HOUSTON OFFICE

1900 N. Loop West, Ste. 400

Houston, Tx 77018

(281) 447-6800

IntegraNet Health: http://www.integranethealth.com

For assistance with the Provider Portal,contact (281) 591-5289.

Fax: (281) 405-3431

Inetdr.com

DALLAS OFFICE

3010 LBJ Freeway, Ste. 1450

Dallas, TX 75234

(469) 322-8232

Physician Portal Pre-Authorization

Manual/User Guide

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Utilization Management Provider Submission Process

I. Provider Access a. Must have a valid email address. b. A User name and temporary password will be created for you. c. Your user name and password will be emailed to you. The email will be from “noreply@AaNeel.com”. **You will be prompted to reset your password when you enter the Provider Portal for the first time.

NOTE: Should Portal Access Expire, Enter Assigned User ID and Reset Password

II. Utilizing Google Chrome

URL –Inetdr.com

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III. Steps to Navigate to Preauthorization Request Page (Referral)

Step 1: Modules

Step 2: Referral (Note “Outbound Referral” = Prior Authorization)

***Outbound referral/Referral Request is now called Prior Authorization Request***

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IV. Locate a Member/Patient Step 1: Search Member

Step 2. Search by Member ID, HICN# or Name & DOB

Choose Search Preference from Drop Down Box. Choices include: Member ID, HICN # or Member Name & Date of Birth

Step 2a: Search by Member Preference

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Step 3. + Add New Select “Add New” to add a referral request to the selected member

NOTE: If message receives states, “No active member found” then F5 to refresh screen.

V: Entering a Referral Tracking Request on a Patient

STEP 1. Referral Detail

Select Request Type (Select One – If an Urgent request is needed please call the UM Dept at 281-591-5289 with a clinicals reason for the urgency)

i. Retro ii. Standard

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Note: Timeframes

a. Non-Urgent/Standard Request – A non-urgent/standard request may take up to 14 days to process. Request will be processed in the order they are received.

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b. Urgent/Expedited Request – An urgent/expedited request may take up to 72 hours to process. Request are processed in the order they are received. (Must call the UM dept with a clinical reason for the urgency to have request updated to an Urgent request)

STEP 2. A.1: If Standard is selected, proceed to next step.

A. 2: Notes – The note section is to allow free text messages to the UM staff and/or

document additional information to help process the referral request.

B. 1: If Urgent or Expedited is needed, you must call the UM department and provide

a Clinical Reason for Urgent Request.

URGENT/EXPEDITED REVIEW IS ONLY AVAILABLE IF THE STANDARD TIME FOR MAKING A DETERMINATION COULD SERIOUSLY JEOPARDIZE THE PATIENT’S HEALTH, LIFE OR ABILITY TO REGAIN MAXIMUM FUNCTION.

STEP 3: REFERRAL FROM

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3. A: Search Physician By You can search by Provider name, NPI, DEA, Tax ID, Office name, etc.

3.A. 1: Provider Name will appear below, select

**You may also enter the NPI number directly in the Name/Provider name box and the provider will pop up as seen below.

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STEP 4: REFERRAL TO

NOTE: The Contract Type will indicate if the Provider is Par (in-network) or Non-Par (out of network). Use the NOTES (Step 4.A.2) section to document reasons for referral to Non- Par providers.

Search Physician By – Process is the same as “Referral From”. You can search by Provider name, NPI, DEA, Tax ID, Office name, etc.

NOTE: You can also search for the provider by typing in NAME.

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STEP 5: PLACE AND TYPE OF SERVICE

Place of Service – Drop down box; use blue scroll bar to find Place of Service that applies

to request.

Type of Service – Drop down box; use blue scroll bar to find Type of Service.

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STEP 6. DATE RANGE

Begin/From Date and To/End Date – Click on each box to select begin and end dates of service.

STEP 7. REQUEST FOR – (Free Text) Enter TOTAL Number of Visits Being Requested

TYPE OF CARE – Drop Down Box; Select

STEP 8. DIAGNOSIS CODE(s)

Add ICD 10 code or description; select (Search by ICD 10 Code or Description)

**Repeat steps 1-6 for each diagnosis

Step 1 & 2 – Enter Diagnosis Code or Description and Search

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Step 3 – Select Diagnosis Code

Step 4 - Enter “Onset Date” Step 5 - Select “Primary” Step 6 – Select “+ Add”

STEP 9. CPT CODE(s) –

Add CPT Codes for each requested service; select (Search by CPT code or Descpt.)

Add # of Requested Units for each CPT Code

**Repeat Steps 1-5 for each CPT Code Being Requested.

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Step 1 – Enter CPT Code or Description Step 2 - Select CPT Code/Description Step 3 – Enter “Onset Date” Step 4 – Select “Primary” Step 5 – Select “+ Add”

**Note: Diagnosis Codes & CPT Codes can be deleted by selecting trash bin

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STEP 10. ATTACHMENTS

Uploading supporting documents.

10.1 – Save Documents to be uploaded to a folder, desk top, etc. 10.2 – Choose Files (drag and drop file or click to upload)

STEP 11. SAVE / SAVE & FINISH

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STEP 12. LOG OUT

TROUBLESHOOTING

If you are unable to save (submit), check the upper right-hand corner of screen for error message. Displayed message will direct you to corrective action needed. Once the issues have been resolved, click save again to submit.

Successful submission

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Locked for Editing

IV: CHECK AUTHORIZATION STATUS

STEP 1: Repeat Section III – Navigating to the Outbound Referral page.

STEP 2: Click on member line to enter referral for complete view; select view.

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STEP 3: When the member file is open, you can view the entire record.

Scroll to the bottom of the page to view: Documents that have been uploaded to member file Communication History MSO Auth Review (UM Staff Notes, Criteria used to make determination, etc.) Authorization Status.

STEP 4: LOGOUT

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V. ALERTS

You will receive an alert notification each time an action occurs with the referral (i.e. Referral status changes from “Pending to Extend Info; Extend Info to Extend MD; Pending to Under Review; Pending to Approval, etc.)

The alert will be sent via email and an alert will be recreated in the Provider Portal.

**Email Alert

The email alert will be sent to the User ID and email on file for the person who created the original referral.

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A. Portal Alerts

Step 1: Notification Bar

Step 2: Select Alert

Step 3: Alert Box

Step 4: View Details: Create Task, Dismiss, Review or Close Details You can create a task for other Portal Users; Dismiss the Alert, Review the Alert or Close the Alert. **NOTE: To go directly to specific member alert, chose “Review”

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**NOTE: Select “Action -> Review” to be redirected to Specific Member Alert

Step 5: Delete Alert NOTE: If an Alert is received, check the MSO Auth Review Section of the Referral Detail Screen for notes documented by UM Review Staff.

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B. Send & Receive Portal Emails Note: Emails can only be sent to users with portal access and only sent & received within the Portal.

Step 1: Select Envelope from Notification Bar to Send Emails & Review Emails Received

Step 2. Compose and/or Review Emails

VI. ADVANCE SEARCH OPTION Advance Search can be used to sort referral entries. Enter the desired information and “Search”.

Step 1: Select “Advance Search”

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Step 2: Enter Specific Information to be reviewed NOTE: Arrows indicate selection has a drop down box to search for specific items Example 1: Auth. Status – Search the authorization status of referrals entered. (i.e. pending, approved, denied, under review, etc.)

Example 2: Referral Date - Search date ranges of prior authorization request NOTE: Advance Search feature MUST be cleared between each search and prior to entering or reviewing prior authorizations.

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REMINDERS

1. Authorization status can be checked by logging into Provider Portal.

2. Urgent request may take up to 72 hours to process from the date and time of submission into the Provider Portal. Standard request may take up to 14 days to process from the date of submission into the Provider Portal.

3. Request are handled in the order they are received.

4. Precertification for coverage of selected standard outpatient and ancillary services with all supporting documentation should be submitted immediately upon identifying the need for the request 14 days prior to scheduling the service(s).

5. Urgent request that do not meet criteria for an expedited request will be downgraded to Standard and processed accordingly.

6. Emails should be checked regularly for alerts. 7. ***FOR ASSISTANCE WITH THE PORTAL CALL THE UM DEPARTMENT AT

(281) 591-5289

8. To check if precertification is required: https://providers.amerigroup.com/Pages/PLUTO.aspx