As announced last month, we are working on provider portal enhancements that will allow users to save draft preauthorization requests and emergent inpatient admission notifications (requests/notices). This will allow you time to collect the clinical information or hand off the case to someone who has the clinical expertise to address the clinical criteria and supporting documentation.
While we are developing the new portal feature, we would like to make some recommendations to help you prepare for this new way of creating a request/notice.
Note: One user will still be able to complete a request, from start to finish in one sitting if they have all the necessary information. This new portal update, though, is designed to help organizations that divide responsibilities between nonclinical and clinical staff.
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.
- 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.
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.
JP66620 08/2024