The preauthorization request and emergent inpatient admission notices (request/notice) features on our provider portal just got easier to use.
Here are the key changes you will start to see Sept. 16, 2024:
- The ability to save a draft request/notice for up to 96 hours. This will allow time to collect the clinical information or hand off the case to someone else with the clinical expertise to address the MCG/Clinical Criteria and provide supporting documentation.
- The Submit Request button will not activate until expected clinical information is addressed and documents are attached.
- The number labeled “Authorization” on the MCG screen is the “Draft Number” or “Reference ID” and is not considered an approval of the preauthorization or initial concurrent review.
- You will see the addition of a new Take action box on the home page and an item in the Preauthorization menu that will take you to a list of unsubmitted draft requests/notices.
- The duplicative screen for uploading documents has been removed. All documents will need to be attached using the MCG screen that collects clinical information.
- The identified Contact will be sent email reminders before a draft expires and again if it expires.
What These Changes Mean to You
All providers associated with the request/notice will be able to see a list of incomplete drafts that they can open and complete. This means that more than one person can contribute to the request/notice. For example:
- The primary care provider who sends their patient to a specialist for a procedure may start the preauthorization request, and the specialist who is selected will be able to address the clinical criteria and attach supporting documentation.
- The emergency room staff can start the notice and the clinical staff treating the admitted member can finish it once the actual diagnosis is determined and clinical information for a concurrent review is available.
Note: If the initial diagnosis is different from the actual diagnosis, we recommend that you enter a new notice so the portal asks you for the applicable clinical criteria.
The person who initiates a request/notice will be sent email reminders before a draft expires and again once a draft expires.
