Qualitrac Guide...b) Enter provider and facility information.Treating facility is required (when...

Qualitrac Guide: Submitting 3808 and 3871b Reviews Using Telligen’s Provider Portal

Qualitrac Guide: Telligen’s Provider Portal |

© 2016 Telligen, Inc.

Table of Contents Section 1: Provider Portal 3

1) Starting a New Request 3

2) Acute Hospital and Adult Chronic Hospital Review Process 3

3) Submitting a Prior Authorization Review 4

4) Submitting a Concurrent Review 5

5) Retrospective Review Submission 5

6) Nursing Facility Request Process 7

7) Home or Community Based Review Process 10

8) Special Pediatric Hospital Review Process 11

Section 2: Security Administrator Instructions 12

1) Adding a New User 12

2) Modifying User Information 13

3) Resetting the Password 14

4) Deactivating a User 14



Section 1: Provider Portal Welcome to Telligen’s provider portal where providers can quickly and efficiently submit Medicaid review requests. Portal usage offers providers the following benefits:

Secure means for submitting data

Paperless submission — no mailing or faxing

Quick turnaround times

Email notifications on case status and outcomes

Mobile and tablet-friendly interface

Getting Started Go to http://telligenmd.qualitrac.com and click login (upper right corner) to reach the sign-on page.

1) Starting a New Request a) Select the add authorization button and specify the request type:

• Acute Hospital Review — 3808 reviews for acute hospital or acute rehab hospital — includes prior authorizations and concurrent and retrospective reviews.

• Adult Chronic Hospital —Post-acute services for adult patients requiring extensive medical, nursing and rehab services.

• Home or Community-Based — Waiver-based adult requests including PACE, MADC and model waiver.

• Nursing Facility — Patients requiring skilled nursing and/or rehab services.

• Special Pediatric Hospital — Recipients 19 years of age or younger requiring care in a specialized post-acute setting.

2) Acute Hospital and Adult Chronic Hospital Review Process a) Enter member’s Medicaid ID and date of birth *Must be exact match in

order to proceed

http://telligen.medicalauth.com/



b) Enter provider and facility information. Treating facility is required (when

entering the treating facility, search the facility MA number to ensure selection of the correct facility).

c) Enter service request information

• The following information can be entered (required fields are marked with a red asterisk): ‒ Admission Type*

‒ Level of Care*

‒ Authorization Type*

‒ Principal Diagnosis*

‒ Secondary Diagnosis (Maximum of three, if applicable)

‒ Procedures (Maximum of three, if applicable)

‒ Admit Date*

‒ Discharge Date* (For Concurrent and Retrospective Reviews only)

‒ Discharge Status* (For Retrospective Reviews only)

‒ DRG (For Retrospective Reviews only)

3) Submitting a Prior Authorization Review (required for all elective admissions)

a) The system will recognize the submission as a prior authorization by the date entered in the admit date field (date entered should be a future date).

b) After a future date is entered, the discharge date, discharge status, and DRG fields will not be available to be filled in (see example at right).



4) Submitting a Concurrent Review (required for all elective and emergency admissions and when an acute care facility requests additional days for a patient stay)

a) The system will recognize the submission as concurrent by the dates entered in the admit date and discharge date fields.

• The admit date should be a current or past date.

• The discharge date should be the expected future date of discharge. to indicate number of days you’re requesting for the stay.

b) Discharge status and DRG fields will not be available to fill (see example below). • Should have the same admission date as previously submitted prior

authorization or concurrent review (if used for emergent admission) ‒ Discharge date should be entered as the new expected discharge

date, extending the stay to include the additional days being asked for.

5) Retrospective Review Submission (required for all elective and emergency admissions).

a) The system will recognize the submission as retrospective by the dates entered in the admit date and discharge date fields.

• For a retrospective review, the admit date and discharge date entered should be past dates.

Emergency Submissions

If the emergency admission occurs on a weekend, the concurrent review must be submitted by end of day on the first business day following the weekend.

(e.g., submission deadline for a patient admitted Friday at 6:00 p.m. is end of

day the following Monday).



• Discharge status and DRG fields will be available to be filled in as in the example below.

b) Attach Supporting Documentation

• Upload any supporting clinical documentation pertaining to the authorization type requested. ‒ The medical record must be uploaded with each request.

‒ Multiple files can be attached; size limitation of 300 MB per file.

• For specific request types, this screen may contain reminders to attach required forms or documentation.

c) Review, Attest and Submit



• Review request details and enter username attestation to the information submitted.

6) Nursing Facility Request Process a) Enter member’s Medicaid ID and date of birth *must be exact match in order

to proceed

• If the patient does not have a Medicaid ID, select Or click here if the member does not have a Medicaid ID to create a temporary ID (a).

b) Fill out fields under enter new member information (b) (all required fields are marked with a red asterisk).

a

b



c) Fill out fields on the member information screen (a).

• If yes is selected for the second question referencing a personal representative, fill out the personal representative information screen (b).

d) Enter request and diagnosis information.

e) Answer each question in the medical eligibility questionnaire.

b a



f) Upload supporting documentation. • Upload supporting clinical documentation pertaining to the authorization

type (screen may contain reminders to attach required forms or documentation for specific requests). ‒ The medical record must be uploaded with each request.

‒ Multiple files can be attached; size limitation is 300 MB per file.

g) Click upload documents (a) and the attach clinical documentation box appears (b).

• Click choose files (c) to find and select the necessary documentation and start upload (d) to upload documentation to the system.

• Following upload, click close (e) to move to the next screen.

a

c

d

e

b



h) Review, attest and submit • Review request details and enter username attestation for submitted

information.

7) Home or Community Based Review Process

a) Select the service type associated with the review request

b) If model waiver is selected, a ventilator dependent question will open on the screen.

• If answer to ventilator dependent question is yes, follow steps d - i as detailed in the long-term care review process.

• If answer to ventilator dependent question is no, follow steps h - i as detailed in the long-term care review process.



8) Special Pediatric Hospital Review Process a) Provide answer to a ventilator dependent question

• If answer to ventilator dependent question is yes, follow steps d - i as detailed in the long-term care review process.

• If answer to ventilator dependent question is no, follow steps h - i as detailed in the long-term care review process.

Portal Tips

1) Email Notifications

• Following submission of a completed request, users will receive email notification referencing the case ID, and a direct link to view the status of the case.

• Once Telligen completes the review portion, a follow-up email will provide the outcome of the review and a link to view the case and documentation generated with the review.

2) System Recommendations

• To enhance the user experience, the most recent versions of the following browsers are recommended: Google Chrome, Mozilla Firefox or Apple Safari.

3) Additional Features

• Attach supporting documentation to an existing case, including any additional supporting documentation requested by Telligen.

• Submit a reconsideration request for providers requesting a re-review of cases denied or partially approved.

4) Usage Questions

• Email: [email protected]

• Toll-Free Number: 1-888-276-7075



Section 2: Security Administrator Instructions

1) Adding a New User a) Go to the user management tab (a) and select add user at the bottom of the

page (b)

b) Complete all required user information on the add user page (required fields are marked indicated with red asterisks).

• At the bottom of the page, check the provider group or facility the user is associated with (options provided will be consistent with provider groups or facilities the security administrator has access to).

• Inputting the user’s information, select the provider or facility group and click save.

a

b



2) Modifying User Information a) From the user management tab:

• Search for the user you wish to update and click their username (this will navigate you to the details page for the user).

• Click edit on the upper right hand side (a) and the edit screen will display (b).

• After completing edits, select save to upload changes (c).

a

b

c



3) Resetting the Password a) Click the user management tab, search for the user you wish to update and

click their username (this will navigate you to the details page for the user).

b) On the upper right hand side, click the reset password option. c) When prompted to continue, click yes.

4) Deactivating a User a) Click the user management tab, search for the user you wish to update and

select their username (this will navigate you to the details page for the user).

b) Select deactivate on the upper right hand side.



c) When prompted to continue, click yes.

• Once deactivated, the user’s association to your facility or provider group has been removed. ‒ To reactivate a user, contact the help desk at 1-888-276-7075.

Qualitrac Guide...b) Enter provider and facility information.Treating facility is required (when...

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