Provider Portal Demonstration: New Clinical Criteria Requirements

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Provider Portal Demonstration: New Clinical Criteria Requirements

09/06/2024

We wanted to let you know there are going to be demonstrations on upcoming changes to our provider portal (see original announcements EmblemHealth | ConnectiCare) to help you receive quicker determinations. Please mark your calendars for one of the sessions listed below.

We will show you the new workflows for requesting preauthorizations and submitting elective inpatient admission notifications. You will also learn how to:

  • Save draft requests and notices for 96 hours.
  • Find drafts.
  • Address clinical guidelines and supporting documentation.

We would like to make some recommendations to help you prepare for this new way of creating a request/notice.

You should make sure:

  • Everyone who may contribute to a request/notice is set up with a provider portal account and assigned to the Administrator/Office Manager or Clinical Staff role.
  • Workflows are in place so there are clear hand-offs and responsibilities defined so request/notice drafts are completed and submitted within the 96-hour time frame.

Note: To help you manage the new process, we will send an email to the person identified in a draft request/notice as the Contact to remind them that there are incomplete drafts that require their attention. We will also send them an email when any of their drafts expire.

  • Workflows are in place for addressing expired drafts.
  • Staff responsible for adding clinical information are trained on finding incomplete drafts, addressing clinical criteria, and attaching supporting documentation.
  • Everyone is aware that the portal will not allow a request to be submitted without expected clinical criteria addressed and supporting documents attached.
  • Everyone is aware that once a draft expires, a new request/notice will need to be entered.

Please join us during one of the Zoom sessions listed below. For the best experience, make sure you have Zoom on your computer or other device you will be using. Just click “Join the Meeting” for the one you want to attend five minutes before the session begins. In case you are prompted, included below are Meeting ID and Passcode for each session.

Provider Update

Sessions for Facilities

 

These sessions are recommended for hospitals and skilled nursing facilities that need to enter:

  • Emergent inpatient admission notifications.
  • Elective inpatient admission preauthorizations.
  • Post-acute care preauthorizations.


Session 1
Date: Wednesday, Sept. 11, 2024
Time: 11 a.m.
Meeting ID: 898 0816 3069
Passcode: 795050
Join the Meeting

Session 3
Date: Thursday, Sept. 12, 2024
Time: 2 p.m.
Meeting ID: 824 1125 5098
Passcode: 868262
Join the Meeting

Session 5
Date: Monday, Sept. 23, 2024
Time: 11 a.m.
Meeting ID: 814 1615 7391
Passcode: 897605
Join the Meeting

Session 7
Date: Tuesday, Sept. 24, 2024
Time: 2 p.m.
Meeting ID: 830 4100 3625
Passcode: 168950
Join the Meeting

Sessions for Physicians and Other Health Care Professionals

These sessions are recommended for physicians and other health care professionals who need to request preauthorizations for:

  • Elective inpatient admissions.
  • Outpatient hospital services.
  • Surgical procedures.
  • Nonparticipating providers.


Session 2
Date: Wednesday, Sept. 11, 2024
Time: 3 p.m.
Meeting ID: 875 5818 0452
Passcode: 751620
Join the Meeting

Session 4
Date: Thursday, Sept. 12, 2024
Time: 11 a.m.
Meeting ID: 835 7774 8151
Passcode: 390769
Join the Meeting

Session 6
Date: Monday, Sept. 23, 2024
Time: 2 p.m.
Meeting ID: 874 6768 0674
Passcode: 643110
Join the Meeting

Session 8
Date: Tuesday, Sept. 24, 2024
Time: 11 a.m.
Meeting ID: 819 5315 3383
Passcode: 959142
Join the Meeting