Version Date - PDF document

Version Date 3/14/16 Jiva™
Version Date 3/14/16 Jiva™ Integrated Care Management Software Provider Portal Training Material: Out of State Authorization Entry Provider Training Manual - JivaTM 1 This user guide provider instruction for out-of-state providers entering a prior authorization for a Blue Cross of Idaho member. Step A: Entering an Authorization 1. Hover over Authorizations/Notifications on the top navigation on the blue bar. 2. Select Medical/Behavioral; select the Launch button near the bottom of the page. 3. When the JIVA Dashboard appears select New Request highlighted at top left of page. a. Enter Member Last Name and Member DOB (date of birth) b. Select Search c. Member Search Results: Once you find the correct member you will have a “+” button to the right to select. This will start the process of entering the Authorization (see below) [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the 99/99/1999 99/99/1999 [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text Provider Training Manual - JivaTM 2 4. Add New Request: Episode Type , select Outpatient then select Save Complete only the fields labeled in RED. Episode Type: Outpatient or Inpatient, depending on the type of place of service Episode Class: Prior Authorization  Urgency: Routine  Diagnosis; Enter your primary ICD10 diagnosis

(exclude decimal) then select Save
(exclude decimal) then select Save [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] 70000000 99/99/1999 970000000 970000000 99/99/1999 Provider Training Manual - JivaTM 3 99/99/1999 5. After you have selected Save in the step above, you will see 8 steps on the left hand navigation side. Step 1: Edit Request - Already completed. Step 2: Select Provider: in middle section of page, select Attach New

a. Under Attach Provider Enter
a. Under Attach Provider Enter Provider Last Name and Provider First Name (may enter city for a shorter list) for Out of State providers, you may enter the clinic name or group. b. Select Search [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools

tab to change the formatting of the
tab to change the formatting of the pull quote text [Type a quote from the document or the summary of an interesting point. You can position the [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the docume[Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] 970000000 140000000 140000000 Provider Training Manual - JivaTM 4 c. A list of providers will display below the search window. Choose the provider at the correct address (do not use mailing address or PO boxes, always choose servicing address). 1. Select a Provider Role by choosing Servicing from the drop down menu. 2. Select the Actions button with the paperclip to attach the provider.* *Once complete you should have a Servicing Provider or Servicing Group in your Prior Authorization. [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] SmithSmith, John[Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab

to change the formatting of the p
to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summ[Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] 970000000 140000000 99/99/1999 John Smith Male Provider Training Manual - JivaTM 5 Step 3: Add Diagnosis - (Optional) - add any other diagnostic codes that may apply besides the primary diagnosis Step 4: UM Services - add your service information on the following: then select Save.  Service Type: Always use Medical, regardless of service type  Place of Service: Choose Appropriate from drop down  Service Code: Enter the main CPT code  Requested #: 99  Start Date: Enter Today’s date  Time Frame: Per Year  Units/Visits: Blank  Time Period: Enter 1  End Date:

Should automatically default to reflec
Should automatically default to reflect the 1 year effective period [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the [Type a quote from the document or the summary of an interesting point. You [Type a quote from the document or the summary of an interesting point. You can posit[Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting p[Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document

. Use the Drawing Tools tab to cha
. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] 970000000 970000000 140000000 14000000 99/99/1999 99/99/1999 Provider Training Manual - JivaTM 6 Step 5: Add Assessment - Skip - this step is not required. Step 6: Add Notes: Additional information such as your contact information, the provider and state, Fax number, Telephone number and all other CPT codes. If an out of State referral is required: Enter in the notes box, the Dr. and State the referral is being sent to (Dr. XXX, New York City) Referral Provider Date and contact persons full name, phone number and fax. Step 7: Add Documents - Optional - only needed if attaching medical records. Step 8: Submit Request - Once completed all of the above, select the Submit button. The next screen will confirm that you have submitted the request. You have the option to View Abstract (request) at this stage, or Print a hard copy. [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.] 14000