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Maryland Medicaid: Telligen Provider Portal
Audiology Reviews
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Our mission is to improve quality and cost effectiveness of healthcare for consumers and providers
Welcome
Why update the Telligen Provider Portal: As technology continues to advance and security regulations continue to increase, Telligen is working to stay ahead of the curve. The Portal updates allow for continued advancement in the market.
The enhancements allow for the Provider Portal to stay ahead of the stringent security rules and regulations necessary to keep personal information safe.
Streamlined review process with all necessary information contained on one page. Increased security around medical documentation uploads.
Combining extensive clinical and technical expertise to solve complex healthcare challenges
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Provider Portal Submit a Review Request View Request Status and Outcomes Appeals Authorized Official Training
Agenda
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Provider Portal
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The Telligen Provider Portal allows healthcare providers to submit review requests online.
Starting August 1, 2020, the md.qualitrac.com site will no longer be available. Telligen will transition data from the previous system and beginning Monday, August 3, the new portal will be available.
Please bookmark the telligenmd.qualitrac.com webpage. Please monitor this website for ongoing information pertaining to the
Telligen Provider Portal and the review process.
Telligen Provider Portal
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Please bookmark this site: telligenmd.qualitrac.com
Click on the Sign In link at the upper right‐hand corner of the page
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For those of you that have a username and password for the current Portal, we will transition your username to the updated Portal.
All usernames must be unique. If your username already exists in the new system, it will need to be changed. In that case, we will contact you directly through email. If not, your current username will remain.
For security reasons, you will be required to re‐establish your password.
Provider Portal
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Go to telligenmd.qualitrac.com and use the sign‐in link on the top right‐hand corner.
On the Sign In page, click Reset Password
Do not bookmark this page. The security around the login page will cause issues thenext time you log in.
Provider Portal
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The Reset Password modal will open. It will ask you to enter your username. Please enter the username that you utilize to log in to the system. Do not enter your email address.
The system will recognize your username, find the email associated to your account and send you an email with a link to reset your password.
Telligen Portal
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1. Remember to utilize the telligenmd.qualitrac.com website to log in to the Portal.
2. Use the username you are using in the current portal unless we contact you directly to let you know it has been changed.
3. Follow the reset password process to get logged in to the system. 4. All historical reviews/data will be available to you in the Portal so that
you can look back at completed reviews or reviews that are still in progress.
Key points for Review Submission
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New Landing Page
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Provider Portal: Landing Page
This is the Telligen Provider Portal Menu Bar. This will remain available to you wherever you are in the system.
The Qualitrac Logo will take you back to the landing page from wherever you are currently working in the system.
The “magnifying glass” will open search options for you to search for a specific case or for a specific member.
This icon indicates the task queue. This is where you will go to complete any assigned tasks such as Requests for Information.
This icon will take you to the Knowledge Center. The Knowledge Center provides user guides, FAQs, and Tip Sheets.
Selecting this icon will allow you to view and manage your profile. Here you can make changes to your phone number, email address etc.
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Start Tasks will take you to the task queue to view requests for additional information
Search will allow you to search for a member or a case just like the magnifying glass at the top of the page.
New Landing Page
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Submit a Review Request
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Find a member
Click on Search to find a member and start your review request.
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Find a member
Enter the Member ID and Date of Birth to start the search. As in the previous system, the Member ID and the Date of Birth must match the member data in our system. If it does not match, please confirm the member information and try again.
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Find a member
Click on any of the data fields in blue to access the member information or to start a new review for the member.
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Clicking on the blue link will bring you to the Member Hub. This is a new feature to the Telligen Provider Portal that allows you to view information related to the member including his or her contact info and any review requests that have been previously submitted.
Member Hub
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Clicking on the View Member Details box opens the window to provide the user with more information for the member.
View Member Details
Hide Member Details will minimize the panel display
View Even More Member Details will provide additional info such as member eligibility information.
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The Utilization Management Panel will display information related to any UM reviews previously submitted for the member. Per the panel, this member has not had any UM requests submitted for them.Use the Add button to start a new request.
Utilization Management Panel
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To begin a new request, you will first fill in the Authorization Request panel. The date and time of your request is completed for you. Each of the remaining sections will be completed based on the specifics of your request.
Add New Review Request
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Review Type
Review Type: Select the type of review you are requesting.
For Audiology reviews, you will select DME as the review type.
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Place of Service is where you will select the place where care is being given. Type of Service is the type of care being provided. Here you will select Audiology. Timing: In the timing field, you will select Prospective (Prior Authorization)
Authorization Request Panel
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When all the selections are complete, you will select Add New Request.
You can select Cancel if you’ve made the request in error.
Authorization Request Panel
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Next, you will provide the dates of service for your request. Enter the Service Start and Service End Date information.
Dates of Service Panel
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The Coverage Panel will detail information about the member’s coverage and eligibility. The Medicare Indicator and Third‐Party Liability information will default to No/Not Supplied
unless there is information in our system as provided in the State eligibility file.
Coverage Panel
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If the information we have in the system indicates the member does not have eligibility coverage, you will be alerted that the member is not eligible AND will be required to provide a reason for continuing with your review request.
Coverage Panel
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Entering Provider InformationThe next sections ask for information related to the Treating Provider and the Ordering Provider. You will click the Add button on each box to fill in the necessary provider information.
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Clicking Add will open a search box. You can search for providers by entering an NPI number or by filling in any of the information boxes provided.
When you have entered the necessary information, click Search to locate the physician or facility.
Entering Provider Information
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Clicking Search will return any results that meet the criteria you entered. Use the green plus box to the left of the name to select the
provider/facility you need for the review.
Entering Provider Information
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The physician or facility information will populate in the corresponding panel.
If the ordering provider is the same as the treating physician or the treating facility, you can select Copy, to quickly populate that information.
You can select Remove if you’ve made a selection in error.
Entering Provider Information
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This is where you will select the DME provider that is supplying the necessary equipment.
The Treating Provider can be a physician or an organization.
Treating Provider
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To ensure all applicable organizations have access to the review in the Qualitrac system, please select the organization or facility in the Provider Organization Visibility panel.
Provider Organization Visibility
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The Diagnosis Panel is where you enter the diagnosis information related to this review.
Click the Add button to add a new diagnosis to the panel. You can enter as many diagnoses as needed.
Diagnosis
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You can search by Code or by Term. To search by code, simply enter the code and then click Search. To search by term, enter the term and then click Search. Add the code to your request by clicking on the radio button to the left of the
code.
Diagnosis
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After selecting the diagnosis you want added to the review, you can select Submitor Submit and Add Another. – Submit will add the diagnosis to the review. – Submit and Add Another will allow you to submit the diagnosis to the review
and re‐open the window where you can repeat the process and search for another diagnosis.
Diagnosis
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In the Durable Medical Equipment Panel you will enter the code information related to this review.
Click Add to add a new Audiology item to the panel. Just like the diagnosis, you can search by code or term.
You can enter as many items as needed and can re‐order their position on the screen using drag and drop functionality.
Audiology codes
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When you select an Audiology code, you will then enter the Modifier, amounts, frequency, and cost as applicable.
Audiology codes
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After selecting the item you want added to the review, you can select Add or Add Another. – Add will add the item to the review. – Add Another will allow you to submit the Audiology item to the review and
re‐open the window where you can search for another item to add.
Audiology
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The Documentation Panel is the final panel on the page. This is where you will upload any related clinical documentation necessary for the review to be processed. To submit documentation, click Add.
Documentation Panel
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When you click the Add button on the Documentation Panel, a modal will open where you can drag and drop files or select Click here to open a windows directory and find the necessary files.
Documentation Panel
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Documents must be in PDF or Word format.
The file name cannot contain spaces or special characters.
The name of the document can be edited in the Name box as applicable.
Documentation Panel
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Category allows you to select the type of document you are attaching. This will most always be clinical.
Topic further defines the type of clinical information you are attaching.
Click Upload to attach the information to the review.
This can be repeated as many times as necessary to attach all relevant documentation to your request.
Documentation Panel
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When all the request steps have been completed, click Continue at the bottom right corner of the page.
Documentation Panel
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When you have entered all the request information and click continue, the system will take you to the MCG tool (formerly known as Milliman Care Guidelines) for documentation of the clinical criteria.
MCG
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MCG
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The benefits of utilizing MCG:– Ensures gathering of pertinent clinical information– Enhances quality of care by ensuring compliance with clinical standards– Improves turnaround time for all reviews– Provides opportunity for immediate authorization decisions– Reduces appeal volume
MCG
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MCG
Patient, diagnosis and procedure information will pre‐populate for you. To document the clinical criteria, click the Document Clinical button
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If there are clinical guidelines that apply to your request, they will be listed for you. Select Add to specify which clinical indications are present.
MCG
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MCGSelect all that are relevant and then select Save to continue.
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If No Guideline Applies to your request, click Add under the Action column
MCG
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You will be presented with a text box to document clinical information relevant to the review.
Once all applicable data has been entered, click Save.
MCG
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When all clinical criteria has been entered, click Submit Request to finish this section and return to finalizing the review.
MCG
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The last step in the submission process is to certify that all information is accurate and complete. Enter your username in the attestation section and click Submit to send the review to Telligen.
Attestation
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After completing the attestation, users have the option to add a comment to the request if applicable.
A comments modal will open, and the user can enter additional information related to the review.
This is not required to complete the review. Click Submit.
Comments
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After submitting your review request, you will be routed back to the Summary page. Here you can review all the details regarding the request as you submitted it.
Summary
Select Task Queue at the bottom of the page to begin a new search and submit other reviews.
Or you can use the links or icons at the top of the page to navigate through the Qualitrac system.
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View Request Status and Outcomes
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After a request has been submitted, you can find the review by clicking on the magnifying glass and completing either a Member Search or a Case Search.
Review Request
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If you are searching by Case ID, simply enter the Case ID in the box and click Search.
Click on the blue link to be directed to that specific review.
Case Search
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If searching by using the Member Search function, you will be directed to the Member Hub.
The Member Hub allows you to view information related to this member including all review requests that have been previously submitted.
Member Search
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In the Utilization Management panel, click on the ellipsis at the right side of the review line to open a menu.
Click on View Request to see the status and details. If the request has not yet been reviewed by our clinical team, users also
have the option to Delete the request.
Member Hub
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Users will receive email notifications when:– Reviews are received from the portal– Reminders are needed if you have started a review request but failed
to submit it– Additional information is requested– Review outcome is rendered
Reminder: To make sure that everyone that should receive email notification for reviews is properly notified, please select the organization or facility in the Provider Organization Visibility panel.
E‐mail Notifications
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If our clinical team determines additional information is needed before proceeding with the review, the Provider will receive an email and a Request for Information task in the Scheduled Task queue.
Users can access the Scheduled Task Queue two ways.
Request for Information
From the top navigation bar
Or from Start Tasks button on the landing page
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At the scheduled task queue, you will see all tasks currently assigned to you. Helpful tip: If you have a Request for Information task, you can click on the blue
comment bubble to the left of the task. A model will open with a note from the reviewer indicating what information has been requested.
Click on the ellipsis to the left of the page, to start the task
Request for Information
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You can also view the Requests for Information letter by scrolling to the correspondence section of the Member Hub
Click on the blue link to open the letter and see what information is being requested.
Request for Information
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To attach additional information to the request, scroll to the Documentation panel.
Click the Add button as was demonstrated earlier in the presentation, to attach the additional clinical documentation.
Request for Information
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When you have added all the necessary information, scroll to the bottom of the page and click the Done button. This will finalize the request and send it back to the clinical team to finish the review.
When you click Done, the system will return you to the Scheduled tasks queue and the task will no longer be visible.
Please do NOT start a new review request when asked for additional clinical. This will create a duplicate request and will delay the review process.
Request for Information
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To view the outcome of your request, go to the Member Hub, find the review in the Utilization Management panel, click on the ellipsis to the right and select View Request
View Outcome
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Scroll down the page to the Outcomes Panel. The determination is displayed on the right Click on the dark brown section of the panel to expand and view the
details.
View Outcome
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View Outcome
The Requested tab will display what was requested in the review.
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View Outcome
The Final Recommendation tab will display the determination and the authorization number.
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Appeals
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To submit an appeal for a denied review, go to the UM panel in the Member Hub and click on the blue ellipsis to open the action menu.
Select 1st Level Appeal from the menu.
Appeal
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Attach any additional documentation that is necessary to support the appeal and enter your user id in the Attestation section. Click Submit to send the appeal to Telligen for review.
Appeal
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Authorized Official Training
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Security Administrators are now called Authorized Officials. They will serve the same functions.
– Ability to Add and Deactivate users.– Reset Passwords– Submit and view review requests submitted by individuals within the
same organization(s)
Authorized Official Training
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Authorized Officials will see an additional option in the top menu
Click on the tool icon to get the drop‐down menu to show and then click Manage Users.
Authorized Official Training
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The Authorized Official (AO) will be able to view all users associated with any organizations/physicians that the AO is associated to.
The AO can click on any of the blue links in the line to access the details for that individual user.
Authorized Official Training
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Authorized Official Training
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The Authorized Official can edit any user information (address, phone, last name, etc.) except for the username field.
Once a username is created, it cannot be changed. The username would need to be deactivated and a new one established for that user.
All usernames must be unique within the system. If the username is not unique, the system will alert the AO and an alternate username will need to be established.
Authorized Official Training
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To create a new user, click the Add User button in the top right corner of the Manage User page.
Create a new user
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Create a new user All fields with a red asterisk, *, are required fields. The Organizations drop down will allow the AO to associate users to the
organizations available to the AO to select from. When all required information has been completed, click Save to continue.
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After clicking Save, the system will direct the AO to the Reset Password page.
The username will pre‐populate. Click Submit The system will then send a link to the email associated to that
username so they can reset their password and log in for the first time.
Create a new user
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Create a new user The email link will direct the user to the reset password page. The user will then create their password using the criteria listed and click
Submit.
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Deactivate users To deactivate a user, simply go to the Manage Users tab, find the username
you need to access and click Deactivate User.
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The End
