자원
Jiva FAQ: 공급자 포털에서 요청 입력 및 관리
Alliance는 Jiva라는 플랫폼을 사용하여 온라인으로 승인 및 추천을 입력하고 관리합니다. 여기에는 입원 환자 체류, 외래 환자 서비스, 추천, 의사가 투여하는 약물, Enhanced Care Management 및 Community Supports(ECM/CS), 운송 및 DME에 대한 요청이 포함됩니다.
검토할 수 있는 교육 자료는 다음과 같습니다.
- 승인 및 추천서 제출에 관한 1시간짜리 교육 비디오
- Jiva 공급자 포털 교육(슬라이드)
- 주제별 짧은 동영상 요청 제출, 수정 및 연장이 포함됩니다.
- 주제별 작업 지원:
자주 묻는 질문에 대한 답변은 아래와 같습니다. 추가 지원이 필요한 경우 관련 부서의 연락처 정보를 참조하세요. 시설에 대한 개별 교육을 설정하려면 Provider Services 담당자에게 문의하세요.
| 부서 | 연락처 정보 |
|---|---|
| 활용도 관리(UM) |
|
| 비응급 의료 수송(NEMT) |
|
| 향상된 의료 관리/커뮤니티 지원 |
|
| 공급자 포털 |
일반적인 질문
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.
이 변경 사항은 동맹 요청에만 적용됩니다.
Provider Services 또는 Provider Services Representative(PSR)에 831-430-5504로 전화해야 합니다. Portal Support에 831-430-5518로 연락할 수도 있습니다.
Yes, the Procedure Code Lookup is available in the Provider Portal. Select the Procedure Code Lookup tool under the 승인 및 추천 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).
지금은 아닙니다. 이는 앞으로 개선되기를 바라는 기능이지만, 지금은 수동으로 입력해야 합니다.
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.
아니요. 포털에서 일반적인 절차를 사용하여 자격을 확인하세요.
업데이트된 내용을 표시하려면 대시보드를 새로 고치세요.
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.
검색
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 찾다 button to display results below. You can also filter your results by choosing 인증 보기 from the Search Request screen. You can filter your search by Non-PCP, Provider Name 그리고 Submitted by.
If your facility is a PCP, you can search and populate a list of linked members for your facility by going to 메뉴 > My Members 그리고 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 또는 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 메뉴, go to Search Request and enter the authorization number to return a member by authorization number.
요청 편집, 수정 및 취소
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 취소 또는 변화 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.
- 강화된 케어 관리/커뮤니티 지원 권한: 이메일 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 삭제. 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 취소 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.
대부분의 "연장"은 더 긴 기간 동안 승인 요청입니다. 이것은 새로운 요청이어야 합니다. 새로운 요청은 이전 요청이 만료되기 2-4주 전에 제출할 수 있습니다. 현재 승인이 만료된 후에 시작되도록 요청한다는 것을 명확하게 기록하세요.
요청을 제출한 것과 동일한 방법을 통해 알림을 받게 됩니다. Jiva의 PCR 노트를 통해 요청한 변경 사항을 확인하는 팩스를 받지는 않지만, 에피소드 화면에서 요청한 변경 사항을 볼 수 있습니다. 팩스를 통한 모든 PCR의 경우 팩스 확인을 받게 됩니다. 요청이 이메일로 전송된 경우 확인 이메일을 받게 됩니다.
Providers can fax us for any kind of change request on closed (approved) episodes. ECM/CS providers (HTNS) can also email us.
보류 중인 제출(초안)
You can find your drafts on your dashboard. Click on the bar next to Pending Submissions in the top right widget.
그만큼 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.
승인
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, 클릭하세요 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 페이지.
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.”
처리 시간 및 자동 승인
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.
이것은 긴 목록이며 변경될 수 있습니다. 가장 흔한 것은 지역 추천(상담/후속 조치)과 ECM 요청입니다.
공급자 연결
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.
서비스 제공자를 첨부할 때에는 의사와 동일하게 병원을 검색하여 서비스 제공자로 첨부하세요.
단일 첨부는 해당 제공자 하나만 첨부합니다. 두 번째 제공자를 추가하려면 검색 화면을 다시 열어야 합니다. 모범 사례는 항상 여러 첨부 파일을 사용하는 것입니다.
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.
공급자 서비스 담당자(PSR)에게 문의하세요.
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.
네, 하지만 "다중 연결"을 두 번 눌러야 하며 하나는 요청 중으로, 하나는 서비스 중으로 표시해야 합니다.
요청 제출
입원은 회원이 병원, 전문 간호 시설, 장기 요양 시설 등과 같은 시설에 있는 것을 의미합니다. 그 외의 모든 것은 외래 환자입니다. 상담/후속 조치, 시술, 엑스레이, ECM/CS, PAD 등
그만큼 코드 유형 is required due to Jiva configurations that cannot be changed. The common code types include HCPC, CPT 또는 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; 추천 (범죄자 to bring up choice of Consultor Consult with Follow-up Visit; 폴 to bring up Follow-Up Visit only); Palliative Care (PLTVCR); ECM (ECM01, ECM02) 그리고 CS (CS01 – CS08).
예.
PCP Referral 또는 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 서비스 and the Service Type 추천 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.
네. 요청 추가 드롭다운에서 다음을 선택하세요. 외래 환자. 그런 다음 요청 사유 드롭다운에서 다음을 선택하세요. OP 약국. 선택하다 RX-의사가 투여하는 약물 서비스 유형 드롭다운에서 평소처럼 서비스 코드를 입력합니다. Medi-Cal Rx를 통해 다른 약물을 계속 입력합니다.
When entering new requests for DME from the Add Request dropdown, choose 외래 환자. 그런 다음 요청 사유 드롭다운에서 다음을 선택하세요. OP 서비스. 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.
예. Add Request 드롭다운에서 ECM/CS 서비스에 대한 새 요청을 입력할 때 다음을 선택하세요. 외래 환자. 그런 다음 요청 사유 드롭다운에서 다음을 선택하세요. ECM 또는 ECM CS. In the Service Type dropdown, choose 강화된 의료 관리(ECM) 또는 커뮤니티 지원. The code type is CUS (Custom의 경우) 및 서비스 코드는 그대로 유지됩니다. ECM01 그리고 ECM02 for ECM and CS01 – CS08 for CS. For the Medically Tailored Meals community support, use the code type HCPC and the codes S5170 또는 S9977 그리고 S9740.
서비스/전문 분야/약물 요청 필드에서.
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 요청 이유. Or, you can add details in the notes at the bottom of the page.
최소한 하나의 진단이 있어야 합니다. 필요한 만큼 입력할 수 있습니다.
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 문서 추가 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 인증번호 and enter the authorization number. Open the episode using the gear (action) icon and Choose 문서 추가 화면 오른쪽에 있는 문서 섹션에서.
Enter the first modifier in the service request screen in the 수정자 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.
사용 Outpatient Request, Reason = OP 서비스, 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 서비스.
요청을 입력할 때 첫 번째 질문은 선택 사항으로 사후 서비스를 포함하는 드롭다운입니다.
If it is a request type that gets auto-approved, then it should be auto-approved regardless of being a retro request.
아니요, 하지만 1년이 기준입니다. 1년 이상 된 경우, 왜 그렇게 늦었는지에 대한 정당성이 필요합니다. 그렇지 않으면, 서비스를 제공한 지 1년이 넘었기 때문에 거부됩니다.
모든 후진 요청은 관련 문서가 필요하며, 이는 사전 서비스 요청과 동일한 기준입니다. 의료적 필요성을 충족하는지 여부를 판단하기 위해 문서가 필요합니다.
Reason = OP 서비스, Service Type = 재활 치료, 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.
추천
아니요. 추천을 입력할 때 코드 유형은 다음과 같습니다. CUS (관례를 위해). 입력한 후 범죄자, you will have the option to choose Consultation Visit 또는 Consultation with Follow-up Visits. Typing in 폴 후속 방문만 선택할 수 있습니다.
Alliance는 모든 제공자가 포털에 액세스할 수 있는 경우 포털을 사용하는 것을 선호합니다. 팩스는 수락하지만 처리하는 데 더 오랜 지연이 있으며 이로 인해 모든 프로세스를 자동화할 수 없습니다. 추천 요청을 제출하기 전에 누가 볼 수 있는지 알아보려면 제공자에게 연락해야 합니다.
You choose a 코드 유형 (this is new) and it will be CPT, HCPC 또는 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 서비스 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 추천. For Service Code Type, choose CUS. In Service Code field, type in 범죄자 and choose either Consultative Visit 또는 Consultative and follow-up visits.
This is an Outpatient Request. Under Reason for Request, choose Specialist-to-Specialist Referral. The Service Type is 추천 and the Code Type is CUS. In the Code field, type 폴 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 서비스, 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 서비스.
No. Choose Code Type CUS. Under Code, type in 범죄자 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.
약국
From the Add Request dropdown, choose 외래 환자. Then, in the Reason for Request dropdown, choose OP 약국. Choose RX-의사가 투여하는 약물 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 서비스. 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.
전자상거래/전자상거래
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.
선택하다 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.
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