Authorizations Application-CareAffiliate Training Manual Inpatient Behavioral Health

Enter prior authorization requests for inpatient admissions for psychiatric care and substance abuse online – seven days a week, 24 hours per day.

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Table of Contents Training ................................................................................................................................................................... 3

Navigation Bar ......................................................................................................................................................... 3

Logout ..................................................................................................................................................................... 3

Moving from field to field ....................................................................................................................................... 3

Coordinated Behavioral Health Department Hours ............................................................................................... 3

Troubleshooting ...................................................................................................................................................... 3

Partial Hospitalizations, Rehabilitation, Long-Term Residential, and Domiciliary Intensive Outpatient Programs................................................................................................................................................................................. 3

Time Saving Tips ...................................................................................................................................................... 4

Helpful Tips ............................................................................................................................................................. 4

Alert Messages ........................................................................................................................................................ 6

Steps for Entering a New Authorization – Psychiatric Care Example ..................................................................... 8

Other Search Options for Finding Authorizations ................................................................................................ 18

Steps for Entering a New Authorization – Chemical Dependency Example ......................................................... 19

Other Search Options for Finding Authorizations ................................................................................................ 30

Note: The member data found in this Training Manual is fictitious data.

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IMPORTANT Welcome to HAP’s online authorization application, CareAffiliate! You can enter initial authorization requests for inpatient admissions for psychiatric and substance abuse care - seven days a week, 24 hours per day. Important! Concurrent review has not changed. Please call HAP within 24 hours of the admission to speak with a case manager.

Training • There are several helpful tools to assist you with

CareAffiliate. Log in at hap.org and select the Authorizations-CareAffiliate Help link under Quick Links. You’ll find help guides, training manuals and other resources. You can also find this information on the CareAffiliate home page under HAP Help.

Navigation Bar • Appears at the top of every screen

Logout • When logging out of the application, always select Log Out, not the X.

Moving from field to field • After entering data in a field, use the TAB key to get to the next field. Your data may not save if you use

the enter key through the fields.

Coordinated Behavioral Health Department Hours • (800) 444-5755, Monday – Friday, 8 a.m. to 5 p.m. Closed on all major HAP holidays.

Troubleshooting

Issue Contact Hours

Help with Authorizations application-CareAffiliate

• Authorizations missing from home page

• Password resets and system lockout

Provider Services (866) 766-4708 or prelweb1@hap.org

Monday-Friday 8:00 a.m. to 4:30 p.m.

Partial Hospitalizations, Rehabilitation, Long-Term Residential, and Domiciliary Intensive Outpatient Programs

• At this time, please do not enter authorization requests for partial hospitalization, rehabilitation, long-term residential, and domiciliary intensive outpatient in the online application, CareAffiliate. Continue to call HAP’s CBHM department.

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Time Saving Tips • Choose the correct Request Type – see tips in this manual.

• Submit complete information.

− The more information you provide upfront, the better your chances of receiving a quick determination.

− Authorizations that are called in have a longer “pend” time because clinical information is not attached to the request.

Helpful Tips Tip Details

Adding providers to your drop down

• The first time that you request an authorization from each individual provider in your site, you will need to search by clicking the magnifying glass icon.

• Once the provider is selected, the Requesting Provider/Facility field will populate.

• For all future authorizations, you will no longer need to search. Begin typing the NPI or name and the provider will appear for you to select.

• If you can’t find one of your providers, contact Provider Services at (866) 766-4708 or prelweb1@hap.org.

Assessments • Complete all required fields outlined in orange.

• Complete white fields with appropriate information.

• Complete the Assessment with as much information as possible. Responding with N/A or incomplete information will cause a delay in the turnaround time of your request.

Copying and pasting into fields

• Do not paste directly into a field from a document or application.

• Field types must match (i.e., can’t copy text into a date field, etc.).

• All formatting must be removed from your document. You can do this via Notepad or a similar application if you are not using a Microsoft based system. Simply:

− Copy document or item from your system or file (Epic, Word, etc.).

− Open Windows Notepad and paste the document or item into the Notepad.

− Copy text from Notepad.

− Paste it into the appropriate field in Assessment or Notes. Important:

• There is a 2,000 character (including spaces) limitation for each field. There is no warning. Any characters exceeding the limit will be cut off.

Default provider

From the Service 1 screen:

• Select the magnifying glass to search by NPI or Name; if Provider or Facility does not return, uncheck “Contract Only” and search again. If no records return, enter Provider NPI AUTH99999999 (AUTH9*), or Facility NPI FAC999999999 (FAC99*) and select the record – Provider, Default.

• Select Note link in left panel and enter provider and/or facility complete name, NPI or Out of Country Code, address, phone, fax and specialty.

• You can also select the for instructions.

In-line messages

• Fields with this icon contain instructions on the information to enter.

• Select it to see details.

InterQual • HAP uses InterQual along with HAP criteria.

• InterQual is not embedded.

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Tip Details

Messages • We don’t use this function, please disregard.

Reference number

You’ll receive a Reference # after you successfully submit a request. You can use this number to confirm if the request was approved or pended.

Request types There are four (4) Request Type profiles specific to inpatient behavioral health services: • BH21_016:BH Chem Dep_Inpt Tx_Inpatient Hospital

Inpatient Substance Abuse Detoxification on a substance abuse treatment unit in a medical facility

• BH55_016: BH Chem Dep_Inpt Tx_RSATF Inpatient Substance Abuse Detoxification in a free-standing substance abuse treatment facility

• BH21_015: BH Psych_Inpt Tx_Inpt Hospital Inpatient psychiatric treatment on a psychiatric unit in a medical facility

• BH51_015: BH Psych_Inpt Tx_Inpt Psych Facility Inpatient psychiatric treatment in a free-standing inpatient treatment facility

Tip! If you check Show Behavioral Health/Substance Abuse only box and Show Inpatient Only you will only get the 4 Request Types above.

Search using the wild card

For Member and Provider Names • Type 5 characters and *

Example: Johns* or Lee__ __* (note if a last name has less than 5 letters, use spaces)

For Diagnosis and Procedure Code/Description • Use the * before and after the first 3 characters of a code/description.

Example: *123* OR *bar*

For Request Type Description • Use the * before and after the first 3 letters of a description.

Example: *inp*

Submission outcomes for behavioral health inpatient requests

• Certified in Total: Indicates authorization approved • Pended: Indicates requires review

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Alert Messages You can find Alert messages under the navigation bar or as pop-up messages. They indicate a potential issue with your authorization request. Read the warnings carefully as some:

• Will not allow the authorization to be submitted and will provide instructions to correct.

• Are missing required information.

• Are informational only and will allow submission.

Alert Message Details

Required fields

There are required fields that must be completed before you can submit the request. You can return to the Authorization Request or Service 1 screens to find the missing data.

Potential duplicate authorization The authorization request may have already been submitted for the member. Note: if you want to proceed, you will need to select Submit twice.

A more specific diagnosis code exists for the condition specified

There may be a more specific diagnosis for the procedure or service.

Timing out

• After 89 minutes of inactivity in CareAffiliate, you will receive a warning that your session will time out in 1 minute.

• You will lose any information that has not been submitted.

• Select OK to continue working.

• Note: The timeout period for the HAP provider portal is 30 minutes. While you can still work in CareAffiliate for 90 minutes, you could be timed out of other applications (e.g., member eligibility, claims) after 30 minutes of inactivity. Simply log in again.

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Entering Authorization Requests The following pages demonstrate the steps for entering a new authorization. There are two scenarios.

• Psychiatric care

• Chemical dependency

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Steps for Entering a New Authorization – Psychiatric Care Example

Facility home page

• Select Authorizations.

CareAffiliate Home Page

• Select Authorizations.

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• Select New Authorization.

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• Complete all required fields outlined in orange. See table below for details.

Field Information to enter

Member ID 11-digit HAP member ID number; TAB and member name will auto populate.

Name Member name (you can enter 5 characters and a wild card *) or click magnifying glass icon.

Request Type The appropriate Request Type. The Request Type is essentially the place of service and service combined. It determines what fields auto populate throughout the authorization—less data entry for you! • To search for a Request Type:

• Click on the magnifying glass next to Request Type. • Check Show Behavioral Health/Substance Abuse only box and Show Inpatient Only then

click Search.

• Review details if present to ensure you choose the correct Request Type. • Choose appropriate Request Type.

Wrong request type If you realize you have entered the wrong Request Type and it’s populated in the Request Type field:

• Select Home (from the navigation bar). • Answer Yes to confirm you want to lose all changes. • Start over.

Tip! If you’ve entered the wrong Request Type here – see steps below.

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• After you enter the Request Type, you get the screen below.

• Complete all fields outlined in orange. See table below for details.

Field Information to enter

Event Classification Nothing. It auto populates.

Case Type Nothing. It auto populates.

Contact Name Name of person entering authorization. Note: field defaults with facility name. Please remove and enter contact name.

Contact Phone The best phone number for HAP to contact you with questions. (note: not outlined in orange but is required)

Requesting Provider/Facility

The name or NPI of the physician or facility you used to log in.

Requesting Group Leave blank. (Note: Orange outline disappears after you enter the Requesting Provider/Facility).

Diagnosis

The ICD-10 DX code with or without a decimal; TAB and the description auto populates. You can also search for the code by clicking on the magnifying glass.

See next page for screen shot of all fields completed.

Tip! Check this box if servicing provider/facility is the same as the requesting provider.

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Screen shot of General Information, Request and Diagnosis fields completed.

• Next, select Service 1

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Service 1 (note: screens below are separated for illustration purposes).

• Complete all required fields outlined in orange. See table below for details.

Field Information to enter

Service From This auto populates. It’s the date of the admission.

Service To Enter end date. Typically, 1-2 days. 24-hour concurrent review due next business day. (Click in the field and a calendar appears. Click the appropriate date).

Facility The NPI or name of rendering facility.

Actual Date Admitted Date of admission.

Admitting Diagnosis Diagnosis of patient.

Actual Discharge Date/Discharge Diagnosis/Disposition

Leave blank.

Ignore the Procedure Information field on this screen. See next page for screen shot of completed fields.

Auto populates if Use for all Requested Services was checked on previous screen.

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Service 1 – all fields completed. Note: Screens are separated for illustration purposes.

• Next, select Assessment.

• Click on Launch Assessment.

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• Complete all required fields outlined in orange. Complete white fields with appropriate information. Responding with n/a or incomplete information will cause a delay in a response to your request.

• When finished entering all the fields, select Complete. (Please disregard “Met” and “Not Met.”) Note: Screens are separated for illustration purposes.

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• You’ll receive an Assessment summary. Review and make any corrections or additions in Additional Notes.

• If you are finished with the request, select Submit.

• You’ll receive the Confirm message below. If you’re ready to submit, select Yes.

• You’ll obtain a submission outcome of Pended and a Reference #.

• You can print a copy by selecting the Print icon.

To see if the request was approved (Certified in Total): • Document the Reference #. • Select Authorizations.

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• Enter Reference #. • Select Search Existing Records. • You obtain authorization with status.

• For details select the Reference # hyperlink.

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Other Search Options for Finding Authorizations

Go to Authorizations Home Page (screen shot below) by:

• Logging in at hap.org

• Selecting Authorizations, then Authorizations Search for an authorization(s) by one of the options below:

• Enter Reference #

• Member ID or Name

For any of the searches below, you must enter dates in either the Service Dates From and To or the Submission Dates From and To (note: you can only enter a 30 day span of time)

• Requesting Provider ID or Name

• Servicing Provider ID or Name

• Servicing Facility ID or Name

After you enter information, select Search Existing Records.

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Steps for Entering a New Authorization – Chemical Dependency Example

Facility home page

• Select Authorizations.

CareAffiliate Home Page

• Select Authorizations.

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• Select New Authorization.

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• Complete all required fields outlined in orange.

• See table below for details.

Field Information to enter

Member ID 11-digit HAP member ID number; TAB and member name will auto populate.

Name Member name (you can enter 5 characters and a wild card *) or click magnifying glass icon.

Request Type The appropriate Request Type. The Request Type is essentially the place of service and service combined. It determines what fields auto populate throughout the authorization—less data entry for you! • To search for a Request Type:

• Click on the magnifying glass next to Request Type. • Check Show Behavioral Health/Substance Abuse only box and Show Inpatient Only then

click Search.

• Review details if present to ensure you choose the correct Request Type. • Choose appropriate Request Type.

Wrong Request Type If you realize you have entered the wrong Request Type:

• Select Home (from the navigation bar). • Answer Yes to confirm you want to lose all changes. p • Start over.

If you’ve entered the wrong Request Type here – see steps below.

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• After you enter the Request Type, you get the screen below.

• Complete all fields outlined in orange.

• See table below for details.

Field What you should enter

Event Classification Nothing. It auto populates.

Case Type Nothing. It auto populates.

Contact Name Name of person entering authorization. Note: field defaults with facility name. Please remove and enter contact name.

Contact Phone The best phone number for HAP to contact you with questions. (note: not outlined in orange but is required)

Requesting Provider/Facility

The name or NPI of the physician or facility you used to log in.

Requesting Group Leave blank. (Note: Orange outline disappears after you enter the Requesting Provider/Facility).

Diagnosis

The ICD-10 DX code with or without a decimal; TAB and the description auto populates. You can also search for the code by clicking on the magnifying glass.

See next page for screen shot of all fields completed.

Tip! Check this box if servicing provider/facility is the same as the requesting provider.

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Screen shot of General Information, Request and Diagnosis fields completed.

• Next, select Service 1

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Service 1 (note: screens below are separated for illustration purposes)

• Complete all required fields outlined in orange. See table below for details.

Field Information to enter

Service From This auto populates. It’s the date of the admission.

Service To Enter end date. Typically, 1-2 days. 24-hour concurrent review due next business day. (Click in the field and a calendar appears. Click the appropriate date)

Facility The NPI or name of rendering facility.

Actual Date Admitted Date of admission.

Admitting Diagnosis Diagnosis of patient.

Actual Discharge Date/Discharge Diagnosis/Disposition

Leave blank.

Ignore the Procedure Information field on this screen. See next page for screen shot of completed fields.

These grayed out fields auto populate.

Auto populates if Use for all Requested Services was checked on previous screen.

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Service 1 – all fields completed. Note: Screens are separated for illustration purposes.

• Next, select Assessment.

• Select Launch Assessment

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• Complete all required fields outlined in orange. Complete white fields with appropriate information. Responding with n/a or incomplete information will cause a delay in a response to your request.

• When finished entering all the fields, select Complete. Disregard “Met” and “Not Met.” Note: Screens are separated for illustration purposes.

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• You’ll receive an Assessment summary. Review and make any corrections or additions in Additional Notes field.

• If you are finished with the request, select Submit.

• You’ll receive the Confirm message below. If you’re ready to submit, select Yes.

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• You’ll obtain a submission outcome of Pended and a Reference #.

• You can print a copy by selecting the Print icon.

To see if the request was approved (Certified in Total):

• Document the Reference #.

• Select Authorizations.

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• Enter Reference #. • Select Search Existing Records. • You obtain authorization with status.

• For details, select the Reference # hyperlink.

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Other Search Options for Finding Authorizations

Go to Authorizations Home Page (screen shot below) by:

• Logging in at hap.org

• Selecting Authorizations, then Authorizations Search for an authorization(s) by one of the options below:

• Enter Reference #

• Member ID or Name

For any of the searches below, you must enter dates in either the Service Dates From and To or the Submission Dates From and To (note: you can only enter a 30 day span of time)

• Requesting Provider ID or Name

• Servicing Provider ID or Name

• Servicing Facility ID or Name

After you enter information, select Search Existing Records.