Community Health Network of CT, Inc.

Clear Coverage

Online Authorizations

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Overview

• Lowers authorization turn around time

• Improves workflow by decreasing administrative tasks

• Automates clinical evaluation processes

Clear coverage is an online authorization tool which:

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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 theirauthorization request.

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Minimum Computer Requirements

An Internet browserAn Internet browser

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An Internet browserAdobe Reader

An Internet browserStandard Screen Resolution

An Internet browserReliable High Speed Internet Access

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www.ct.gov/husky

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Public Web Portal:

www.huskyhealthct.org/providers

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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, real-

time response to their request.

Sign in or create an account here.

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Log in Screen

The Log in Screen

for Clear Coverage

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CHNCT Help Desk: 877.606.5772

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Changing your password

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Home Tab

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Authorization Search

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New Authorization

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Patient Eligibility

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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.

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Administration

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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

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Step One

Select the Member

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Authorization Panes

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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.

Clear Coverage Authorization Panes

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Step Two

Select the Clinician (Admitting Provider)

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Default Inpatient Provider

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CT Medical Assistance Program

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Step Three

Add the Diagnosis Code (Up to Four)

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Step Four

Select the Service (Inpatient)

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Step Five

Select the Service Information (Admitting Facility)

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Step Six

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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

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Clear Coverage Printing

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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.

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Home Tab

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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 authorizationrequest via letter, phone or web.

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Questions before the live demonstration

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Inpatient

Authorization Process

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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: 1.800.440.5071 and follow prompts for authorization• Fax: 203.265.3994 for initial notification• Fax: 203.774.0551 for submission of clinical information

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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 1.877.552.8247)

• Elective admissions. Providers to submit requests via fax to CHNCT.

• Medicare Part A admissions.

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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.

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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.

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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.

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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.

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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.

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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.

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Thank You

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