this user guide will provide detail on how to navigate and ... · title: novologix medical drug...

Confidential and Proprietary Page 1 of 30

2018 CVS Health and/or one of its affiliates. All rights reserved.

Not To Be Reproduced Or Disclosed to Others Without Prior Written Approval ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

SCOPE

This user guide will provide detail on how to navigate and utilize the NovoLogix Prior

Authorization online tool.

Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 2 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

Table of Contents

1. CREATING AN AUTHORIZATION…....………………….…………………………………………………12

1. STEP 1 – GETTING STARTED……………………………………………………………………….13

2. STEP 2 – ENTER PATIENT DETAIL………………………………………………………………….17

3. STEP 3 – ENTER AUTHORIZATION DETAIL……………………………………………………18

4. STEP 4 – ENTER AUTHORIZATION LINES……………………………………………………..19

5. STEP 5 – COMPLETING THE PROTOCOLS AND SUBMITTING YOUR REQUEST …….20

2. NOTES………………………………………………………………………………….……………………………………………………………23

3. DOCUMENTS……………………………………………………………………….……………………………………………………………24 4. FIND AN AUTHORIZATION………………………………….…………………….……………………….…25 5. QUICK SEARCH……………………………………………….…………………………………………..………27

10. HOW TO ACCESS ASK NOVOLOGIX…..……………….………………………………………………………………...……37

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 3 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

1. CREATING AN AUTHORIZATION

All authorizations that have been submitted will be available through the Find Authorization option.

1. From the User Home Page, hover over Authorizations and click Create

Authorization

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 4 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

Step 1 – Get Started

1. Select the applicable plan. If you are only linked to one plan, this field will be pre-

populated.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 5 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

2. To select your patient either enter the Member ID under Quick Start to search for existing authorizations to copy

OR

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 6 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

1. Enter the Member ID under the Search for Existing Patient field click Search

2. Click on the correct line to select your member from the results returned at the bottom of the screen.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 7 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

Step 2 – Enter Patient Detail

1. Confirm Patient information and complete any additional required fields (Please Note:

all required fields are denoted by a red asterisk) in the Patient Detail screen

Click Next

Click on arrows next to each header (i.e., Patient Detail, Addresses, Insurance Detail,

Memberships) to expand/collapse each section.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 8 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

Step 3 – Enter Authorization Detail

1. Complete fields for Requesting Physician and any other required or applicable

authorization detail.

*If the Requesting Provider field is not pre-populated, you can search by entering

either the NPI or Provider name in the NPI field.

2. Click Next

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 9 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

Step 4 – Enter Authorization Lines

1. Enter applicable start and end dates under Date(s) of Service

2. Enter requested drug name or NDC in the NDC Code field

3. Enter the quantity (if applicable; if not applicable the field will disappear upon drug selection)

4. In the Sig Field please provide the prescription information (i.e. frequency, drug name, dose, duration, routine etc…)

5. Enter any other additional information in the applicable field(s).

6. Click Next

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 10 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

1. Review information entered under the Authorization Detail Screen.

2. If no changes are needed, click Submit

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 11 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

Step 5 – Completing the Protocols and Submitting Your Request

Upon clicking Submit, you will be brought through a series of required clinical protocol

questions that will display on the screen.

1. Answer all clinical questions as they are presented in the pop-up screen that

displays, and click Next to move on to the next question.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 12 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

2. Once the clinical protocol questions are completed your authorization will

either be auto approved, or released to the next party for review. Once the

outcome is displayed on the last pop-up screen, click DONE.

The status / outcome of the authorization will be displayed at the top of the screen

along with the authorization number assigned.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 13 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

3. Once a determination is made, the Authorization will be sent back to your

home page under the Provider Notification queue. You will then be able to

open the authorization to review the determination of your Authorization

request.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 14 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

7. NOTES

After creation you will have access to add additional Notes.

1. Click Add Note

1. Enter your desired note in the Note window that is presented and click

Save.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 15 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

8. DOCUMENTS Additional documentation can be added to any authorization at any time.

1. Select Add Document

If prompted to add a document during the clinical question process, you can Save

and Close your clinical questions and add the document or you can add after the

questions have been completed.

2. Browse through your directories to locate the desired file

3. Select Document

4. Rename the document

5. Click Upload to attach

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 16 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

9. FIND AN AUTHORIZATION

1. From the Home page select Find Authorization from the Authorizations tab in the top navigation menu.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 17 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

2. Enter Search Criteria

3. Click Search

4. Select the authorization from the search results presented at the bottom of the screen.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 18 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

10. QUICK SEARCH The Quick Search option lets you search for Authorizations in the system using simple text, pre-set filter or advanced filters.

To access the Quick Search system, from the Authorization dropdown menu, select Quick

Search.

Once in the Quick Search screen, you have the option to search by Text Search, Filtered Search or Advanced Search.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 19 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

1. To search by text, enter your search term in the search field and click Search. Your

results will display at the bottom of the screen.

From the search results, you can view the high level detail of an Authorization record (i.e. Novologix authorization number, provider, member name and ID etc…).

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 20 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

If you do not use the free-text search field, you can use the pre-defined criteria to search by that specific criteria (highlighted in yellow).

2. To view a specific record on your search results, click the Authorization number in blue, to open the Authorization detail.

To export the search results, click the Export icon.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 21 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

To make a quick copy of an Authorization from the search results, click the Copy icon.

To refine your results, you can use Search Operators

a. To search for an exact pharse, place quotes around the text entered on the

search field.

b. To search for an equivalent or a given term, enter the word “OR” (in all caps)

between both search terms in the search text field.

c. To search for results that include more than one term, enter the word “AND”

(in all caps) between both search terms in the search text field.

d. To exclude a search term from your results, enter the word “NOT” (in all

caps)before the search term in the search text field.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 22 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

1. To reach Filtered Search, click the Filtered Search tab.

2. To search from the Filtered Search tab, select the filter you wish to apply from the

Select Your Filter dropdown.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 23 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

3. Enter the value of the filter you are search for in the Enter Value field.

4. From the Date Range field, click on the date range field to select the type of date you

want to search by.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 24 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

5. Click Search.

Your results will display at the bottom of the screen.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 25 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

2. To reach Advanced Search, click the Advanced Search tab.

3. Once in the Advanced Search tab, complete the fields you wish to filter your results by. Click Search

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 26 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

Your filtered results will appear at the bottom of the screen.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 27 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

11. HOW TO ACCESS “ASK NOVOLOGIX”

The “Ask NovoLogix” Help tab was established to assist users with gaining access to support

items such as forms, manuals, videos, client-specific detail and other support information. 1. Select Help and AskNovoLogix

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 28 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

2. This will take you to the “Ask NovoLogix” interface.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 29 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY

3. Click on the item(s) you want to review.

TITLE: Novologix Medical Drug Prior Authorization (PA) - Provider User Guide

Page 30 of 30 ELECTRONIC DATA = OFFICIAL VERSION – PAPER COPY – INFORMATIONAL ONLY