iexchange inpatient certifications and referral requests · iexchange ®’ inpatient c...

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iEXCHANGE®’

Inpatient Certifications and Referral Requests

Web ApplicationReference Guide

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.

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iEXCHANGE Web

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Access iEXCHANGE on the Provider Web site: www.bcbstx.com/provider

Availability is 24 Availability is 24 Hrs/Day 7 Days/Wk Hrs/Day 7 Days/Wk

Exception: Every 3Exception: Every 3rdrd

Sunday of every Sunday of every month the system will month the system will be unavailable from be unavailable from 11am11am--2pm CT2pm CT

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Reference Guides for Reference Guides for the the iEXCHANGEiEXCHANGE IVR IVR Phone and Phone and iEXCHANGEiEXCHANGE Web Web application can be application can be located to the left located to the left

Tip sheets and Tip sheets and FAQsFAQs are located in this are located in this section as wellsection as well

The Reference Guides The Reference Guides and and FAQsFAQs can also be can also be located under the located under the Provider Library on the Provider Library on the main pagemain page

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iEXCHANGE Support Desk number and hours of availability

1-800-441-9188select 1, then 3, then 2

Monday-Friday8am-5pm CST

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System requirements for iEXCHANGE

To run the new iEXCHANGE® Web application this requires a PC or Laptop with the following minimum hardware and software specifications.

iEXCHANGE® Hardware Specifications– RAM of 32 MB or higher– Connection speed of 36K or higher– Screen Resolution of 800x600– Platform of Windows95 or higher

iEXCHANGE® Software Specifications– Supported Web Browsers:– Internet Explorer 5.5 or higher all with 128-bit security– Netscape Navigator 4.08 or higher all with 128-bit security– JavaScript must be enabled for all web browsers

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What you need to begin• User ID *

– No restrictions on format• iEXCHANGE ID

– Provided by BCBS Texas • Password *

– Case sensitive– Expires every 30 days– You will be prompted to change

• Certain words are restricted – you will get a prompt– After 3 invalid entries – you will be revoked and wait 5 minutes to

login again– If you have forgotten you password, you will need to have the

office administrator reset your password

* These will be set up by the office administrator

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Log in here Log in here with your with your User ID, User ID, iEXCHANGEiEXCHANGE ID, and ID, and PasswordPassword

Make sure to select Make sure to select Provider loginProvider loginHelp topics Help topics

are available are available to assist you to assist you in logging onin logging on

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Select Preferences to get to Select Preferences to get to the area where you can reset the area where you can reset your password and access your password and access Administrator functionsAdministrator functions

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This is where you go to This is where you go to change your password change your password and access administrator and access administrator functionsfunctions

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Always choose Blue Cross Blue Always choose Blue Cross Blue Shield of Texas from the drop Shield of Texas from the drop down menu and click down menu and click ““SelectSelect”” * *

* You must click * You must click ““SelectSelect”” to to move forwardmove forward

On the beginning screen you On the beginning screen you must select a payer from the must select a payer from the drop down box before drop down box before continuing.continuing.

Important: References throughout this application to Important: References throughout this application to ““payerpayer”” or or ““MCOMCO”” (Managed Care (Managed Care Organization) = BlueCross BlueShield of TexasOrganization) = BlueCross BlueShield of Texas

Important: References throughout this application to MCO ID = MaImportant: References throughout this application to MCO ID = Managed Care Organization naged Care Organization Identification Number for BlueCross Blue Shield of Texas Identification Number for BlueCross Blue Shield of Texas –– Not your regular Provider Number. Not your regular Provider Number. Please note you must look this up by using the Search tab Please note you must look this up by using the Search tab –– See Slides 13 & 14 for exampleSee Slides 13 & 14 for example

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Note that you now see the Note that you now see the payer displayed in the top leftpayer displayed in the top left-- hand corner. hand corner.

Treatment Updates will be listed in Treatment Updates will be listed in this area this area –– based on your loginbased on your login

Check Announcements from Check Announcements from BCBSTX and BCBSTX and MEDecisionMEDecision in these in these areasareas

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Searches can be performed Searches can be performed in the Search tab. If you are in the Search tab. If you are new to new to iEXCHANGEiEXCHANGE, you will , you will need to know how to look up need to know how to look up providers in order to providers in order to complete the set up in order complete the set up in order to use the Web application. to use the Web application. For more information on set For more information on set up, please see the up, please see the iEXCHANGEiEXCHANGE Administrator Administrator section.section.

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The quickest search for the MCO ID is to use Option A: The quickest search for the MCO ID is to use Option A: Standard Search drop down and provide your NPI. (If the Standard Search drop down and provide your NPI. (If the search is for a physician, please use the Type 1 NPI.) This search is for a physician, please use the Type 1 NPI.) This will only work if you have validated your NPI number with will only work if you have validated your NPI number with BCBSTX. Otherwise you will need to use one of the other 3 BCBSTX. Otherwise you will need to use one of the other 3 options options –– or you can choose to search by Option B: or you can choose to search by Option B: Geographic/Specialty Search. Geographic/Specialty Search.

Standard Search, you can Standard Search, you can search by:search by:

Provider NameProvider Name

Phone NumberPhone Number

NPI NumberNPI Number

MCO IDMCO IDCaution: Many physicians/professional Caution: Many physicians/professional providers have the same first and last providers have the same first and last name. Please be sure to verify name, name. Please be sure to verify name, address & specialty when making a address & specialty when making a selection. Also make sure to choose the selection. Also make sure to choose the correct listing when multiple listings correct listing when multiple listings appear under 1 NPI.appear under 1 NPI.

Input NPI HereInput NPI Here

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iEXCHANGE Administrator

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Office Administrator Functions

• Sets up new providers• Maintains and edits providers• Sets up new users• Inactivates users no longer needed• Sets up frequent provider listing• Sets up frequent procedure code listing• Sets up frequent diagnosis listing• Resets passwords for users when needed

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Advantages

• More control for your office• Add and inactivate users as needed• Set up custom listings• Edit/Add/Delete information as needed• Instant updates• Ability to reset passwords in house for

users

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Group administration:Group administration:

Enter or edit information Enter or edit information about your about your iEXCHANGEiEXCHANGE Provider GroupProvider Group

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You You cannot cannot edit the Group IDedit the Group ID

The remainder of The remainder of the fields can be the fields can be editededited

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Account administration:Account administration:

Enter or edit information Enter or edit information about account users for about account users for your your iEXCHANGEiEXCHANGE Provider GroupProvider Group

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Add a new user by selecting the Add a new user by selecting the Add new user buttonAdd new user button

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Enter the logon and Enter the logon and password password information*information*Enter the user Enter the user namename

Staff or AdministratorStaff or AdministratorActive or InactiveActive or Inactive

* The user will be prompted to change their password when they l* The user will be prompted to change their password when they log onog on

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Watch for Watch for errors like this errors like this one one –– in this in this case I chose case I chose ““testtest”” as the as the password, password, which is not which is not allowedallowed

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You will receive You will receive this message this message once you have once you have successfully successfully added or added or updated a userupdated a user

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You will now You will now see that the see that the new user has new user has been addedbeen added

Once you have Once you have inactivated the inactivated the user, the user, the current status current status will change to will change to ““inactiveinactive””, but , but will not be will not be deleteddeleted

You can also Edit You can also Edit the user by the user by selecting the line selecting the line and then clicking and then clicking Edit userEdit user

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Submitting providers:Submitting providers:

Enter or edit information Enter or edit information about the providers for about the providers for which an which an iEXCHANGEiEXCHANGE transaction can be transaction can be submitted and should submitted and should correspond to healthcare correspond to healthcare providers within your providers within your iEXCHANGEiEXCHANGE Provider Provider GroupGroup

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You can add a You can add a new provider by new provider by selecting Add new selecting Add new providerprovider

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Fill in the Fill in the information for information for the submitting the submitting provider you provider you are addingare adding

Please leave this Please leave this field blankfield blank

The fields with the red The fields with the red asterisks are required. asterisks are required. You may choose to fill You may choose to fill out the remainder of out the remainder of the information. the information.

Organization Organization name is for name is for facility set upfacility set up

OR OR

First and Last First and Last Name is used Name is used for physician for physician set upset up

Also, make sure to fill Also, make sure to fill in the Type 1 NPI if in the Type 1 NPI if you are entering a you are entering a professional provider professional provider or Type 2 NPI for a or Type 2 NPI for a facility. This is facility. This is required.required.

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HINT: Before filling in the HINT: Before filling in the Provider ID information, Provider ID information, please perform a provider please perform a provider search for the MCO ID search for the MCO ID Number to ensure that the Number to ensure that the information you are entering information you are entering is accurate. Please enter is accurate. Please enter the alpha characters in the the alpha characters in the MCO ID as capital letters.MCO ID as capital letters.

Please make sure the Please make sure the information that you fill information that you fill out on this page out on this page matches what we have matches what we have in our systemin our system

You will choose Blue Cross and Blue You will choose Blue Cross and Blue Shield of TexasShield of Texas

If you are a solo If you are a solo practice, you can check practice, you can check this box to default as this box to default as the Submitting providerthe Submitting provider

Not UsedNot Used

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You can access the Provider Finder on the BCBSTX Web site to accYou can access the Provider Finder on the BCBSTX Web site to access NPI ess NPI numbers, or you can perform a provider search on the Search tab numbers, or you can perform a provider search on the Search tab within the within the iEXCHANGEiEXCHANGE Web application using different search criteria. MCO ID numbersWeb application using different search criteria. MCO ID numbers will no longer appear in Provider Finder. will no longer appear in Provider Finder.

Physician example: Smith, Bob T, MD 123 Main St Any City, TX 75123 . . . . . . . (972) 111-1111 Hospital Affiliations: AO Practice Information: No patients over 2 years old National Provider Identifier (NPI): 1111111111

Facility example: Medical Hospital . . . . . . . . . .(972) 111-1111 123 Main St Any City, TX 75123 National Provider Identifier (NPI): 1111111111

Provider Finder Information

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This is the listing This is the listing of Submitting of Submitting Providers that are Providers that are currently currently associated with associated with your your Administrative Administrative GroupGroup

You can Edit You can Edit a providers a providers information information by clicking by clicking EditEdit

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Make any Make any necessary necessary changeschanges

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marshall, g

Fill out the correct Fill out the correct information on this page information on this page and then save the and then save the informationinformation

Not UsedNot Used

HINT: Before filling in the HINT: Before filling in the Provider ID information, Provider ID information, please perform a provider please perform a provider search for the MCO ID search for the MCO ID Number to ensure that Number to ensure that the information you are the information you are entering is accurate. entering is accurate. Please enter the alpha Please enter the alpha characters in the MCO ID characters in the MCO ID as capital letters.as capital letters.

You must select the You must select the payer againpayer again

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Frequent providers:Frequent providers:

Set up a shortlist to be Set up a shortlist to be used in used in iEXCHANGEiEXCHANGE to to hold the providers your hold the providers your Provider Group uses Provider Group uses most oftenmost oftenCaution: Many physicians/ Caution: Many physicians/ professional providers have the professional providers have the same first and last name. Please be same first and last name. Please be sure to verify name, address & sure to verify name, address & specialty when making a selection.specialty when making a selection.

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You can You can Edit, Edit, Delete, Delete, or Add or Add providersproviders

You can You can also use also use the drop the drop down to down to narrow narrow your listing:your listing:

AllAll

AttendingAttending

FacilityFacility

ServicingServicing

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Fill in Organization Fill in Organization Name OR First and Name OR First and Last Name of the Last Name of the provider you wish to provider you wish to add and fill in the NPI add and fill in the NPI number.number.

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Select the PayerSelect the Payer

Fill in the MCO Provider Fill in the MCO Provider Code Code –– which can be which can be found by performing a found by performing a search under the Search search under the Search tab on the main screen. tab on the main screen. Please enter the alpha Please enter the alpha characters in the MCO ID characters in the MCO ID as capital lettersas capital lettersNot UsedNot Used

Select the Select the role(srole(s) for the ) for the provider by checking the provider by checking the boxesboxes

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By Selecting By Selecting ““AttendingAttending”” then only the then only the Attending Attending providers providers would be would be displayeddisplayed

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Frequent procedures:Frequent procedures:

Set up a shortlist to be Set up a shortlist to be used in used in iEXCHANGEiEXCHANGE to to hold the procedure hold the procedure codes your Provider codes your Provider Group uses most oftenGroup uses most often

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You can set You can set up a shortlist up a shortlist for the for the frequent frequent procedures procedures specific to specific to your practice your practice which will which will save you timesave you time

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Frequent diagnoses:Frequent diagnoses:

Set up a shortlist to be Set up a shortlist to be used in used in iEXCHANGEiEXCHANGE to to hold the diagnosis codes hold the diagnosis codes your Provider Group your Provider Group uses most oftenuses most often

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You can set You can set up a shortlist up a shortlist for the for the frequent frequent diagnoses diagnoses specific to specific to your practice your practice which will which will save you timesave you time

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Inpatient Certifications

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Select New Select New Inpatient Inpatient Request in Request in either place either place

Please note that Extensions cannot be completed online for Texas. You will need to contact the Medical Care Management (MCM) for assistance

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Choose Choose ““Member Member searchsearch”” to to bring up bring up search search screenscreen

Your first step Your first step is to search is to search for a Member for a Member by selecting by selecting the Member the Member Search Search ButtonButton

NPI

NPI

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Input the Input the membermember’’s ID s ID number here number here exactly as it exactly as it appears on the appears on the cardcard

Hints:Hints:

No three letter alpha No three letter alpha prefix is needed prefix is needed

FEP Member searches FEP Member searches need to include theneed to include the RR

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If there is more If there is more than one than one member under member under the ID number, the ID number, you will be you will be prompted to prompted to provide provide additional additional information information –– such as:such as:

Date of birthDate of birth

oror

First nameFirst name

123456789

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By providing By providing the date of the date of birth or first birth or first name, you name, you will narrow will narrow the searchthe search

12345678901 01 2001

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You You must must view view existing existing cases for a cases for a member member before you before you can select can select the memberthe member

D01111123456789 Your Patient

01/01/2001

iEXCHANGEiEXCHANGE will automatically default to the will automatically default to the required system formatrequired system format

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Even though Even though there may be there may be no cases, you no cases, you must follow must follow this step to this step to proceed. proceed.

Note that the Note that the ““SelectSelect”” button is now button is now available. available.


01/01/2001

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NPI

NPI

D011111123456789

The member The member ID field is now ID field is now populated.populated.

The submitting The submitting provider should be provider should be available in the available in the drop down menu*drop down menu*

*If the submitting provider is not in the drop down menu, he/she*If the submitting provider is not in the drop down menu, he/she will need to be added will need to be added through your Administrator before you can proceed through your Administrator before you can proceed

Your Provider

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NPI

NPI

D011111123456789

Your Provider

You now need You now need to choose a to choose a Facility from Facility from the drop down the drop down menu.menu.Caution: Many Caution: Many facility providers facility providers have the same name. have the same name. Please be sure to Please be sure to verify name & verify name & address when address when making a selection.making a selection. Also, if there is more Also, if there is more than one match that than one match that pulls up for the NPI, pulls up for the NPI, please be sure to please be sure to choose the correct choose the correct line.line.

If the facility is not in the drop If the facility is not in the drop down box, you will need to down box, you will need to search for one by clicking on search for one by clicking on ““Facility searchFacility search””

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This will take This will take you to the you to the provider search provider search screenscreen

This defaulted to This defaulted to Facility because Facility because you chose on you chose on previous screen to previous screen to search for a search for a FacilityFacility

This defaulted to This defaulted to Blue Cross Blue Blue Cross Blue Shield of Texas Shield of Texas because you because you chose that payer chose that payer on the main on the main screenscreen

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For A For A -- Standard Standard Search, you can Search, you can use the drop use the drop down menu to down menu to search by:search by:



NPI Number NPI Number

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For B For B -- Geographic Geographic Search, you Search, you can search can search by:by:

StateState

TownTown

CountyCounty

Zip CodeZip Code

Make sure Make sure to choose to choose TXTX

You can then choose the You can then choose the provider specialty through provider specialty through the drop down and click the drop down and click ““Submit searchSubmit search””

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Please note that the NPI Numbers are Please note that the NPI Numbers are located in the first column and you will located in the first column and you will only be able to select records that only be able to select records that have an NPI displayed.have an NPI displayed.

The MCO ID Numbers used for set up The MCO ID Numbers used for set up are located in the second column.are located in the second column.

If you are a border provider please If you are a border provider please select the line that displays the MCO select the line that displays the MCO ID number beginning with H0.ID number beginning with H0.

This will list the findings from your search This will list the findings from your search criteria. You can click on criteria. You can click on ““SelectSelect”” next to a next to a facility from the listing, or choose facility from the listing, or choose ““nextnext”” for for more facilities, or click on more facilities, or click on ““New SearchNew Search”” and change your search criteria. and change your search criteria. Caution: Many facility Caution: Many facility providers have have the same name. Please be sure to the same name. Please be sure to verify name & address when making a verify name & address when making a selection.selection. Also, please make sure if there is more Also, please make sure if there is more that one match for NPI, please be sure to that one match for NPI, please be sure to choose the correct line.choose the correct line.

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Choose Choose ““Member Member searchsearch”” to to bring up bring up search search screenscreen

D011111123456789

Your Provider Note that the Facility Note that the Facility NPI is now populatedNPI is now populated

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You now need to You now need to select/fill in the select/fill in the appropriate information appropriate information and scroll downand scroll down

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Now you need Now you need to choose a to choose a primary primary diagnosis. diagnosis.

If you donIf you don’’t know the code, you can use t know the code, you can use the drop down menu for the short listthe drop down menu for the short list

Or you can use the Diagnosis Search Or you can use the Diagnosis Search functionfunction

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You can You can search by:search by:

Description Description to codeto code

Code to Code to descriptiondescription

Choose Choose from the from the short list of short list of frequently frequently used codesused codes

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We will We will search by search by description description to code to code and then and then select select ““EncodeEncode””

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Choose the one that best fits the Choose the one that best fits the descriptiondescription

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Select Select ““YesYes”” to add to the list to add to the list –– or choose or choose ““New SearchNew Search”” to look up a different codeto look up a different code

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The diagnosis The diagnosis code you chose code you chose will now display. will now display. Click Click ““SaveSave”” to to save as the save as the primary diagnosisprimary diagnosis

Please Note: Please Note: There can only be There can only be one primary one primary diagnosis, so you diagnosis, so you will only be able to will only be able to choose one for choose one for this selection.this selection.

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You now You now need to need to select the select the length of length of stay and the stay and the Attending Attending physicianphysician

2

Or through the Or through the Provider Provider search feature search feature that was that was previously previously used. used.

This can be done This can be done through the drop through the drop down menudown menu

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You will need to select the appropriate release of information oYou will need to select the appropriate release of information option ption from the drop down menu. from the drop down menu.

For an Inpatient For an Inpatient Certification, Certification, Section 2 is Section 2 is optional. You can optional. You can now select now select ““Next Next stepstep””

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Please pay Please pay attention to any attention to any warning messageswarning messages

Your Patient

Your Patient

A recap of the information you submitted A recap of the information you submitted is shown to the leftis shown to the left

While in While in preview, you preview, you can make can make changeschanges

Then look at the case Then look at the case status and decide if status and decide if there is anything you there is anything you need to change before need to change before submitting for the submitting for the confirmation page.confirmation page.

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If you receive this message If you receive this message –– please make sure your diagnosis please make sure your diagnosis code is valid code is valid –– for diagnosis for diagnosis codes with a codes with a ““VV””, you must use an , you must use an uppercase uppercase ““VV””

If there is no link in this If there is no link in this section, then there is section, then there is no questionnaire no questionnaire requiredrequiredYour Patient

Another Example from the Preview PageAnother Example from the Preview Page

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You also want to pay attention if you get You also want to pay attention if you get a pended message. Review the a pended message. Review the information to see if there was something information to see if there was something you missed you missed –– such as in this case the such as in this case the diagnosis code needed the 4diagnosis code needed the 4rdrd & 5& 5thth

digits.digits.

Your Patient

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In this instance by correcting the In this instance by correcting the diagnosis and choosing preview diagnosis and choosing preview changeschanges

Your PatientYour Patient

Your Provider

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You can see that it would be authorizedYou can see that it would be authorized

Your Patient

Another Example from the Preview PageAnother Example from the Preview Page

Your Provider

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Now scroll Now scroll down and click down and click on submit to on submit to proceed and proceed and receive your receive your case numbercase number

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If you are If you are printing this printing this page, please page, please select printer select printer friendly friendly versionversion

This page will This page will display the display the authorization authorization number, along number, along with a recap of with a recap of the information the information you submittedyou submitted

Please capture the Please capture the Case ID for Case ID for submission on the submission on the claimclaim

Do not useDo not use



This is the confirmation page. If you stop before This is the confirmation page. If you stop before reaching this page, your request did not finalize.reaching this page, your request did not finalize.

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This is This is what will what will print out print out for your for your file.file.

Your Patient

Your Patient



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Checking Status on Inpatient

Certifications

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This is the This is the Search pageSearch page

You will be able to perform You will be able to perform Treatment searches for referrals and Treatment searches for referrals and inpatient certificationsinpatient certifications

Note to the administrator: Before Note to the administrator: Before you can use this function your you can use this function your doctors must be accepted by the doctors must be accepted by the iEXCHANGEiEXCHANGE Support desk after Support desk after completing the set up process. If completing the set up process. If you or your staff are having you or your staff are having difficulty using this function, difficulty using this function, please call 800please call 800--441441--9188, select 9188, select 1, then 3, then 2.1, then 3, then 2.

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Select to Select to search by: search by:

Treatment Treatment RangeRange

Case IDCase ID

Treatment Range:Treatment Range:

Fill in Start/End DatesFill in Start/End Dates

Choose the Search FilterChoose the Search Filter

Choose the Requesting provider Choose the Requesting provider from the drop down menufrom the drop down menu

Optional Optional -- Enter the Member ID Enter the Member ID to search for to search for precertificationsprecertifications or or referrals for a specific memberreferrals for a specific member

Case ID:Case ID:

Enter Case IDEnter Case ID

Choose the Requesting Choose the Requesting provider from the drop down provider from the drop down menumenu

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You will be able to perform Provider You will be able to perform Provider and Member searches such as the and Member searches such as the ones in the Inpatient Certification ones in the Inpatient Certification example direct from this pageexample direct from this page

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You will be able to perform You will be able to perform Treatment update searches for Treatment update searches for referrals and inpatient certifications. referrals and inpatient certifications. This is where you can look for This is where you can look for updates and comments to your updates and comments to your requestsrequests

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Updates from MCO are updates Updates from MCO are updates from the payer (BCBSTX)from the payer (BCBSTX)

Updates for PCPs are updates to Updates for PCPs are updates to the PCPs regarding their patientsthe PCPs regarding their patients

New or updated treatments include New or updated treatments include new cases that have been set up, new cases that have been set up, as well as updates on existing as well as updates on existing casescases

Your Submitting Provider List

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Inter-plan Inpatient Request

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Revised 02/24/10

Enter the 3 Enter the 3 letter alpha letter alpha prefix hereprefix here

This section is used to obtain inpatient This section is used to obtain inpatient precertificationsprecertifications for members that have an for members that have an out of state BCBS policy.* out of state BCBS policy.*

* Note: You do not need to use Inter* Note: You do not need to use Inter--plan plan for members with policies from IL, NM, and for members with policies from IL, NM, and OK, as they are Health Care Service OK, as they are Health Care Service Corporation members, and may be Corporation members, and may be obtained through the same drop down as obtained through the same drop down as the TX members.the TX members.

Pg 82Version 4.0

Revised 02/24/10

The screen will The screen will display the name display the name of the Plan that of the Plan that the alpha prefix the alpha prefix you entered you entered belongs tobelongs to

Pg 83Version 4.0

Revised 02/24/10

Please note that the member Please note that the member ID should be entered exactly ID should be entered exactly as it appears on the ID card as it appears on the ID card excluding the three letter excluding the three letter alpha prefixalpha prefix

You will then choose You will then choose the Submitting provider the Submitting provider from the drop down from the drop down –– or have the or have the Administrator add itAdministrator add it

Your next step is a Your next step is a Facility searchFacility search

Your Provider

Pg 84Version 4.0

Revised 02/24/10

For A For A -- Standard Standard Search, you can use Search, you can use the drop down menu the drop down menu to search by:to search by:



NPI Number NPI Number Caution: Many facility Caution: Many facility providers have the same providers have the same name. Please be sure to name. Please be sure to verify name & address when verify name & address when making a selection.making a selection.

Pg 85Version 4.0

Revised 02/24/10


StateState

TownTown

CountyCounty

Zip CodeZip Code


Make sure Make sure to choose to choose TXTX

Pg 86Version 4.0

Revised 02/24/10

Select the facility you Select the facility you wantwantCaution: Many facility providers Caution: Many facility providers have the same name. Please be have the same name. Please be sure to verify name & address sure to verify name & address when making a selection.when making a selection.

Also, please make sure Also, please make sure if there is more that one if there is more that one match for NPI, please match for NPI, please be sure to choose the be sure to choose the correct line.correct line.

Pg 87Version 4.0

Revised 02/24/10

The The information will information will now be now be populatedpopulated

Now you need to fill Now you need to fill in the rest of the in the rest of the information and information and then scroll down then scroll down and click on and click on ContinueContinue

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Pg 88Version 4.0

Revised 02/24/10

This is the This is the screen you screen you will see, will see, which will which will confirm that confirm that the request the request was sentwas sent

And will And will give you a give you a tracking ID tracking ID numbernumber

Please note: This is not your Please note: This is not your preauthorization/precertification number. Your preauthorization/precertification number. Your case has not been approved yet. Please use the case has not been approved yet. Please use the search feature to check for updates from the search feature to check for updates from the other plan.other plan.

Pg 89Version 4.0

Revised 02/24/10

Inter-plan Request Status

Pg 90Version 4.0

Revised 02/24/10

To check To check status, you status, you would go to the would go to the Search menu Search menu and choose and choose InterInter--plan plan Request StatusRequest Status

Pg 91Version 4.0

Revised 02/24/10

You can You can choose the choose the correct correct submitting submitting provider from provider from the drop downthe drop down

An then An then choose the choose the submission submission day spanday span

Pg 92Version 4.0

Revised 02/24/10

You will see InterYou will see Inter--plan plan requests for that provider and requests for that provider and can match based on the can match based on the Tracking ID numberTracking ID number

Pg 93Version 4.0

Revised 02/24/10

Referrals Online

Pg 94Version 4.0

Revised 02/24/10

New New Referral Referral RequestRequest

Click on Click on pop up: pop up: ““Referral Referral TemplateTemplate””

Please note that Extensions cannot be completed online for Texas. You will need to complete a new referral

Pg 95Version 4.0

Revised 02/24/10

Click on Click on ““Member Member searchsearch”” to search to search for a memberfor a member

Pg 96Version 4.0

Revised 02/24/10

Input the Input the membermember’’s ID s ID number here number here exactly as it exactly as it appears on the appears on the cardcard

Hints:Hints:

No three letter alpha No three letter alpha prefix is needed prefix is needed

FEP Member searches FEP Member searches need to include theneed to include the RR

Pg 97Version 4.0

Revised 02/24/10

If there is more If there is more than one than one member under member under the ID number, the ID number, you will be you will be prompted to prompted to provide provide additional additional information information –– such as:such as:

Date of birthDate of birth

oror

First nameFirst name

123456789

Pg 98Version 4.0

Revised 02/24/10

You You must must view view existing existing cases for a cases for a member member before you before you can select can select the memberthe member


01/01/2001

iEXCHANGEiEXCHANGE will automatically default to the will automatically default to the required system formatrequired system format

Pg 99Version 4.0

Revised 02/24/10

Even though Even though there may be there may be no cases, you no cases, you must follow must follow this step to this step to proceed. proceed.

Note that the Note that the ““SelectSelect”” button is now button is now available. available.


01/01/2001

Pg 100Version 4.0

Revised 02/24/10

The member The member ID field is now ID field is now populated.populated.

D011111123456789

The submitting The submitting provider should provider should be available in be available in the drop down the drop down menu. If the menu. If the submitting submitting provider is not in provider is not in the menu, he/she the menu, he/she will need to be will need to be added by your added by your administratoradministrator

Your Provider

Pg 101Version 4.0

Revised 02/24/10

D011111123456789

Your Provider

If the Servicing provider is not in the drop down box, you will If the Servicing provider is not in the drop down box, you will need to need to search for one by clicking on search for one by clicking on ““Provider searchProvider search””

Pg 102Version 4.0

Revised 02/24/10

This defaulted to This defaulted to Practitioner Practitioner because you because you chose on previous chose on previous screen to search screen to search for a Servicing for a Servicing ProviderProvider

This is the This is the provider search provider search screen.screen.Caution: Many Caution: Many physicians/professional physicians/professional providers have the same providers have the same first and last name. first and last name. Please be sure to verify Please be sure to verify name, address & name, address & specialty when making a specialty when making a selection.selection.

Pg 103Version 4.0

Revised 02/24/10

For A For A -- Standard Standard Search, you can Search, you can search by:search by:



NPI Number NPI Number Caution: Many Caution: Many physicians/professional physicians/professional providers have the same providers have the same first and last name. first and last name. Please be sure to verify Please be sure to verify name, address & name, address & specialty when making a specialty when making a selection.selection.

Pg 104Version 4.0

Revised 02/24/10


StateState

TownTown

CountyCounty

Zip CodeZip Code


Pg 105Version 4.0

Revised 02/24/10

This will list the findings from your search This will list the findings from your search criteria. You can click on criteria. You can click on ““SelectSelect”” next to a next to a provider from the listing, or choose provider from the listing, or choose ““nextnext”” for for more providers, or click on more providers, or click on ““New SearchNew Search”” and and change your search criteria.change your search criteria.Caution: Many physicians/ professional providers have the Caution: Many physicians/ professional providers have the same first and last name. Please be sure to verify name, same first and last name. Please be sure to verify name, address & specialty when making a selection.address & specialty when making a selection.

Also, please make sure if there is more that Also, please make sure if there is more that one match for NPI, please be sure to choose one match for NPI, please be sure to choose the correct line.the correct line.

Please note that the NPI Numbers are located Please note that the NPI Numbers are located in the first column and you will only be able to in the first column and you will only be able to select records that have an NPI displayed. select records that have an NPI displayed.

The MCO ID Numbers are located in the The MCO ID Numbers are located in the second column.second column.

If you are a border provider please select the If you are a border provider please select the line that displays the MCO ID number line that displays the MCO ID number beginning with H0.beginning with H0.

Pg 106Version 4.0

Revised 02/24/10

D011111123456789

Your Provider

Note that the Note that the Servicing Servicing provider is provider is now listednow listed

Now you need to choose a primary Now you need to choose a primary diagnosis. If you dondiagnosis. If you don’’t know the t know the code, you can search for it.code, you can search for it.

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Pg 107Version 4.0

Revised 02/24/10

You can You can search by:search by:

Description Description to codeto code

Code to Code to descriptiondescription

Choose Choose from the from the short list of short list of frequently frequently used codesused codes

Pg 108Version 4.0

Revised 02/24/10

We will We will search by search by code to code to description description and then and then select select ““EncodeEncode””

Pg 109Version 4.0

Revised 02/24/10

The result will The result will display the display the diagnosis code diagnosis code –– note that the note that the encoder encoder changed the changed the ““v70.0v70.0”” to to ““V70.0V70.0””

If you select If you select ““yesyes”” to add to add to list, it will bring over the to list, it will bring over the correct formatcorrect format

Pg 110Version 4.0

Revised 02/24/10

The diagnosis The diagnosis code you chose code you chose will now display. will now display. Click Click ““SaveSave”” to to save as the save as the primary diagnosisprimary diagnosis

Please Note: Please Note: There can only There can only be one primary be one primary diagnosis, so you diagnosis, so you will only be able will only be able to choose one for to choose one for this selection.this selection.

Pg 111Version 4.0

Revised 02/24/10

D011111123456789

Your Provider

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You will now need to You will now need to select the appropriate select the appropriate Release of Release of Information from the Information from the drop down menudrop down menu

V70.0

Pg 112Version 4.0

Revised 02/24/10

D011111123456789

Your Provider

1122334455

V70.0

The procedure code The procedure code defaults to an office visit.defaults to an office visit.

Select the number of Select the number of units/visits and Start and units/visits and Start and End dates and click End dates and click ““Next Next stepstep””

24

Pg 113Version 4.0

Revised 02/24/10

If you receive this message, your referral will be If you receive this message, your referral will be pended. You must click on Submit to get the case pended. You must click on Submit to get the case number. You can then check status through the Search number. You can then check status through the Search feature or you may contact someone from Medical Care feature or you may contact someone from Medical Care Management @ 800Management @ 800--441441--9188 Option 1, then 3, then 3, 9188 Option 1, then 3, then 3, then 2.then 2.

If there is no link in this If there is no link in this section, then there is section, then there is no questionnaire no questionnaire requiredrequired

Your Patient

Your Patient

While in While in preview, you preview, you can make can make changeschanges

Pg 114Version 4.0

Revised 02/24/10

You can You can make any make any changes changes that are that are needed and needed and then then preview the preview the changeschanges

Click on Click on Submit to Submit to complete the complete the referral and referral and receive your receive your case numbercase number

Your Patient

Your provider

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24

Pg 115Version 4.0

Revised 02/24/10

You can then You can then print it by print it by clicking on clicking on the Print the Print Friendly Friendly VersionVersion

Capture the Case ID for Capture the Case ID for submission on the claimsubmission on the claim

Do not useDo not use

Your patientYour patient

Pg 116Version 4.0

Revised 02/24/10

This is what This is what will print out will print out for your file. for your file.

Please note Please note that this that this case is case is pended.pended.

It has not It has not been been authorized.authorized.



Pg 117Version 4.0

Revised 02/24/10

Checking Status on Referral Requests

Pg 118Version 4.0

Revised 02/24/10


You will be able to perform You will be able to perform Treatment searches for referrals and Treatment searches for referrals and inpatient certificationsinpatient certifications

Note to the administrator: Note to the administrator: Before you can use this Before you can use this function your doctors must function your doctors must be accepted by the be accepted by the iEXCHANGEiEXCHANGE Support Support desk. If you are having desk. If you are having difficulty using this difficulty using this function, please call 800function, please call 800-- 441441--9188, select 1, then 3, 9188, select 1, then 3, then 2.then 2.

Pg 119Version 4.0

Revised 02/24/10

Select to Select to search by: search by:

Treatment Treatment RangeRange

Case IDCase ID

Treatment Range:Treatment Range:

Fill in Start/End DatesFill in Start/End Dates

Choose the Search FilterChoose the Search Filter

Choose the Requesting provider Choose the Requesting provider from the drop down menufrom the drop down menu

Optional Optional -- Enter the Member ID Enter the Member ID to search for to search for precertificationsprecertifications or or referrals for a specific memberreferrals for a specific member

Case ID:Case ID:

Enter Case IDEnter Case ID

Choose the Requesting Choose the Requesting provider from the drop down provider from the drop down menumenuCaution: Many physicians/professional Caution: Many physicians/professional providers have the same first and last name. providers have the same first and last name. Please be sure to verify name, address & Please be sure to verify name, address & specialty when making a selection.specialty when making a selection.

Pg 120Version 4.0

Revised 02/24/10


You will be able to perform Provider You will be able to perform Provider and Member searches such as the and Member searches such as the ones in the Inpatient certification ones in the Inpatient certification example direct from this pageexample direct from this page

Pg 121Version 4.0

Revised 02/24/10


You will be able to perform You will be able to perform Treatment update searches for Treatment update searches for referrals and inpatient certifications. referrals and inpatient certifications. This is where you can look for This is where you can look for updates and comments to your updates and comments to your requestsrequests

Pg 122Version 4.0

Revised 02/24/10

Updates from MCO are updates Updates from MCO are updates from the payer (BCBSTX)from the payer (BCBSTX)

Updates for PCPs are updates to Updates for PCPs are updates to the PCPs regarding their patientsthe PCPs regarding their patients

New or updated treatments include New or updated treatments include new cases that have been set up, new cases that have been set up, as well as updates on existing as well as updates on existing casescases

Your Submitting Provider List

Pg 123Version 4.0

Revised 02/24/10

Inter-plan Referral Request

Pg 124Version 4.0

Revised 02/24/10

Click in either spot to Click in either spot to select an Interselect an Inter--plan plan Referral RequestReferral Request

This section is used to obtain referrals for This section is used to obtain referrals for members that have an out of state BCBS members that have an out of state BCBS policy.* policy.*

* Note: You do not need to use Inter* Note: You do not need to use Inter--plan for members with policies from plan for members with policies from IL, NM, and OK, as they are Health Care Service Corporation membIL, NM, and OK, as they are Health Care Service Corporation members, ers, and may be obtained through the same drop down as the TX membersand may be obtained through the same drop down as the TX members..

Pg 125Version 4.0

Revised 02/24/10

Alpha prefixes will consist Alpha prefixes will consist of the first three letters of the first three letters preceding the memberpreceding the member’’s s ID numberID number

Enter the memberEnter the member’’s s alpha prefix herealpha prefix here

Pg 126Version 4.0

Revised 02/24/10

The health plan name The health plan name will be displayedwill be displayed

Pg 127Version 4.0

Revised 02/24/10

Fill in the Member Fill in the Member informationinformation

An example would be:An example would be:

Submitting provider information Submitting provider information should be in drop down or will should be in drop down or will need to be addedneed to be added

Information Information on serviceson services

Diagnosis Diagnosis search or drop search or drop down boxdown box

Pg 128Version 4.0

Revised 02/24/10

You can key You can key in your in your procedure procedure code, use code, use the short the short list, or use list, or use the the Procedure Procedure searchsearch

Next you will need to Next you will need to perform a provider perform a provider search for the search for the servicing providerservicing provider

Pg 129Version 4.0

Revised 02/24/10

This defaulted to This defaulted to Practitioner Practitioner because you because you chose on previous chose on previous screen to search screen to search for a Servicing for a Servicing ProviderProvider

This is the This is the provider search provider search screenscreen

For A For A -- Standard Standard Search, you can Search, you can search by:search by:



NPI Number NPI Number

Pg 130Version 4.0

Revised 02/24/10


StateState

TownTown

CountyCounty

Zip CodeZip Code


Pg 131Version 4.0

Revised 02/24/10

This will list the findings from your This will list the findings from your search criteria. You can click on search criteria. You can click on ““SelectSelect”” next to a provider from the next to a provider from the listing, or choose listing, or choose ““nextnext”” for more for more providers, or click on providers, or click on ““New SearchNew Search”” and and change your search criteria.change your search criteria.Caution: Many physicians/ professional providers Caution: Many physicians/ professional providers have the same first and last name. Please be sure to have the same first and last name. Please be sure to verify name, address & specialty when making a verify name, address & specialty when making a selection.selection.

Also, please make sure if there is more Also, please make sure if there is more that one match for NPI, please be sure that one match for NPI, please be sure to choose the correct line.to choose the correct line.

Please note that the NPI Numbers are Please note that the NPI Numbers are located in the first column and you will located in the first column and you will only be able to select records that have only be able to select records that have an NPI displayedan NPI displayed

The MCO ID Numbers are located in The MCO ID Numbers are located in the second column.the second column.

If you are a border provider please If you are a border provider please select the line that displays the MCO ID select the line that displays the MCO ID number beginning with H0.number beginning with H0.

Pg 132Version 4.0

Revised 02/24/10

The servicing provider The servicing provider will now be listedwill now be listed

You will need to choose the You will need to choose the number of units as well as number of units as well as start and end datesstart and end dates

1122334455

Pg 133Version 4.0

Revised 02/24/10

Service 2 Service 2 & 3 are & 3 are optionaloptional

Pg 134Version 4.0

Revised 02/24/10

You will now You will now receive a receive a confirmation that confirmation that the request was the request was submitted to the submitted to the other health planother health plan

You will also You will also receive a receive a tracking number tracking number which can be which can be used to track the used to track the status of the status of the requestrequest

Please note: This is not your referral Please note: This is not your referral number. Your case has not been number. Your case has not been approved yet. Please use the search approved yet. Please use the search feature to check for updates from the feature to check for updates from the other plan.other plan.

Pg 135Version 4.0

Revised 02/24/10

Inter-plan Request Status

Pg 136Version 4.0

Revised 02/24/10

Choose InterChoose Inter-- plan status plan status request from request from the drop the drop down menudown menu

Pg 137Version 4.0

Revised 02/24/10

You can selectYou can select the submitting the submitting provider from provider from the drop down the drop down menumenu

The InterThe Inter--plan plan requests for requests for that provider that provider will then be will then be displayeddisplayed

Pg 138Version 4.0

Revised 02/24/10

Questions

iEXCHANGE Support Desk 800-441-9188

Options 1, then 3, then 2.

iexchange inpatient certifications and referral requests · iexchange ®’ inpatient c...

Documents