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Electronic Prior Authorization
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What is Electronic PA ?
Electronic PA Details – Web-based solution for managing medical
information – Allows providers to submit PA requests over
the Internet by providing online access to enter specific information needed for the member’s medical necessity review to occur
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Value / Benefits of Electronic PA
Provider Benefits – Authorization Requests - Requests, whether simple or
complex, are contained in one simple, clean web page – Inpatient Admission Notifications – Inpatient admission can
be submitted securely over the internet 24 hrs. day 7 days/week – PASRR Submission – Submit applicable PASRR documents
with an Authorization by using document attachment feature – Security - Security framework was specifically designed to meet
the rigorous requirements of the HIPAA security and privacy regulations
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Required Information What is needed to successfully submit a PA?
– Access to KYHealth Net – Facility Medicaid ID # – Member Medicaid ID # – ICD-9 Diagnosis Codes – Procedure codes (Revenue codes for Ancillary requests) – Dates of Service – Quantities of items requested (If applicable) – Notes to gather appropriate clinical information – Use Map 726 as a
guide – Attachments as applicable – PASRR documents
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System Access
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How to access Electronic PA Access gained through KYHealth Net
1.Using your Internet browser, navigate to the https://home.kymmis.com Web site either by selecting a predefined bookmark or typing the Web site address into the Address Bar of your Internet browser
2.Enter your user name and password in the appropriate fields
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How to access Electronic PA Select Electronic Prior Authorization from the Applications Menu
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System Navigation and Functionality
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Main Menu
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Navigation Bar Navigation
– Allows navigation to any module – Contains a link to the online help
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Navigation Breadcrumbs Navigation with Breadcrumbs
– Standard way of displaying current location within a browser-based application
– Can always return to the home page by clicking the Main Menu hotlink in the breadcrumbs
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Calendar Icons Date Entry
– Dates can be manually typed into a text box, or – Select the Calendar icon to launch a standard calendar pop-up
window
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Drop-down Lists List Selection
– Type directly into a drop-down list, or – Click the down arrow to view an entire list of choices
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Detail Hyperlinks Additional Information
– Text labels that have colored text and are underlined indicate a hyperlink
– Opens a details pop-up window with information relative to the field
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Required Fields Required Information for submission
– Required fields exist in submissions that must be completed to successfully allow a provider to submit an electronic PA request
– Any field or drop down selection box highlighted with a yellow background indicates that field is required for successful PA submission
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Required Fields – Error Messages
Required Information Errors – If an electronic PA is submitted with one or more of the required
fields that is not completed, an error message will appear – PA submission will not be complete until the required information
is added to the electronic PA request
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New PA Submission
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New PA - Step 1 Select Submit Authorization Request
– Use the Main Menu or Navigation Bar – Will open the Authorization Request module
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New PA - Step 2 Verify Contact Name
– Should list the name of someone at the provider office who can be contacted by Carewise Health
– Name can be changed by deleting the current name and re-typing a contact name
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New PA - Step 3 Enter Required Information
– Contact Phone number – Member Identification Number – Requesting Provider Identification Number
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New PA - Step 4 Select appropriate Request Type
– Select the proper type of Prior Authorization request being submitted – Will advance the module to the next screen
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New PA - Step 4 – NF Request Types
• Nursing Facility Brain Injury Locked Unit • Nursing Facility Brain Injury Non –Locked • Nursing Facility ICF MR/DD • Nursing Facility IMD • Nursing Facility Oxygen/Therapy • Nursing Facility Room & Board • Nursing Facility Swing Bed Room & Board • Nursing Facility Vent
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New PA - Step 5 (Room & Board) Diagnosis Codes, Facility, Dates
– Enter all available diagnosis codes – Enter your Nursing Facility provider number – Enter the Service From Date – Enter Service End Date (30 days from the Service From Date) – Enter Quantity – (will always be 30)
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New PA - Step 5 (Ancillary) Diagnosis Codes, Facility, Dates
– Enter all available diagnosis codes – Enter your Nursing Facility provider number – Enter the Service From Date – Enter Service End Date – Enter Rev Code (0410 – O2, 0420 – PT, 0430 – OT, 0440 – ST) – Enter Quantity Requested
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New PA - Step 6 Enter Notes and Complete Assessment
– Additional information can be entered in Notes • Comments regarding Ancillary requests should be entered here, Assessment is not
required for Ancillary requests
– The Assessment questions follow the MAP 726
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New PA - Step 6 (Continued) Attachment Details
– Click Select to open a Windows browser dialog box and select a file – Click Add to repeat the process to add another file
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New PA - Step 7 Electronic PA Submission
– Click the Submit button at the bottom of the Authorization screen to submit the PA request
– Reference number will be displayed
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What to expect after successful submission
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New PA Confirmation Screen
– Reference number will be displayed
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Status Checks
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Checking Status of a PA Use existing 3 methods
– KY Health Net website - http://home.kymmis.com – Automated Voice Response system 800-807-1301 – Receive PA Letter - letters can also be downloaded
from KyHealth Net
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Resources
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ePA materials are available on kymmis website under Provider Relations/ KyHealth User Manual/Electronic Prior Authorization
Documentation
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PRO Cert
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• PRO Cert is a electronic record that is created when a member is admitted to a nursing facility
• PRO Cert records are required to be on file with the local DCBS office prior to the member completing their Medicaid application
• When do I advise a family to go to the DCBS office to apply or complete the financial eligibility process? • A PRO Cert is transmitted to the DCBS office when the level of care
is approved. *It can take up to 2 business days from the date of the approval for the PRO Cert to be visible in the system to the DCBS workers.
• I have a Prior Authorization letter for services, but the DCBS office is telling me the PRO Cert is not on file? • Contact Carewise Health. Staff will review the case for any errors
and will work with HP staff and Member Services staff to resolve any confusion or errors.
• PRO Certs are not issued for a recertification
Contact Information
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Tracy Treat 502-326-4512
Pam Smith 502-209-3159
