onehealthport overview of services · 2017-06-20 · 1 created by and for the local healthcare...
TRANSCRIPT
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Created by and for the local healthcare community, OneHealthPort solves information
exchange and workflow problems shared across healthcare organizations.
OneHealthPortOverview of Services
WA State Physical Therapy Association
Teresa Davis, RN, Director of Market DevelopmentKerry Tye, Senior VP Business Operations & Marketing
May 11, 2017
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Agenda
• Single Sign-On (SSO) Update
• Health Information Exchange (HIE)
• Clinical Data Repository (CDR)
• Pre-Authorization/Pre-Service
• Credentialing Update
• Q&A
• Introduce Premera
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OneHealthPort
Who We Are
Created in 2002, by and for the local healthcare community, OneHealthPortsolves information exchange and workflow problems shared across healthcare organizations
What We Do
• Single-Sign-On
• Admin Simp – Lead Organization
• Credentialing Data Collection
• WA Healthcare Forum
• Health Information Exchange– Lead Organization
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Single Sign-OnReminder: Monthly Webcasts
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Single Sign-On (SSO) Activity
• SSO started in 2003
• Total Transactions in 2016 = 20,000,000!
• As of 12/31/2016:
– Total Organizations = 70,000
– Active Subscribers = 102,000
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OneHealthPort’s Home Page
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SSO Login Page
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CDR Access• Testing in the clinical portal is
accessed with a “Test Role Only”
– Assigned by your organization’s SSO Administrator
• Once testing is complete other roles are assigned by your Administrator
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Health Information Exchange (HIE)&
Clinical Data Repository (CDR)
1111
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Clinical Data Repository
Clinical Data Repository Initiative
Sponsors
• Washington State Health Care Authority (Medicaid)
• Physicians of Southwest Washington (Managed Medicare)
• More in the future
Sponsor use for CDR service
– Aggregate data for specific patient populations
– Work with specific provider contributors to provide data
– Used to create longitudinal health record for patients
– Accumulate data for managing contractual obligations and performing analytics
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• Authenticate connections
• Use Provider Directory to route messages
• Facilitate exchange of standard data
• Host API/web services• API Directory• Standards Propagation
C-CDA Response to API Query from/to EHR
Push
EHR pushes C-CDA to CDR
View only use of the CDR using Portal
Sponsor bulk loads claims and
eligibility data
Sponsor and other authorized parties can access reports
and/or data
C-CDA Exchange with the CDR
Clinics
Clinics
Providers
Providers
Hospitals
Hospitals
Authorized Party
Clinical Organization EHRs push C-CDA to CDR after each sponsored patient encounter. After a critical mass of data is reached, Clinical Organizations can draw C-CDA from CDR into their EHR through the HIE, or view CDR through secure portal.
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Who Should Participate?
Provider organizations that meet the criteria below are required to submit C-CDAs
– Contracted with Managed Medicaid Care Organizations to provide care for patients covered under Apple Health plans
– Use a certified electronic health record system (EHR) system
– Received Meaningful Use incentive payments
– Behavioral health and substance use disorder providers will begin participation in second phase of the CDR initiative later in 2017
• For specific questions about provider participation requirements contact the HCA at [email protected] Enter CDR in the subject line of the email to route your question to the Link4Health team
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CDR Questions
Health Care Authority CDR Initiative
• Visit HCA website for general CDR information: www.HealthIT.wa.gov
• General questions about CDR participation requirements email HCA Health IT team at [email protected] (Put “CDR” in the subject line)
• Get started with HCA CDR participation: http://www.onehealthport.com/hca-cdr
Physicians of Southwest Washington CDR Initiative• Get started with PSW CDR participation:
http://www.onehealthport.com/psw-cdr
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Pre-Authorization/Pre-Service
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Pre-Auth Best Practice Recommendations (BPRs)
• Extenuating Circumstances– When obtaining a pre-auth is
extremely difficult
o Unable to Know
o Not Enough Time
• Timeliness– Standard Notification timeframes for
responding to pre-auth requests• Defines type of requests and
corresponding timeframes
• Meets or exceeds NCQA standards
• Payer Websites– Outlines requirements for payers
to provide browser capabilities to access pre-authorization and admission notification information
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Payer Website Enhancements
Provider Requested Priority
Provider Administered Medication
• 11 Requested Enhancements– Identify excluded benefits
– Updated status information
– Supporting document requirements for new requests and renewal or extension of services
Worksheet: Provider Requested Priority for Implementation of BPR-Browser Capability Related Enhancement
BPR Enhancement BPR
Page# Priority
Rank 1 -11
Comment
Identify excluded benefits Use unlisted codes to look up investigational/ experimental
services
9 1 (17)
1 provider gave this an 8 priority
Link to supporting documentation requirements, for New requests Renewal or extension of current services (if different than
new request) Unlisted codes
9-10 2 (24)
Updated status information 14-15 3 (24) 1 provider gave it a 10 priority
Include information about ‘Provider Administered Medications’ and ‘Provider Administration of Medications’ on web site, similar to other medical services Lookup Specialty Pharmacy Status Information
3-4, 6 8 9 14-15
4 (31)
A number of providers thought #11 – “specialty” Pharmacy should be included
Identify when coverage for a service is dependent upon clinical requirement for previously tried services or diagnostic tests
10 5 (33)
Identify services that require a medical review, separate from pre-auth
Able to request a pre-service authorization review of these services
9, 10 10
6 (34)
For questions about supporting clinical information – provide check list selection of answers and/or allow for complete entry of information
13 7 (36) Break point where more ‘High” ranking than “Essential”
Identify any ‘professional restrictions’ associated with a service
On auth request form, include question(s) about these restrictions with check list of responses for which authorization will be considered.
9, 10 13
8 (42)
Eliminate requirement for provider signature for an authorization request
13 9 (47)
When multiple authorization for the same service are required, allow for requesting them at the same time
13 10 (49)
Identify ‘specialty’ Pharmacy related information associated with ‘Provider Administered Medications’
9 11 (57)
Priority Legend: (xx) – sum of all rankings for the enhancement, with lower number having a higher priority Critical Essential High
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Best Practice Recommendations (BPR)Online BPR Search Tool Under AdminSimp
• Search by Category: Claims Edits, HIPAA Transactions, Prospective Review for Medical and Pharmacy
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Workflow NavigatorPre-Service Search Tool Demo
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Workflow Navigator
www.onehealthport.com/workflow-navigator
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Workflow Navigator
Select from either Pre-Service Processing or Admission Notification
Participating Health PlansAsuris Northwest Health CommercialAsuris Northwest Health Medicare AdvantageCignaCommunity Health Plan of WashingtonKaiser Permanente – Washington Region (formerly GHC)Labor & IndustriesLifeWiseLifeWise Health Plan of OregonLifeWise Health Plan of WashingtonPremera Blue CrossPremera Blue Cross Blue Shield of AlaskaRegence CommercialRegence Federal Employee ProgramRegence Medicare AdvantageRegence Uniform Medical Plan
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Premera Blue Cross – Visits & Procedures
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Premera Blue Cross – View Medical Policies
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Premera Blue Cross – Check Status of Request
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Workflow Navigator – Carved Out Service
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Workflow Navigator – Carved Out Service
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Workflow Navigator – Carved Out Service
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Pre-Auth – Ongoing Efforts
• Validation
– Observe provider workflow as they navigate through different sites
• Meetings with Payers
– Provide feedback from validation findings and what we learn during Lunch & Learns
• Host Payer Webcasts
– Payers highlight pre-auth tools on their website and allow time for Q&A
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Credentialing
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Legislative Update – Credentialing
• A new law passed requiring providers and credentialing entities to use ProviderSource
• Effective 6/1/18
• Delegated entities are exempt
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Physical TherapistProvider Source sections that
cause the most confusion
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Documents Page Overview
• Manage Documents • Application Documents
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Other IDs and Certifications• This section is payer specific
• If you answer YES, then you need to upload to Manage Documents
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Other IDs and Certifications
• Certification Type: If you respond YES, then complete the below
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Application Document Audit
• Required documents for every payer(if Liability is not uploaded then it
doesn’t show in Audit)
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Professional Liability• Sovereign immunity is a judicial doctrine that prevents the government or its political subdivisions, departments, and
agencies from being sued without its consent. The doctrine stems from the ancient English principle that the monarch can do no wrong. NOTE: If you don’t have a Sovereign immunity document, the answer is most likely NO
• Liability History is a payer required element to display information within 0-10 years history (especially for initial credentialing). If so, the answer is YES
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Professional Liability Question:
• How many of you have additional insurance via a large trust fund? Trust Fund=$3-5 million?
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Professional Liability Answer:• This screen should be responded to 99% of the time=NO
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Practice Location
• If using Office Manager application, you can add Practice Location from the Manage Practice page - if completed, then select YES
• If you are entering on an individual provider (and not add from the Manage Practice page), please select NO
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Practice Location
• If the answer is NO=you must complete all 9 tabs of Practice Location section
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ProviderSource Most Common Issues
• Practice Location - must fill out all 9 tabs and then save!
• Browser Compatibility: ProviderSource supports all browsers, providers seem to have the most issues with Chrome, if that’s the case, we recommend Firefox
• Tablets - At this time Provider Source is not compatible with phones and tablets
• Professional Liability - Many health plans require an explanation for a gap longer than 2 or so months (please use the Gap section for any gap in coverage)
• Document Upload - difference between Manage Documents and Application Documents = Application Documents is for use by Washington State
• Data field with an Asterisk is a mandatory field
• Sections of a record such as DEA Record, Medicare Record, etc. must be filled out in ALL fields
• For Practice Call Coverage, use the PRACTICE LOCATION - PARTNERS tab for that information or use Covering Colleagues
• Signature - Credentialing Managers cannot attest– Provider signatures cannot be scribble - it has to be somewhat readable
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Q&A
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Thank YouFor any questions please contact:
Kerry Tye
Senior VP Business Operations & Marketing
Phone: 1.206.624.3128 x 119
Email: [email protected]
Teresa Davis, RN
Director of Market Development
Phone: 1.206.624.3128 x 152
Email: [email protected]
Robert Alexander
Provider Relations Manager
213.607.3635
Medversant Technologies, LLC
Stephanie Cole
Provider Experience
425-918-4830
Premera Blue Cross