Why do I have to register to use the new Qualitrac Provider Portal to submit utilization review requests?(Top)
In order for you to take advantage of the group access features in the new/upgraded portal, registration is required. Also, although a slight inconvenience for existing portal users, it is worth the effort to register to be able to use the new auto-authorization features available only in the new portal.
Who can submit requests from my office? (Top)
Anyone registered in your provider office/practice or facility as a group member can submit and access cases in the portal. Groups are created during the registration process. You will also be asked to designate a Security Administrator who will maintain the access rights for your group members. For more information on registration, click here.
Can I see requests made by providers if I work at a separate facility such as a hospital or imaging center? (Top)
For security purposes, only the group members (managed by the Security Administrator of the providers' office/practice, or Security Administrator of the facility) can access cases submitted by their group members.
What is a provider group? (Top)
One of the new features in the upgraded portal, this is a group of users created by and managed by a designated person in the provider's office/practice or facility office, that will be able to submit and access cases for the affiliated provider(s) or facility. Through the registration process, a Security Administrator is designated that will be responsible for managing the groups' members. For more information on the registration process, click here.
Do I need any special software to use the Provider Portal? (Top)
Using the Provider Portal is easy and does not require the installation of special software. If you have not already done so, you will need to complete and submit a Provider Registration Packet
.The Provider Portal is a secure website that allows providers and members to electronically submit medical authorization requests. This provides a fast and secure turn around for medical authorization review. In some instances the decision may be made immediately upon submission of the request. Users may also login to the Provider Portal to see the status of their medical authorization request. Documents can be securely uploaded directly to the medical authorization request instead of faxing or mailing information which may delay the process.
What information is needed to begin the medical review (precertification) process in the Portal? (Top)
To enter an authorization request on the Portal the following information is needed, some of which can be found on the patient or member's health plan identification card:
- Patient Policy ID number
- Patient's date of birth
- The treating provider and/or facility to be used
- Type of service being requested
- Date of service to be authorized
- Any supporting documentation that will help with reviewing the request (if needed)
You will have an opportunity to select clinical criteria using our Auto-Authorization process, provided by MCG, when you submit the request. If the request is immediately approved, no additional information will be needed.
What is Auto-authorization?(Top)
As a user of the upgraded Qualitrac Provider Portal, you have the ability to submit cases for utilization review that could be instantly approved via the use of our connected clinical criteria system supplied by MCG. If your case meets criteria, it's possible that it could be immediately approved. For those cases that require clinical review by a professional, our new system speeds up the process by gathering the clinical criteria and documentation from users when the case is submitted.
What happens if I can't access the system? (Top)
If you've tried to login three times unsuccessfully, you will be locked out for 30 minutes. You can access the system again with the same password after a 30-minute wait. If you are unsure of your password and need it reset, your designated Security Administrator can reset your password for you. If you need additional assistance, please contact our support staff at: email@example.com
Do I need to have modifiers for the codes when I submit a case? (Top)
Modifiers are not required for submission of cases. Our clinical criteria system, (supplied by MCG), guides the user through clinical guidelines which will provide the needed detail.
What is the best way to submit request? Can I still fax requests? (Top)
The new Qualitrac Provider Portal, with its Auto-Authorization and group management features, is the quickest method for submitting your utilization requests. Many requests can be Auto-authorized giving you immediate approvals. You can still fax in your requests, but we encourage you to use the Qualitrac Provider Portal for your submissions. It is designed to deliver a fast, accurate, complete process for expediently completing your requests, even those that require a clinical opinion from one of our experts. If you need training or assistance for using the portal, please see our User Guide here (link to User Guide) or contact our support center firstname.lastname@example.org
What happens after I submit a case? (Top)
If the case is not immediately approved in our Auto-Authorization process, a Telligen nurse reviews the medical information provided. If the treatment appears medically necessary, you, your patient and the facility (if applicable) will be notified about the approval. If it appears it may not be medically necessary, our nurse contacts a physician consultant to make a review decision. You, your patient, and when appropriate, the facility will be notified about the physician consultant's decision.
I only submit a few requests each year. Is it really worth the effort to register to use the portal? (Top)
Even with only a few submissions, you will benefit from using the Qualitrac Provider Portal. You can submit requests any time of day, and with the Auto-authorization feature, many cases can be immediately approved.
I have a complicated request that involves multiple CPT codes. Will the system be able to accept it? (Top)
The Qualitrac Provider Portal is designed to accept all types of utilization request, including those with multiple codes. In addition, our process is able to expedite requests because the system guides you through the necessary steps to ensure that needed information is submitted. Even complicated requests are resolved more quickly when submitted through the portal.
What if I disagree with Telligen's decision regarding a medical review? (Top)
You, the patient or their family member, or the facility may appeal the review decision by contacting Telligen at: email@example.com
. It is important to provide any additional information or documentation about your case at this time. Discussion between you and the Telligen physician is encouraged. Following this second review, the initial recommendation will either be upheld or modified. Telligen will notify all concerned parties as soon as the second review is complete.
What type of documentation is required for submissions? (Top)
Documentation that would help the reviewer determine the medical necessity of a request can be uploaded to the Provider Portal when the submission is made. It can also be uploaded later if/when more documentation is needed during a review. This can be in any of these types of file formats:
- Adobe Portable Document Format (pdf)
- Plain Text (txt)
- Images (png, jpg, jpeg, bmp)
- Microsoft Office Word (doc & docx)
- Microsoft Excel (xls & xlsx)
- Rich Text Format (rtf)
- XML Paper Specification (xps)
How is the security and confidentiality of information submitted through the portal handled?(Top)
Maintaining the confidentiality and security of your medical information is very important to Telligen and required under the Health Insurance Portability and Accountability Act (HIPAA). Telligen complies to all HIPAA requirements as well as other state and federal requirements, to safeguard your information and comply with the timing and notification needs for the services we provide.
Is Telligen an insurance company? (Top)
No, Telligen is not an insurance company. Your patient's health plan has partnered with Telligen, an independent health management company, to serve as an advocate for his/her health and safety in the health care system. Our primary concern is to promote high-quality, medically necessary care that is delivered in the most efficient setting.