HealthCare Provider Portal Prior Authorization Process: AFMC Radio ButtonTabitha Kinggard,RNAFMC Outreach Services

Topics to Discuss

–New AFMC PA process on the Healthcare Portal–Top denials for AFMC prior authorizations–Contact information

Prior Authorization Requests

–As of May 1, 2019, all PA requests are to be submitted via the AR Medicaid Healthcare Provider Portal.–Providers will continue using the appropriate PA Process Type listed on the Create

Authorization page on the Care Management tab of the portal.–As a provider, you must register to use the Healthcare Provider Portal if you do not

currently have access. –Providers who use clerical staff to submit PAs on their behalf must register their staff as

delegates. View job aids to assist with provider registration and delegate registration.

Submitting Prior Authorization Requests

–Most efficient: submit directly into the Healthcare Provider Portal

–Advantages of submitting requests through the portal:o Once PA approval is issued, provider can bill immediately

o The portal is available 24/7

o A specific tracking number is provided at the time of submission request

o More secure and efficient than fax or mail

o Attaching electronic records via the portal reduces security risks

o More efficient process than calling for inpatient hospital stays (MUMP)

o Provider can review PA request before submitting, reducing data entry errors

o Allows request to be processed expeditiously

o Allows provider to check status of submitted PA request

o Provider can download and view attached letter pertaining to the review

– PA through portal allocated directly to AFMC based on process type; viewable by AFMC same day submitted

Submitting Prior Authorization Requests

–Select AFMC radio button, then select correct process type to ensure that PA request flows to AFMC rather than DMS–Upload and attach all pertinent information to the request–Submit daily summary of MUMP days, not the full medical record–For DME requests, submit form DMS-679A with supporting documentation–For personal care requests, submit DMS-618 form with pertinent information–Provider can download and view attached letter pertaining to review

Things to Remember

–File size limitation – 5 MB files o Potential changes coming to file size limitations within next few monthso If file size larger than 5 MB, contact AFMC at 479-649-8501 for assistance with submission via secure

email

–Submit only pertinent/select informationo Provider can upload additional information if request is denied and request reconsideration through

Healthcare portal

–Letters are produced and mailed by DXC o AFMC is not able to produce or mail letters

–Provider can view current status of PA by using the associated tracking number –Provider can view letters under file exchange for further rationale

Top Submission Errors

–Incorrect radio button selected –Medical radio button is selected most often rather than AFMC radio button –All PA requests submitted under Medical flow to DMS – AFMC unable to see or reviewo Provider will need to re-submit request if incorrect radio button is selectedo AFMC works with DMS to have the original case voided in order to eliminate duplicate requestso Requests received and reviewed for incorrect process type will be denied o Provider can submit new PA request with correct process type

Incorrect process type selected – not all process types flow to AFMC for review

Note: These process types are processed by AFMC

– 122 – Anesthesia

– 123 – Assistant surgeon

– 132 – Hyperalimentation

– 128 – Hyperbaric oxygen therapy

– 121 – Inpatient services

– 124 – Lab and radiology

– 125 – Lab molecular pathology

– 131 – Orthotics and prosthetics

– 120 – Personal care – under age 21

– 133 – Physician administered drugs

– 126 – Professional services

– 130 – Targeted case management

– 129 – Ventilators and equipment

– 113 – Viscosupplementation

Top Submission Errors

Top Submission Errors

–No medical documentation attachedo Provider can submit reconsideration and attach missing informationo AFMC will perform review of the submitted information

–Missing information or selection of the incorrect radio button and/or process type

Care Management

Create Authorization Link

Prior Authorization Process Types Using the AFMC Radio Button

View Status of Authorizations

View Status of Authorizations

View Status of Authorizations

Expedited Reconsideration

Prior Authorization Letter – Files Exchange

Prior Authorization Denials

PRIOR AUTHORIZATION/PRE-CERTIFICATION REQUIRED - 735

CLAIM REVENUE DOES NOT MATCH PA REVENUE - 311CLAIM DOS DOES NOT MATCH PA DATE OF SERVICE - 203

– Reminder: Provider ID must be the same as requesting provider ID– Remember to log in with the same provider ID that you used when you requested PA

Contact Information

–AFMC Review Team – 479-649-8501 or 877-650-2362–MMIS Provider Representative – www.afmc.org/mmis or 501-906-7566

Questions