CMCS Connections

3 C M C S c o n n e c t i o n s 4 t h q u a r t e r 2 0 1 5 By Linda Grosser & Miles Jansen A u t o m a t e d p r i o r a u t h o r i z a t i o n ( PA ) w i l l be available in the near future at CMCS, through a provider portal that allows submission of requests for services requiring PA. Authorizations that used to take a few days will now be able to be completed within a few minutes using the web-based Millman Care Guidelines, Cite® AutoAuth program. CMCS will soon be one of over 2,000 organizations to offer this program to streamline the authorization process and p r o v i d e re a l - t i m e a c c e s s t o evidence based information to determine the medical necessity of requested services. Cite® AutoAuth is an automated web-based tool designed to expedite the prior authorization process. Provider offices are presented with Milliman Care Guidelines (MCG) when submitting requests for pre-approvals and submitting clinical details online. Messages and supporting documentation c a n b e s e n t s e c u r e l y a l o n g w i t h a u t h o r i z a t i o n r e q u e s t s . C i t e ® A u t o A u t h e v a l u a t e s t h e information submitted and makes a determination, often in a matter of seconds. Integration of the provider portal and utilization management system allows a smooth flow of the information toward determination. If a decision is required from the health plan's medical director, the pending authorization and all the information is easily accessed in its entirety, allowing an expeditious response. See the Workflow process below as outlined by MCG. CMCS believes that using an a u t o m a t e d p r i o r a u t h o r i z a t i o n p r o g r a m o f f e r s a t re m e n d o u s opportunity for the provider offices to efficiently submit and track any services for their members which require prior authorization. Online authorization has been requested by the providers we work with who currently make use of a web based system for PA. CMCS looks forward to offering this program to all providers that submit requests for services for Healthy Indiana P l a n , H o o s i e r H e a l t h w i s e a n d Commercial members where the request for PA is sent to our offices for determination. Self Service Simplicity with Automated Prior Authorization at CMCS TYPICAL AUTOMATED AUTHORIZATION WORK FLOW PROVIDER OFFICE HEALTH PLAN UTILIZATION MANAGER HEALTH PLAN MEDICAL DIRECTOR Provider enters info via portal Cite AutoAuth Module adjudicates APPROVE? APPROVE? APPROVE? Review pending request Request additional info if needed Medical Director reviews Send denial letter Send approval Display approval in provider browser NO NO NO YES YES YES START HERE For additional information, please contact: Christy Oakes at coakes@cmcs-indy.com or Miles Jansen at mjansen@cmcs- indy.com.

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