WIXLIB

BCBSNM – iEXCHANGEReference GuideFebruary 2011A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue Shield Association.

Table of ContentsSectionTopicPageiEXCHANGEOverviewiEXCHANGE IntroductioniEXCHANGE LoginHELP and PREFERENCESiEXCHANGE Provider Administration3101215New InpatientRequestsInpatient RequestEditing Cases4768TreatmentUpdatesTreatment Update Search71Inter-planRequestsInpatient RequestInpatient Request Status7988Extensions andCommentsExtensions & Comments92TreatmentSearchTreatment Search106Patient ClinicalSummaryPatient Clinical Summary1142

What is iEXCHANGE?iEXCHANGE allows providers to perform healthcare transactionswith health plans using the Internet Supports 4 tiers of health care request processing: Submission Transaction editing Pre-processing business rules (eligibility verification, providernetwork status, etc.) Final determination (approval, pend status) Receive auto-approvals based on clinical and businessrules3

Key Features Real-time approval for initial requests and extensions Immediate posting to BCBS work queues for exception cases Authorization status inquiries Designed for multi-payer access4

Key FeaturesDelegated security model Allows iEXCHANGE hospital system administrator to create andmaintain user IDs for the groupSystem administrators can customize the drop down listsfor their group: Frequently used diagnosis list Frequently used procedure list Frequently used provider list5

Benefits to the Provider Immediate feedback from the plan on auto approvals Auto Responses Pended for further review at the health plan Additional information is required Less phone calls to the health plan Direct communication Treatment updates6

System requirements for iEXCHANGETo run the new iEXCHANGE application, this requires a PC orLaptop with the following minimum hardware and softwarespecifications.iEXCHANGE Hardware Specifications RAM of 32 MB or higher Connection speed of 36K or higher Screen Resolution of 800x600 Platform of Windows95 or higheriEXCHANGE 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 browsers7

What you need to beginUser ID * No restrictions on formatiEXCHANGE ID Provided by BCBSNMPassword * Case sensitive Expires every 30 days - you will be prompted to changeCertain words are restricted – you will get a prompt After 3 invalid entries you will be revoked and need to wait 5 minutes tologin again If you have forgotten your password, you will need to have the officeadministrator reset your password* These will be set up by the office administratorNote: Availity users may opt for Single Sign On (SSO). Please see next slidefor details.8

What you need to begin – SSO UsersAvaility users may opt to use the Single Sign On (SSO) process Registration is fast and simple Allows Availity registered users to access iEXCHANGE via Availity withone sign on In the Availity menu, click My Account BCBS Pre Auth Registration On the BCBS Pre Auth Registration page, verify your organization andthen click Submit Use the Organizational drop-down menu as needed to select theorganization you want to register Follow the instructions as displayed for the registration status(es) youreceive After you have successfully registered, select the Authorizations andReferrals for HCSC topic to submit your authorization or referral requests Please refer to the Availity payer help topics screens for additionalinformation9

iEXCHANGELogin

Login and Starting PointLogin Provider Login is used by provider office/ hospital users Payer Login is used by MCO (Managed Care Organization) usersStarting Point HELP, PREFERENCES and log out links are located at the top ofthe screen Transaction navigation menu is located directly beneath these links Located below the navigation menu is the Select a Payer drop-list Below the Select a Payer drop list you will find Sponsor informationand MEDecision news11

Help topicsare availableto assist youin logging on1. Select Provider login2. Enter your User ID (case sensitive)3. Enter your iEXCHANGE ID4. Enter your password (casesensitive)12

Select a Payer13

Help topicsare availableto assist youin logging onNote: SingleSign On (SSO)users throughAvaility will notsee this screenand will start atthe followingscreen1. Select Provider login2. Enter your User ID (case sensitive)3. Enter your iEXCHANGE ID4. Enter your password (casesensitive)14

ProviderAdministration

iEXCHANGE Administrator Group administration – Allows provider to add/ edit information abouttheir groupAccount administration – Allows providers to add/ edit accountinformation (users) associated with their groupSubmitting providers – Add, edit or delete submitting providernumbersFrequent providers – Add, edit or delete servicing, facility, orattending provider numbersFrequent procedures – Add, edit or delete frequently used procedurecodesFrequent diagnoses – Add, edit or delete frequently used diagnosiscodes16

ClickPREFERENCESto accessiEXCHANGEAdministration17

SelectiEXCHANGEadministrator18

Select Groupadministration19

You cannot edit the Group IDThe remainderof the fieldscan be edited20

Click Accountadministrationto add or editusers21

Click Add newuser to createuser IDs fornew staffmembers22

Passwords are case sensitive andneed to be at least 4 charactersEnter requiredinformation,assign privilegesand click Submitto add new users23

Click Edit userto resetpasswords,change userprivileges, ordeactivateusers24

Resetpasswords byassigning atemporarypassword** The user will be prompted to change their password when they log on25

Change statusoradministrativeprivileges ofcurrent users26

System AdminYou will receivethis messageonce you havesuccessfullyadded or updateda user27

ClickSubmittingproviders28

Organization nameis for facility set upOR (not both)First and LastName is used forphysician set upComplete thefields markedwith a redasteriskPlease leavethis field blankMake sure to also fill in theType 1 NPI if entering aprofessional provider orType 2 NPI for a facility.This is required.Click NextStep29

Test GroupComplete thefields markedwith a redasterisk and clickAdd to list30

Not UsedHINT: Before filling inProvider ID information,please perform a providersearch for the MCO IDNumber to ensure theinformation you are enteringis accurate. Please enter thealpha characters in the MCOID as capital letters.If you are a solo practice,you can check this box todefault as the SubmittingproviderClick Save31

Click FrequentprovidersCaution: Many physicians/professional providers have thesame first and last name. Pleasebe sure to verify name, address& specialty when making aselection.32

SelectProvider type33

Make sure to also fill in theType 1 NPI if entering aprofessional provider orType 2 NPI for a facility.This is required.Enter providerinformation andclick Next step34

Select PayerinformationSelect ProviderRolesClick Add to list35

Click Save listand providerwill be addedto the dropdown list36

Click FrequentProcedures37

Procedure codesthat have beenadded previouslycan be edited ordeleted38

Click on Add tolist to add newprocedure codes39

Enter theProcedure codeand descriptionPlease note that ifa Procedure codechanges or is nolonger valid, youwill need toupdate yourlisting.40

Click Save41

Click Frequent diagnoses42

Diagnosis codesthat have beenadded previouslycan be edited ordeleted43

Click on Add tolist to add newdiagnosis codes44

Enter theDiagnosis codeand descriptionPlease note that ifa Diagnosis codechanges or is nolonger valid, youwill need toupdate yourlisting.45

Click Save46

New InpatientRequest

Select NewInpatientRequest48

SelectMemberSearch49

Search byInsuranceID numberHints:Entering Date of Birth andFirst Name increases theaccuracy of the searchresultNo three letter alpha prefix is neededFEP Member searches need to include the RNote: Due to an FEP Requirement,precertifications for FEP Members must berequested through the State where services areto be rendered.50

Select ViewExisting Casesto avoidduplicaterequests51

Even thoughthere may beno cases, youmust follow thisstep toproceed.ClickSelect tocontinue52

SelectFrequentlyusedfacilitiesfrom thedrop-downlist or selectFacilitySearch tosearch byname or NPIChoose aSubmittingProvider fromthe drop-downNote: If the submitting provider is not in the drop-down menu, he/shewill need to be added through your Administrator before you canproceed53

If you enter anNPI #manually inthis field,make sure toalso select theFacility searchbutton to theright.Click on dropdown arrowsto fill inrequired fieldsNote: If you enter an NPI manually and do not perform a search, thecase is likely to pend due to multiple listings that could exist for thatNPI number.54

Click on dropdown arrowsto fill inrequired fields55

Enter theAdmit date56

Click on dropdown arrowsto fill inrequired fields57

Enter ICD-9code,select fromFrequentDiagnosisList, orclickDiagnosissearch tofind codeusing adescription58

Select the onethat best fits thedescription59

Select “Yes” toadd to the listOr choose “NewSearch” to lookup a differentcode60

Please Note:There can only beone primarydiagnosis, so youwill only be able tochoose one for thisselection.Click “Save” tosave as theprimarydiagnosis61

Enter theRequestedlength ofstay62

SelectFrequentlyusedphysiciansfrom thedrop-downlist orselectProviderSearch tosearch byname orNPI63

Click on dropdown arrowsto completethe remainingrequired fields64

If this is asurgicaladmission,theProcedurecode(s)should beincluded.Clinical Notes shouldonly be added forcases that havepended. Please do notinclude otherwise.Click Next Step65

While inpreview, youcan makechangesPreview Pagewill displayInformationalmessagesalong with theexpected statusof the case66

Your PatientIf you get a Pended message,please review the informationto see if there was somethingyou missed, as in this casethe diagnosis coded wasmissing the 4th and 5th digits.67

If you wouldlike to changeany of theinformationentered onthe RequestEntry Screen,you can editinformationon thepreviewscreen - clickPreviewchanges toupdate yourrequest68

Click Previewchanges toupdate yourrequest69

Click thePrinterFriendlybutton toprint acopy ofyourrequestDetail Line is not usedConfirmationscreenprovides theCase ID andthe status ofthe LOS70

TreatmentUpdate Search

Treatment Update Search Allows providers to search for requests that have changed over anumber of days Select the number of days you want to search (up to 14 days) Select the provider All in your group or a specific physician Display certain types of updates Only view changes to an approved status View only comment changes From the summary you can also view details of the treatmentFrom the “details” page you can Review the changes Request an extension of the treatment Read comments and respond72

SelectTreatmentupdatesearch to viewnewly createdor modifiedrequests73

Specify thetype ofTreatmentUpdates andthe Providersfor whom youwant to searchUpdates from MCO are updatesfrom the payer (BCBSNM)Updates for PCPs are updates tothe PCPs regarding their patientsNew or updated treatments includenew cases that have been set up,as well as updates on existingcases74

This page displays TreatmentUpdates that have beengenerated as the result of theaddition of new treatments and/or modified treatments for theselected ProvidersClick View details75

Click on theTreatmentupdate link toview theupdatedtreatmentinformation76

TreatmentUpdate detailsare displayed77

You will also be notifiedwhen Treatment updatesexist for your group afteryou have selected a payeron the iEXCHANGE startingpoint page78

Inter-plan Inpatient Request79