WellCare Health Plans — Investor Presentation (May 2013)
24 slides from WellCare Health Plans's investor presentation, May 2013
Slide 1: Georgia Centralized PA Feature
Georgia Centralized PA Feature Presentation to: All Contracted Providers Presented by: Georgia CMOs 0 GA022664_PRO_PRS_ENG State Approved 05072013 ©WellCare 2013 GA_05_13
Slide 2: Mission
Mission The Georgia Department of Community Health We will provide Georgians with access to affordable, quality health care through effective planning, purchasing and oversight. We are dedicated to A Healthy Georgia. 1
Slide 3: Overview - Centralized PA Portal Features
Overview - Centralized PA Portal Features • Georgia Medicaid Management Information Services (GAMMIS) Web Portal’s functionality will be expanded to serve as the ‘centralized’ single point of entry for all Georgia Prior Authorization (PA) requests. • Medicaid providers who are participating with a C
Slide 4: Overview - Centralized PA Portal Features (cont'd)
Overview - Centralized PA Portal Features (cont’d) • No change in FFS PA entry • CMO participating providers can use this centralized web portal functionality to submit PAs along with Pregnancy and Newborn Delivery notifications to a CMO. • CMO PA entry to be phased in – request types added in each
Slide 5: Overview - Centralized PA Portal Features (cont'd)
Overview - Centralized PA Portal Features (cont’d) Phase Implementation Authorization Services that should be submitted via the Centralized PA Date Portal Functionality Phase 1A 6/1/2013 1. Newborn Delivery Notification Forms will be completed and submitted by providers on all OB deliveries that wil
Slide 6: CMO PA Submission Facts
CMO PA Submission Facts Centralized Portal Provider Workspace has been customized for CMO PA activities. CMO PA entry is similar to FFS PA entry with these additional changes: -If a request type is selected that is part of the centralized portal functionality process, the provider is prompted to sel
Slide 7: CMO PA Submission Facts (cont'd)
CMO PA Submission Facts (cont’d) • CMO member eligibility and provider network status are validated. • PA requests may be submitted a maximum of 30 days prior to elective service/admission. • Retrospective PA may be requested only if the service/admission was emergent. • Use of the Centralized PA Po
Slide 8: CMO PA Submission Facts (cont'd)
CMO PA Submission Facts (cont’d) CMO PA submission generates a GMCF Tracking ID. The GMCF tracking ID is a 12 digit number that starts with “7”. This is not the PA ID used for CMO claims submission or adjudication. If the PA is approved by the CMO, the CMO’s-assigned authorization number will be dis
Slide 9: How to Request a CMO PA
How to Request a CMO PA • Go to the Georgia Medicaid Mangement Information System (GAMMIS) at www.mmis.georgia.gov • Log-in with assigned user ID and password • On the GAMMIS secure home page, click Prior Authorization • Click Submit/View 8
Slide 10: How to Request a CMO PA (cont'd)
How to Request a CMO PA (cont’d) Select a request type or notification type 9
Slide 11: CMO PA Submission Facts (cont'd)
CMO PA Submission Facts (cont’d) Enter the member’s Medicaid ID Requesting provider ID is auto-populated Enter servicing provider ID or search Click Submit 10
Slide 12: How to Request a CMO PA (cont'd)
How to Request a CMO PA (cont’d) If the member and/or provider(s) are not associated with a CMO, a warning message displays ► Click Continue to bypass and open the PA form 11
Slide 13: Request Information Section
Request Information Section As indicated earlier: • The “Requested Information” section on web form has been modified to capture information needed for CMO specific PA review. • Data fields have been added and selections in drop-lists have been modified. 12
Slide 14: Peach State Request Info
Peach State Request Info Hospital Admissions/Transplants • Admit Date • Discharge Date or Still in Facility indicator • Targeted Discharge Date if still in facility Hospital Outpatient • Place of Service Therapy • Admission Type ► Therapy Start Date • Level of Urgency ► Place of Service ► Admission
Slide 15: Peach State Request Info (cont'd)
Peach State Request Info (cont’d) ► Hospital PAs and Instate Transplants ► Hospital Outpatient Therapy PA 14
Slide 16: Wellcare & Amerigroup Request Info
Wellcare & Amerigroup Request Info • Hospital Admissions/Transplants – Admit Date – Discharge Date or Still in Facility Indicator – Place of Service – Admission Type • Hospital Outpatient Therapy – Therapy Start Date – Place of Service – Admission Type 15
Slide 17: Admit Type Warning
Admit Type Warning • A “Warning” message displays if Emergency or Urgent is selected as the ‘Admission Type’ • This message is informational and does not prevent PA entry 16
Slide 18: CMO PA Submission Facts
CMO PA Submission Facts Providers may request an Expedited review determination if standard timeframe for review seriously jeopardizes the patient’s life or health. Click ‘Yes’ to the question and provide rationale 17
Slide 19: Procedure Lookup & PA Disclaimer
Procedure Lookup & PA Disclaimer •CMO participating providers can be linked directly to the CMO PA lookup Tool in the procedures section of the PA form. •Non-participating CMO providers will not have access to the CMO PA lookup tool. A disclaimer statement will display in the procedures section: DIS
Slide 20: Attestation Statement
Attestation Statement The Attestation Statement at the end of the form has been augmented with the statement highlighted in the screen shot 19
Slide 21: Hospital Outpatient Therapy Procedure Dates
Hospital Outpatient Therapy Procedure Dates • All CMOs: Therapy services may be requested for more than one month. For example,4/20/13 – 8/20/13 • Therapy services determinations are based on individual needs of the member. 20
Slide 22: Pregnancy & Newborn Delivery Notification Forms
Pregnancy & Newborn Delivery Notification Forms • Submit Newborn Delivery Notifications via GAMMIS to trigger the creation of a maternal delivery PA in the CMO’s claims payment system. (Note: The “admit date” on the newborn delivery notification form is the maternal actual admit date) • Newborn Deli
Slide 23: Pregnancy and Newborn Delivery Notification Forms (cont'd)
Pregnancy and Newborn Delivery Notification Forms (cont’d) • To access the notification forms, click Submit/View or Request a Prior Authorization from the workspace • Select the notification type 22
Slide 24: Contact Information
Contact Information • Questions about CMO Centralized Prior Authorization requests? – Contact the specific CMO if you want to inquire about your CMO PA requests Amerigroup Peach State Health Plan WellCare of Georgia 1-800-454-3730 1-866-874-0633 1-866-300-1141 23
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