEDED?

IS MEMBER MEDICATION COMPLIANT?

HAS PROVIDER EXPLORED PAST MEDICATIONS, COMPLIANCE, AND EFFECTIVENESS?

IS THERE A NEED FOR DIFFERENT MEDICATION(S)?

DESCRIBE PLAN FOR MEDICATION COMPLIANCE (INCLUDING SUPPORTS TO ASSIST PRN):

TREATMENT HISTORY:



37. If Child/Adolescent Behavior-Symptom Complex is Required: Indicate the following:

PRESENTING PROBLEM (BEHAVIORAL DESCRIPTION OF BEHAVIORAL ISSUES):

WHEN DO THESE BEHAVIORS TEND TO HAPPEN?

WHEN WAS THE LAST TIME THESE BEHAVIORS OCCURRED

DO THESE BEHAVIORS OCCUR IN THE SCHOOL?

IS SCHOOL INVOLVED IN CURRENT TREATMENT PLAN? DESCRIBE COORDINATION WITH SCHOOL.

IS MEMBER INVOLVED WITH SPECIAL ED?

DO THESE BEHAVIORS OCCUR IN THE HOME?

HAVE FAMILY SESSIONS OCCURRED AS OFTEN AS NECESSARY?

DO THE BEHAVIORS OCCUR IN THE COMMUNITY?

LEGAL/SOCIAL SERVICE INVOLVEMENT?

BASELINE:

TREATMENT HISTORY:

SPECIFIC TO BEHAVIOR PLAN, WHAT ASSISTANCE WILL FAMILY/GUARDIANS NEED IN ORDER TO MAINTAIN BEHAVIOR PLAN?





38. If Eating Disorder-Symptom Complex is Required: Indicate the following:

PRESENTING PROBLEM (DESCRIBE ANY BINGING, PURGING, RESTRICTING, OVER-EXERCISING, FOOD RITUALS, ETC):

% IBW:

ORTHOSTATIC BP: STANDING __/__; SITTING __/__

EKG, ELECTROLYTES, OTHER LAB INFO:

CO-MORBID MEDICAL ISSUES:

CO-MORBID PSYCHIATRIC ISSUES:

BASELINE:

TREATMENT HISTORY:



39. If Neurocognitive-Symptom Complex is Required: Indicate the following:

PRESENTING PROBLEM (BEHAVIORAL DESCRIPTION OF ACUITY):

MEDICAL WORK UP NEEDED TO RULE OUT CAUSALITY OF SYMPTOMS?

HAS A NEUROLOGICAL WORK UP BEEN COMPLETED?

DOES MEMBER HAVE A UTI?

OTHER LABS COMPLETED:

WHAT IS THE MEMBER'S BASELINE? AND WHEN WAS S/HE LAST AT BASELINE?

IS THE OP MED REGIMEN MONITORED FOR UNDER OR OVER MEDICATING?

TREATMENT HISTORY:

DOES THE FAMILY HAVE REASONABLE EXPECTATIONS ABOUT MEMBER'S ABILITY TO RETURN TO BASELINE (OR INABILITY TO RETURN TO BASELINE)?

IS THE MEMBER FROM A NURSING HOME? IF SO, WILL THE NURSING HOME HOLD THE BED FOR MEMBER S RETURN?

IF MEMBER WAS LIVING AT HOME, WILL MEMBER BE ABLE TO RETURN HOME IF RECENT BASELINE IS ACHIEVED?



40. If Substance Use-Symptom Complex is Required: Indicate the following:

PRESENTING PROBLEM (DRUG(S) OF CHOICE, ROUTE OF ADMINISTRATION, AMOUNT OF USE, FREQUENCY OF USE, AGE OF FIRST USE, DATE OF LAST USE ETC):

PSYCHOLOGICAL & LEGAL CONSEQUENCES OF USE:

BASELINE:

TREATMENT HISTORY (PREVIOUS ATTEMPTS AT TREATMENT & OUTCOME):


HISTORY OF DTS OR SEIZURES:

COULD THE PATIENT BE USING DRUGS THAT WOULDN'T SHOW ON UDS?


41. If SA Complex was required then continue to indicate the ASAM/ Other Patient Placement Criteria then complete the 6 Dimension Checkboxes (Required)

Indicate Dimension 1: Intoxication/Withdrawal Potential (Low, Medium or High)

Indicate Dimension 2: Biomedical Conditions (Low, Medium or High)

Indicate Dimension 3: Emot/Beh/Cogn Conditions (Low, Medium or High)



Indicate Dimension 4: Readiness To Change (Low, Medium or High)

Indicate Dimension 5: Relapse Potential (Low, Medium or High)

Indicate Dimension 6: Recovery Environment (Low, Medium or High)

42. If Mood Disorder-Symptom Complex is Required: Indicate the following:

PRESENTING PROBLEM (BEHAVIORAL DESCRIPTION OF ACUITY):

BASELINE:

TREATMENT HISTORY:

IF THERE ARE ANY PSYCHOTIC SYMPTOMS, HOW ARE THEY BEING ADDRESSED?

IF AN ANTIPSYCHOTIC IS BEING USED (FOR PSYCHOSIS OR AS A MOOD STABILIZER), HAS METABOLIC TESTING BEEN DONE?

IS THERE A SEASONAL COMPONENT?

IS THIS POSTPARTUM ONSET?



43. Recovery & Resiliency: Outline the recovery and resiliency environment to support this individual's long term recovery plan. Please include personal strengths, support systems available to support the recovery and details around living environment, as well as outline any identified needs or supports that need to be put in place to assist in the successful recovery. And lastly, include the member’s treatment plan goals and progress toward goals here.

Medications: (If member is currently not on Medication(s), this field is not required on the Initial Request. The Medication field is required on the Concurrent review. If MEMBER is CURRENTLY ON PSYCHOTROPIC MEDICATIONS please indicate the following required fields

44. Enter each of the Medications in the field as necessary (Medication name, Start date, date discontinued, the date added (will populate to today’s date).

First select the hyperlink above the medication name field. It will bring up a list of psychotropic medications, sorted by class. If the medication is found, select the Medication from the list. If a medication is not listed in this list, users can choose ‘Other’ and then enter the name of the medication in the “Other” open text field below the Medication field.

45. Please indicate in the open text field for each of the following Medications: For this medication, please enter any details concerning dosage, side effects, adherence, effectiveness, prescribing provider and any specific target symptoms.

46. If Additional Medications need to be added, then Select the “Add Medication” Box.



47. Please provide an overview with respect to all medications above, please enter any additional details that would assist in coordinating care. Note: The Open text field will allow up to 2000 characters

48. Indicate if there are Med changes this month? Yes or No (Not Required)

49. Meds Require serum blood levels? Yes or No (Not Required)

50. Date of most recent blood draw Enter date (MMDDYYY format or use the calendar icon) or select Unknown (Not Required)

The Best Practices Endorsement

51. Please select the hyperlink: Best Practice Guidelines Related to Primary Behavioral Diagnosis- Please Read

52. Do you endorse that I follow Best Practice Guidelines for the Primary Diagnosis: Yes or No

If No, Please enter the reason why in the open text field (1000 character limit) Based on the members current Primary Behavioral and Medical Diagnosis, you will encounter Hyperlinks that appear. By selecting the hyperlink, you will be redirected to the Achieve Solutions Website which offers additional information to share with the member regarding the condition.

53. Select all members of the Care Planning Team.

54. Is there a child or adult in member’s household in need of any support or services? Yes or No. If Yes, Please answer the following:

Select primary support/services needed from the dropdown

Select additional support/services if needed from the dropdown

If Yes, describe support/services recommended (open text field 250 char.)

55. Is service requested for HLOC because appropriate LLOC not available? Yes or No If Yes:

What LLOC was needed and not available for member? (Indicate from Dropdown menu)

Reason why appropriate LLOC not available? (Check all that apply)

If Other, then describe in the open text field (250 character limit)

56. Planned Discharge Level of Care (drop down menu) 57. Planned Discharge Residence (drown down menu)

58. Expected Discharge Date (MMDDYYYY format or use calendar icon)

59. Select the Next button.



60. The Additional MTPPR Information screen will display next, which is not required.

61. Click Submit

Key Step 4: Submit Request and Confirm Submission Once the Submit button is selected from the final clinical screen, the submission screen will Display. Adult Group Home Requests will be pended to the CT BHP clinical team for further review.

1. For Auto Pended Requests Confirm submission of request.

The status would indicate ‘Pended’ at the top of the screen with a message indicating that the request requires further review.

2. 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 screens/fields completed for the request, including the clinical screens and the Results page.

3. Download the request.

Click the Download Authorization Request button to save a copy of the request either in .pdf format or xml.

4. Exit the Request for Authorization function.

Click the Return to Provider Home to exit the Request for Authorization function.



Completing Concurrent Requests for Higher Levels of Care Providers can easily submit Concurrent Requests for any existing authorization. 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.

Key Step 1: Entering a Concurrent Request

There are (3) ways in which a provider can initiate a concurrent review request on an existing authorization:

a. Providers can Click Authorization Listing on the home page, enter the member id of the member and search existing authorizations by specific member. Users can then click the appropriate authorization link and then click Concurrent Review Request within the authorization, or;

b. Providers can click Enter an Authorization/Notification Request, enter the member id and date of birth to search. On member the member record, click Next and proceed to Step 2, or:

1. Click the Prior Authorization Listing for Concurrent Reviews, Step/Transfer, or Discharge link on the ProviderConnect homepage.

2. The Prior Authorization Listing for Concurrent Review Page will display any open authorizations for your practice within the time frames of the date fields at the top of the page.



3. To complete a concurrent review of a current authorization, select the appropriate authorization for the member and the appropriate level of care that is listed and Click Process Concurrent Review button.

4. A pop-up box asking “Would you like to proceed with the prior authorization vendor?” will appear. This is to select the same service location as the current authorization.

5. Click yes to proceed with the previous service location.

6. For Concurrent Reviews the “Requested Start Date” field will be left blank. “Level of Service”, “Type of Service”, “Level of Care”, and “Type of Care” will be pre-populated.

A. Note: Enter the Requested Start Date: (The Requested Start Date should be the first uncovered (unauthorized) day.) Note: (The Admit Date is the start date on the original pre-certification- (IT MUST MATCH OR AN ERROR WILL OCCUR.)

7. Attach a document

8. Click the Next Button.

1. (A warning message will pop-up to confirm if you want to proceed without attaching a document. Click the OK button to proceed.)

2. Proceed through each clinical screen, clicking next when complete: A number of fields will pre-populate information from the last request into fields in the new concurrent request. The pre-populated fields can be overwritten with new data, if required

3. Complete required fields that are not pre-populated or that require an update in information.

4. Submit Registration once all pages are complete.

Documents

CT BHP ProviderConnect Outpatient Requests...Inpatient facilities are expected to update their bed availability information twice daily by using the following process: 1. Select the