Cov peev txheej
Jiva FAQs: Nkag mus thiab tswj cov lus thov hauv Chaw Pabcuam Portal
Lub Alliance siv lub platform hu ua Jiva rau nkag mus thiab tswj kev tso cai thiab xa mus online. Qhov no suav nrog kev thov rau kev nyob hauv tus neeg mob, kev pab kho mob sab nraud, kev xa mus, tus kws kho mob muab tshuaj, Kev Tswj Xyuas Kev Kho Mob thiab Kev Txhawb Zej Zog (ECM/CS), kev thauj mus los thiab DME.
Cov ntaub ntawv qhia kev cob qhia hauv qab no muaj rau koj los tshuaj xyuas:
- Ib-teev video qhia txog kev xa cov ntawv tso cai thiab xa mus
- Jiva Provider Portal Training (Slides)
- Cov yeeb yaj kiab luv luv los ntawm lub ncauj lus suav nrog kev xa tawm, hloov kho thiab ncua kev thov.
- Job Aids los ntawm lub ntsiab lus:
- Txuas Cov Chaw Haujlwm Pabcuam Haujlwm
- Clear Memory List Job Aid
- Service Request Code Types Job Aid
- Ua kom tiav Cov Ntawv Pov Thawj Ua Haujlwm Pabcuam
- Nkag mus rau New Request Job Aid
- Extending Inpatient Stay Job Aid
- Yuav ua li cas xa daim ntawv xa mus rau Txoj Haujlwm Pabcuam
- Yuav xa Daim Ntawv Tso Cai Ua Haujlwm Li Cas
- Yuav hloov lossis ntxiv li cas rau daim ntawv thov Job Aid
- MRI Thov Kev Pab Ua Haujlwm
- Luam Ntawv Tso Cai (Episode) Job Aid
- Teb rau RFI Job Aid
- Nrhiav Txoj Haujlwm Pabcuam
- SNF/LTC Nkag Mus Rau Kev Thov Haujlwm Tshiab
- Saib daim ntawv thov xa ua ntej Lub Xya Hli 15 Txoj Haujlwm Pabcuam
- Saib Cov Ntawv Sau Ua Haujlwm Pabcuam
Cov lus teb rau cov lus nug uas nquag nug tau piav qhia hauv qab no. Yog xav tau kev pab ntxiv, thov mus saib cov ntaub ntawv tiv tauj rau lub tuam tsev muaj feem cuam tshuam. Yog tias koj xav teeb tsa kev cob qhia tus kheej rau koj qhov chaw, hu rau koj tus neeg sawv cev Kev Pabcuam.
| Department | Cov ntaub ntawv tiv tauj |
|---|---|
| Kev Tswj Xyuas Kev Siv (UM) |
|
| Kev Thauj Mus Los Tsis Muaj Xwm Ceev (NEMT) |
|
| Txhim Kho Kev Tswj Xyuas/Kev Txhawb Zej Zog |
|
| Tus kws kho mob Portal |
Cov Lus Nug
No. It is a single sign-on (SSO) from the Provider Portal. When you are in the Provider Portal, select the Jiva link under Auths and Referrals to access the new platform.
To utilize this service, make sure your existing portal account has the Auth/Referral Search access. For new users, please visit the Provider Portal Account Request Form page, review the agreement and complete the form that is linked in the agreement. You will need to complete the form with some basic registration information. Your account will be created in 5-7 business days and you will be notified by email with login information.
Qhov kev hloov pauv no tsuas yog siv rau Alliance thov.
Koj yuav tsum hu rau Cov Kev Pabcuam lossis koj Tus Neeg Saib Xyuas Kev Pabcuam (PSR) ntawm 831-430-5504. Koj tseem tuaj yeem hu rau Portal Support ntawm 831-430-5518.
Yes, the Procedure Code Lookup is available in the Provider Portal. Select the Procedure Code Lookup tool under the Kev tso cai thiab xa mus section.
You must have the member’s Subscriber ID to search for them. Other fields such as member name and birthdate are optional. You may also choose My Requests on the dashboard (landing page). To enter the Member Overview (member chart or page), click on the member’s name (hyperlink).
Tsis yog lub sijhawm no. Nws yog kev txhim kho peb vam tias yuav ua rau yav tom ntej, tab sis tam sim no koj yuav tsum tau nkag mus rau nws manually.
We do not have a report in Jiva. However, providers can search for requests by PCP or non-PCP cases to generate a list of requests associated with their facility.
If you are idle (not actively entering an auth or referral), you will be logged out after 20 minutes.
Tsis yog. Thov siv cov txheej txheem ib txwm ua hauv Portal los txheeb xyuas qhov tsim nyog.
Nco ntsoov rov kho koj lub dashboard kom pom cov hloov tshiab.
If there is a gap in coverage or eligibility, the Alliance will not cover services. This means that the provider will have to bill the correct entity—possibly Fee-for-Service. Any claims submitted for services when the member is not eligible will be denied.
Yes. Although you can view these on the Jiva platform, you will also receive faxes.
Providers can request extensions for any authorizations through Jiva. However, please note that outpatient services require a new authorization request for an extension.
Nrhiav
You may search all requests associated with your facility and linked member. Search requests by member’s name will display all requests submitted by the user and associated facility for the member. You can search for a list of requests associated with your facility without entering any search criteria by clicking the Nrhiav button to display results below. You can also filter your results by choosing Saib Auths los ntawm Search Request screen. You can filter your search by Non-PCP, Provider Name thiab Submitted by.
If your facility is a PCP, you can search and populate a list of linked members for your facility by going to Ntawv qhia zaub mov > My Members thiab Search as PCP Cases. If your facility is a specialist, you will need to choose New Request from the Menu and enter the Subscriber ID to see that member populate. You can click on the Member Name (blue hyperlink) to go to their record (Member Overview los yog Nurse's View). On the left of that screen, you will see the member's episodes (authorizations, referrals, requests). There are restrictions to open any pending request, but you can view the Episode Abstract in full detail.
In Jiva, you can search for and see requests (episodes) that have been entered in Jiva since July 15, 2024.
You will be able to see faxed requests in the member history after the business processes them, but it will not show on your dashboard. The dashboard only shows what you submitted through Jiva.
You can add from any of the member links. You can also add a request from the Nurse View (Member Overview). You get to the Member Overview by clicking on the member’s name from any of the lines returned in your search.
Yes. You can search by an authorization number for any authorization attached to your provider when submitting the request. Under Ntawv qhia zaub mov, go to Search Request and enter the authorization number to return a member by authorization number.
Kho kom raug, Hloov kho thiab tso tseg thov
You can add notes, documents, diagnosis and providers to a pending request. You may add a note until the episode is closed (reviewed by the Alliance and approved, denied, voided, etc.). If you need to cancel or change a request after submitting it, use note type Tso tseg los yog Hloov with details of change/cancel. The nurse will get an alert that you have added a change or cancel request to the pending request.
After a decision has been made, you will need to create a new request through the portal or submit a Provider Change Request by fax (831-430-5851 for RX-PAD request and 831-430-5850 for all other requests). You can also reach out to follow up on a change at the following contacts:
- Medical authorizations: call 831-430-5506 or email listauthcoordinators@ccahstage.wpengine.com.
- Transportation authorizations: fax 831-430-5850, call 831-430-5640 or email listnemtauths@ccahstage.wpengine.com.
- Pharmacy: call 831-430-5507.
- Txhim Kho Kev Tswj Xyuas / Zej Zog Txhawb kev tso cai: email ecmauths@ccahstage.wpengine.com.
You can only make changes to pending authorizations. If the authorization is processed/closed, please submit a new request.
Prior to submitting (when in draft status), you can click on the gear icon next to the pending submission episode and choose Edit episode. At the bottom of the screen, you can choose Rho tawm. After an episode (request) has been submitted and before a decision has been entered, you can open the episode and add a note with the note type Tso tseg and enter a note requesting the episode be voided. After a decision is made, you will have to call the Alliance UM line at 831-430-5506 or email listauthcoordinators@ccahstage.wpengine.com.
Feem ntau "extensions" yog thov kom pom zoo rau lub sijhawm ntev dua. Qhov no yuav tsum yog qhov kev thov tshiab. Qhov kev thov tshiab tuaj yeem xa tuaj 2-4 lub lis piam ua ntej qhov kev thov ua ntej tas sijhawm. Nco ntsoov kom meej meej tias koj tab tom thov kom pib tom qab qhov kev tso cai tam sim no tas sij hawm.
Koj yuav tau txais kev ceeb toom los ntawm tib txoj kev uas koj tau xa daim ntawv thov. Txawm hais tias koj yuav tsis tau txais fax lees paub qhov kev hloov pauv uas koj tau thov los ntawm PCR daim ntawv hauv Jiva, koj yuav tuaj yeem pom cov kev hloov pauv uas koj thov ntawm qhov screen rov. Rau ib qho PCR ntawm fax, koj yuav tau txais kev pom zoo fax. Yog tias koj qhov kev thov raug xa email, koj yuav tau txais email lees paub.
Providers can fax us for any kind of change request on closed (approved) episodes. ECM/CS providers (HTNS) can also email us.
Pending Submissions (Drafts)
You can find your drafts on your dashboard. Click on the bar next to Pending Submissions in the top right widget.
Cov Pending Decision tab is personal to each user. Therefore, only the user who submitted the request will be able to view pending decisions on the requests they submitted from the Pending Decision icon.
Kev tso cai
Yes. Navigate to Nurse View (MCV, Member Overview) by clicking on the member’s name (blue hyperlink). On the left, there is a list of all episodes associated with the member (both open and closed) that have been entered since July 15, 2024.
It is listed on the episode screen and the Episode Abstract (available to print as a PDF). Note that the authorization number in Jiva is not alphanumeric and only consists of numbers.
Click on the gear icon next to the episode and choose Episode Abstract. You can print from this view.
Yes. If a denial letter was faxed to your facility, you can print it (but you won’t be able to print letters that were not sent to you).
From the Member Overview, nyem rau ntawm expand (X) icon next to the Correspondence widget to open a list of letters. When you find the letter you want to view, click on the gear icon and choose View PDF Letter.
You can also view the letter through the authorization itself. Click the gear icon next to the episode you would like to look at and select Open. Then, use the blue Workflow button in the top left of the screen to go to Correspondence. There will be a list of all letters specific to that authorization. Use the gear icon to print a PDF copy.
It depends on the reason for it being voided. Incorrect submissions are automatic voids with no delay. Requests that are missing information will get an Incomplete Notice and will be voided if we don’t receive the information within 24 hours of requesting it.
Newborns may be eligible under their own ID when Medi-Cal eligibility is granted through the Newborn Gateway program. Newborns enrolled under Newborn Gateway are covered under State FFS Medi-Cal for their month of birth. Eligibility for this program should be verified using the DHCS Provider Portal. For more information, please visit the DHCS Newborn Gateway nplooj.
Newborns who are not covered under their own ID through the Newborn Gateway program will follow the current newborn coverage, where newborns are covered under the mom's ID for the month of birth and up to the second month of birth. Outpatient and Inpatient Pre services would require a TAR form under the mom's ID, which must indicate “baby using mom's ID; baby name, DOB.” For an IP Post (admits), the face sheet, under the mom's ID, must indicate “baby using mom's ID; baby name, DOB.”
Lub Sijhawm Tig Rov Qab thiab Auto Pom Zoo
For routine requests, the turnaround time is 5 days or less. Urgent requests have a 72-hour turnaround time. Post-service/retro requests have up to 30 calendar days. Certain requests are immediately approved based on criteria approval. Some requests may be delayed if more information is requested.
Qhov no yog cov npe ntev thiab tuaj yeem hloov pauv. Cov feem ntau yog Cov Kev Xa Mus Hauv Zos (kev sab laj / ua raws) thiab ECM thov.
Txuas Cov Kev Pabcuam
No. You will need to select your provider as the requesting provider when attaching providers. The PCP Referral option should only be used when the PCP’s office is submitting a Local Referral (consults/follow ups).
You cannot search by specialty. You must search by facility or practice name. In the Provider Contact Information section, you will be asked to enter the servicing provider's name.
Thaum txuas cov kws kho mob, tshawb xyuas lub tsev kho mob ib yam li koj tau ua tus kws kho mob thiab xa mus ua tus kws kho mob.
Ib qho txuas tsuas yog txuas rau ib tus neeg muab kev pabcuam. Koj yuav tsum rov qhib qhov kev tshuaj ntsuam xyuas ntxiv rau tus kws kho mob thib ob. Qhov kev xyaum zoo tshaj plaws yog ib txwm siv ntau qhov txuas.
If you are attaching a provider, you can use NPI #, provider # or facility name. However, you can only search by the facility or practice level (billing) NPI.
The “treating practitioner” refers to either the referring practitioner or the servicing practitioner. If you don’t know the servicing practitioner, you can enter the specific name of the referring practitioner instead, or you can enter “not yet known” or “n/a” for provider’s name in the provider contact section if the request is not from a clinician.
You need to enter the practice or facility name. You cannot search by individual provider. You can add the specific provider and location in the dedicated required field. The exception is if providers have/own their own practice, you can search for them when attaching providers.
Hu rau koj Tus Neeg Muab Kev Pabcuam Tus Neeg Sawv Cev (PSR).
You should only be selecting one requesting and one servicing provider. The Multiple Attach option is so that you can select a requesting and a servicing provider.
Yog lawm, tab sis koj yuav tau ntaus "ntau txuas" ob zaug thiab nco ntsoov sau ib qho kev thov thiab ib qho ua kev pabcuam.
Xa Cov Lus Thov
Tus neeg mob hauv tsev kho mob txhais tau hais tias tus tswv cuab nyob hauv ib lub tsev kho mob xws li tsev kho mob, chaw tu neeg mob, kev saib xyuas mus sij hawm ntev, thiab lwm yam. Txhua yam yog tus neeg mob sab nraud—kev sab laj/ua raws li, cov txheej txheem, x-ray, ECM/CS, PAD, thiab lwm yam.
Cov Hom Code is required due to Jiva configurations that cannot be changed. The common code types include HCPC, CPT los yog CUS (for Custom). HCPC codes are alphanumeric, starting with a letter followed by numbers, such as G0181 for Home Health. CPT codes are fully numeric codes, such as 33016 for heart surgery. If it is a CUS code type, you will need to enter the first few letters of the code to get dropdown choices. Custom codes include Acupuncture (ACUVISITS); Dental Anesthesia (DENTALANESTHI); MRI; Kev xa mus (CON to bring up choice of Consultor Consult with Follow-up Visit; FOL to bring up Follow-Up Visit only); Palliative Care (PLTVCR); ECM (ECM01, ECM02) thiab CS (CS01 – CS08).
Yog lawm.
PCP Referral los yog Specialist to Specialist Referral choices are only for requests for referrals (Office Visits), not for OP Services. If you have selected the Reason for Request OP Services and the Service Type Kev xa mus when entering the specific service, then you will get an error because the selections are contradictory.
You have to manually enter your phone and fax number. You can use your own information if that is the correct information for us to contact.
Yog lawm. Los ntawm Add Request dropdown, xaiv Tus neeg mob sab nraud. Tom qab ntawd, nyob rau hauv Qhov laj thawj rau Kev Thov dropdown, xaiv OP Pharmacy. Xaiv RX-Tus kws kho mob muab tshuaj nyob rau hauv Service Type dropdown thiab nkag mus rau qhov kev pab cuam code raws li niaj zaus. Txuas ntxiv mus rau lwm yam tshuaj los ntawm Medi-Cal Rx.
When entering new requests for DME from the Add Request dropdown, choose Tus neeg mob sab nraud. Tom qab ntawd, nyob rau hauv Qhov laj thawj rau Kev Thov dropdown, xaiv OP Services. In the Service Type dropdown, choose the appropriate DME selection (DME-Equipment, DME-Medical Supplies, DME-Orthotics, DME-Prosthetics). The code type and the service codes remain the same. DME codes are almost always HCPC codes.
Yog lawm. Thaum nkag mus rau kev thov tshiab rau ECM / CS cov kev pabcuam los ntawm Add Request dropdown, xaiv Tus neeg mob sab nraud. Tom qab ntawd, nyob rau hauv Qhov laj thawj rau Kev Thov dropdown, xaiv ECM los yog ECM CS. In the Service Type dropdown, choose Txhim Kho Kev Tswj Xyuas (ECM) los yog Kev txhawb zej zog. The code type is CUS (rau Kev Cai) thiab cov lej pabcuam tseem nyob ECM01 thiab ECM02 for ECM and CS01 – CS08 for CS. For the Medically Tailored Meals community support, use the code type HCPC and the codes S5170 los yog S9977 thiab S9740.
Hauv Kev Pabcuam / Tshwj Xeeb / Kev Thov Tshuaj.
J codes are HCPC codes. You enter them in the same place but change the Code Type to HCPC.
When completing the request, there is a dropdown to answer Yog vim li cas thov. Or, you can add details in the notes at the bottom of the page.
Nws yog qhov yuav tsum tau muaj tsawg kawg yog ib qho kev kuaj mob. Koj tuaj yeem sau ntau npaum li koj xav tau.
You can only attach one document when submitting a new request. However, additional documents can be added immediately after submitting the request. Click on the Episode Type (IP or OP) to return to the episode screen. On the right side, click Ntxiv Cov Ntaub Ntawv and you may add additional documents. There is no size limitation when attaching documents.
Yes, as long as the Alliance has not yet closed (made our determination on) the authorization and if the request was linked to your providers when the request was entered. From the Search Request screen, choose Tus naj npawb and enter the authorization number. Open the episode using the gear (action) icon and Choose Ntxiv Cov Ntaub Ntawv los ntawm cov ntaub ntawv seem ntawm sab xis ntawm qhov screen.
Enter the first modifier in the service request screen in the Hloov kho field and add other modifiers in the notes section.
The Alliance does not need to know this. Use the CUS custom MRI codes to select a range of codes so that contrast can be used or not used as needed per the provider.
Siv Outpatient Request, Reason = OP Services, Service Type = Diagnostic, Service Code Type = CUS, Code = type in MRI and choose from dropdown list. Only use PCP Referral for office visit requests (consults and follow ups) coming from the PCP.
If consults/follow-ups/office visits are for pathology only, then it’s a referral. If it’s actual procedures with CPT/HCPC codes, then it’s an authorization request and should use the Reason for Request OP Services.
Thaum nkag mus rau qhov kev thov, thawj lo lus nug yog ib qho kev poob qis uas suav nrog kev pabcuam tom qab ua kev xaiv.
If it is a request type that gets auto-approved, then it should be auto-approved regardless of being a retro request.
Tsis yog, tab sis ib xyoos yog tus qauv. Yog tias laus dua ib xyoos, nws xav tau kev txiav txim siab vim li cas nws thiaj li lig. Txwv tsis pub, nws yuav raug tsis lees paub rau ntau tshaj ib xyoos txij li cov kev pabcuam tau muab.
Txhua qhov kev thov retro xav tau cov ntaub ntawv muaj feem cuam tshuam, uas yog tib tus qauv raws li kev thov ua ntej. Peb xav tau cov ntaub ntawv los txiav txim seb lawv puas tau txais kev kho mob.
Reason = OP Services, Service Type = Rehab Therapies, Code Type = CPT, Code (enter CPT code). All other steps should be identical to any other request.
Once the request is submitted and a decision is made (approved or denied), the status will change to closed. In this case, your request met “auto-approval” requirements and was immediately approved and therefore closed.
Kev xa mus
Tsis yog. Thaum nkag mus rau kev xa mus, hom code yog CUS (rau kev cai). Tom qab ntaus ntawv CON, you will have the option to choose Consultation Visit los yog Consultation with Follow-up Visits. Typing in FOL yuav tso cai rau koj xaiv cov kev mus ntsib tom qab nkaus xwb.
Lub Alliance nyiam kom txhua tus neeg muab kev pabcuam siv Portal yog tias lawv nkag mus rau nws. Thaum peb lees txais faxes, muaj kev ncua ntev dua hauv kev ua lawv thiab nws txwv tsis pub peb tsis tuaj yeem ua haujlwm txhua yam txheej txheem. Koj yuav tsum hu rau tus kws kho mob kom pom leej twg tuaj yeem pom lawv ua ntej xa daim ntawv thov xa mus.
You choose a Hom Code (this is new) and it will be CPT, HCPC los yog CUS (for custom) depending on the type of service request. If the option was just “follow-up” before, then use the CUS code FOLLOWUP.
It depends on the specific lab services needed. If the lab request does not require authorization and only requires a referral, then the CUS code for the referral will encompass those services. If the specific lab services require authorization, then the CUS referral will not encompass that lab. In this case, providers should submit a separate authorization from the referral using the Reason for Request OP Services and the Service Type Diagnostic, then whichever code is relevant to the labs being requested.
This is not preferred, as it can create duplicative services or delay care. You can if necessary, but there's a high likelihood that we will deny one of them or delay the review because we must ask why there are two.
Yes. Choose Outpatient Request. Under Reason for Request, choose PCP Referral (for request from PCP), Specialist-to-Specialist Referral (for request from specialist) or OON Referral (for a referral to an out of network specialist). In Service Type, choose Kev xa mus. For Service Code Type, choose CUS. In Service Code field, type in CON and choose either Consultative Visit los yog Consultative and follow-up visits.
This is an Outpatient Request. Under Reason for Request, choose Specialist-to-Specialist Referral. The Service Type is Kev xa mus and the Code Type is CUS. In the Code field, type FOL and choose follow-up visits. In Notes, choose the note type Web Note and enter a note requesting continuing care.
Radiology office visits and radiology procedures that do not require authorization are covered under the referral, but radiology procedures that require authorization are not. Procedures and diagnostic tests are entered under OP Services, not referrals.
The PCP should submit the initial request. The specialist should submit a request for ongoing visits using the Specialist-to-Specialist option under Reason for Request.
To request a referral, use PCP Referral (consults/follow up visits). Any other types of services are OP Services. If you are requesting an authorization for an OP service, choose OP Services.
No. Choose Code Type CUS. Under Code, type in CON and choose the appropriate Consult code.
Yes, a specialty office can request a retro RAF through Jiva.
You can submit a referral choosing Specialist-to-Specialist from the Reason for Request dropdown.
You can submit the referral. If you are submitting a request, always attach your provider as the requesting provider. You should never select a different provider as the requesting provider. The servicing provider can be you or another provider.
Tsev muag tshuaj
From the Add Request dropdown, choose Tus neeg mob sab nraud. Then, in the Reason for Request dropdown, choose OP Pharmacy. Choose RX-Tus kws kho mob muab tshuaj in the Service Type dropdown and enter the service code as usual. Continue to enter other medication through Medi-Cal Rx.
Create an Outpatient Request. Under Reason for Request, select OP Services. Under Service Type, choose Procedure. For Code Type, select HCPC and enter the HCPC code.
Under the Service/Specialty Drug Request section, choose Service Code Type HCPC and enter the J code in the Code field. After entering dates and request numbers, click on the blue ADD button. You may repeat the process with additional J codes.
ECM/CS
For ECM, the requested number is 12. The start date and end date are today. If you choose ECM02, the end date will self-correct to 12 months on the authorization.
Xaiv Post-Service in the first dropdown option and select the appropriate Population of Focus in the Population of Focus question. Note that a request is only Post-Service if all services have been completed at the time of the authorization request. If you are asking for a past start date of service but still have future service to provide, this is still considered Pre-Service.
ECM authorizations are auto approved, and you can print the Episode Abstract.
ECM01 does not require authorization and ECM02 is auto approved.
Hu rau Chaw Pabcuam
| General | 831-430-5504 |
| Kev thov Cov lus nug txog kev them nqi, cov xwm txheej thov, cov ntaub ntawv thov kev thov dav dav |
831-430-5503 |
| Kev tso cai Cov ntaub ntawv tso cai dav dav lossis cov lus nug |
831-430-5506 |
| Tso cai xwm txheej Tshawb xyuas cov xwm txheej ntawm cov ntawv tso cai xa tuaj |
831-430-5511 |
| Tsev muag tshuaj Cov ntawv tso cai, cov ntaub ntawv hauv khw muag tshuaj lossis cov lus nug |
831-430-5507 |
Muab Kev Pabcuam
Xov Xwm Tshaj Tawm Tshiab
Tus Muab Kev Digest | Nqe 68
Saib xyuas cov kev cai lij choj tshiab
Kev ntsuas tshiab ntxiv rau Cov Ntaub Ntawv Xa Khoom
Tus Muab Kev Digest | Nqe 67
Lub Alliance koom tes nrog Sprinter Health
Tiv tauj peb | Hu dawb: 800-700-3874