Emdeon Referral Tutorial. May 28, 2014

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Emdeon Referral Tutorial

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Confidential and Proprietary. Not for reproduction or distribution.

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Healthfirst Leaf Plan members will require referrals from their PCPs to

visit a Leaf Plan participating specialist.

Referrals are not required for the following care:

• Primary Care

• Emergency Services

• OB/GYN Visits

• Urgent Care

• Outpatient Mental Health and Substance Abuse

Healthfirst has partnered with Emdeon to coordinate referral requests

for our Leaf Plan members. Leaf Plan providers can access Emdeon

through the Healthfirst secure Provider Portal.

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As a Healthfirst Leaf Plan provider, you may access the Emdeon

Referral Request System one of three ways:

1. On the HF Provider Portal homepage, click on the Authorizations/Referrals link under the Tools section on the right side of the page.

After clicking on the hyperlink, you will be directed to a tab where you can Create a

New Referral and be directed to the Emdeon log in page.

If you are a Specialist, you may also Search for a referral by typing in the Referral/Trace number or by entering in the member’s information.

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2. On the HF Provider Portal homepage, scroll over the header link Provider Inquiries and select Referrals from the drop down menu.

You will then be directed to the landing page below announcing the partnership between Healthfirst and Emdeon to handle Referral requests. Click on the link indicated below to be re-directed to the Emdeon website for your Referral inquiry.

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3. Type in the following URL in the address line of your browser: • https://office.emdeon.com/vendorfiles/healthfirst.html

• This will give you direct access to the Emdeon Login page.

Access to Emdeon

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At the Log In Screen:

1. Enter your User ID and

Password.

2. Click Log In.

3. You will be directed to the

Home Page.

4. If you do not yet have a User ID, click on Enroll New

User and complete the Pre-Registration process.

Getting Started

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Password & Recovery

• To recover or reset your password, click on “I Forgot My Password”

• Answer the two security questions, enter your Tax ID and Zip Code

in the appropriate fields, and click Submit.

• If you select the a pop-up will appear with the Emdeon Support

phone number to call for assistance.

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Submitting Referrals for

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Overview

The New Service Review provides a way to refer patients online.

The New Service Review form is used to send all the pertinent patient

and service information to the payer in the form of a referral request.

Benefits

• Electronic referral requests

• Eliminate time-consuming paper and phone-based processes

• Comply with Managed Care requirements

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Submit a New Referral

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Gather your Healthfirst identification information:

• Patient’s Healthfirst Leaf Plan Member ID number • Your Healthfirst Provider ID number

• The Healthfirst Provider ID number of the specialist you are referring the member to.

1. Select Service Review > New Review from the main menu at the top of the homepage screen.

2. Select a Plan should already be populated with Healthfirst New York however if it is not please select it.

3. The type of service review should already be populated, however if it is not, please select New Specialty Care Review

4. Enter Subscriber ID and Provider information of your new review: • Enter the Healthfirst Leaf Plan Subscriber ID

• Under Requesting Provider the Payer Assigned ID should already be populated; Enter your active Healthfirst Provider ID

• Under Service Provider, please select Payer Assigned ID and enter the specialist Healthfirst Provider ID.

Submit a New Referral

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5. If you need to verify/confirm the Healthfirst Provider ID for the specialist you are referring to, please click on the Provider Directory link on the upper right hand side of the screen.

• Alternatively, you can also access the Healthfirst online provider directory through hfdocfinder.org

6. Select a Service Type. This field will default to Physician Visit – Office: Sick, however it can be changed as appropriate.

7. Enter in the number of Visits. Please note that the maximum number of visits is 6 visits in a 6 month period.

8. The Start Date and End Date will already be populated with a 180 day period. 9. Enter Diagnosis Code. Clicking Edit will allow you to search for diagnosis

codes using key words or code values.

10. Click Send to Payer to submit the new service review.

Next a response appears.

Submit a New Referral

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Make a note of the Emdeon trace number. Healthfirst will want you to use this when checking the status of your service review.

11.An Approved referral will list “Certified in Total”

12. Click on Save Response to Batch. You can save the referral you just

requested by clicking on save. It will save to a default folder that you will be able to view.

13. You may print the approved referral by clicking the Print icon in the top right corner of the screen.

Submit a New Referral

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Emdeon Batch Manager

for Referrals

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Overview

All referral transactions submitted and saved under the “Default” batch name by your practice can be accessed through the Batch Manager function.

1. Select Batch Manager from the main menu.

2. The Manage Batches screen appears.

Emdeon Batch Manager

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3. Select the batch you wish to view by clicking on “Default”. Details from the selected batch will display in the Batch Inquiry screen, as shown below.

Emdeon Batch Manager

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Clicking on any column header on the Batch Inquiry screen will cause

the batch list table to be resorted based on the selected column.

• A yellow triangle is displayed in the column header to indicate which

field is the current sort criterion.

• An upwards pointing triangle means the search is in ascending or

alphabetical order.

• Clicking on a column which is already being used as the sort criteria

will cause the sort order to reverse and the triangle to turn upside

down.

• To search for a specific referral, you may enter the Subscriber ID in

the search filed.

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Search Within a List Referrals

To search within a batch, select the batch by clicking on it.

• When the Batch Inquiry screen displays, enter the data in the

Search Text field to narrow down the number of referral

transactions.

• After clicking the Search button, only those transactions that match

the data in the Search Text field will display as shown in the image

below.

• You can search the “Default” batch for member specific referrals by

using a Healthfirst Member ID in the Search Text field.

• This will produce the a list of referral transactions submitted for that

specific Healthfirst Leaf Plan member

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Search Within a List Referrals

The Clear button (next to the Search button) can be used to remove

the search filter and show all referral requests in the batch. Clicking the

Search button also clears the search filter if no value is entered in the

Search Text field.

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Don’t Forget!

• Check Leaf Plan Member Eligibility on the Healthfirst Provider Portal

• Confirm Leaf Plan member is assigned to your panel

• Check Provider Leaf Plan Participation Status to ensure the

specialist provider you are referring to is an in-network provider on

www.hfdocfinder.org

• Confirm the Healthfirst Provider ID for the provider you will be

referring the Leaf Plan member to. You will need this provider ID

number to finalize the Emdeon referral transaction.

*Please note: There is no out-of-network coverage for Leaf Plan

members with the exception of emergency care.

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