When Telligen went live on Qualitrac 3.0, MCG was integrated into the system which provides transparency into the clinical guidelines and criteria we use to review your authorization requests. Effective August 22, there will be an upgrade to the provider portal that requires you to document the criteria in MCG when you submit an auth request. Designed for use in conjunction with a provider’s clinical judgment, MCG’s evidence-based guidelines describe best practice care and recovery, support care quality, and efficient resource management. MCG guidelines offer evidence-based criteria, goals, optimal care pathways, and other decision-support tools, making it a valuable resource for proactive care management, case review, and assessment of people facing hospitalization or surgery.
It is important that you select the appropriate guideline during the authorization request. The MCG guideline that you use should be based on the member’s primary diagnosis or procedure that is driving the hospital stay. Therefore, it is important that you only list the primary diagnosis and/or procedure in Qualitrac. The MCG guidelines that appear for you to choose from to document the clinical indications for the hospitalization will be based on the diagnosis and procedure codes you entered in authorization request in Qualitrac.
As previously announced, we recently implemented MCG Cite AutoAuth. Depending on the AutoAuth rules applied and the clinical criteria that is selected, an immediate decision for authorization can be made when the criteria is met. If the criteria is not met, the authorization request will pend to a queue for a nurse reviewer to work. Using the MCG integration and AutoAuth rules, Telligen is able to ensure improved clinical controls, quality and compliance with standards, reduced appeals volume, and improved turnaround time to meet contractual obligations. If your request is AutoAuthed, you will receive an immediate response from the system!!
You will find our AutoAuth Desk Guide, that provides step by step instructions on how to submit an authorization request through the Qualitrac portal, and how to document clinical in MCG, here.
And below is the link for a video on how to document clinical in MCG and view the outcome of an AutoAuth.
Additional documents can be found on the Document Library page, under the Qualitrac 3.0 heading.
If you have any questions, please call our customer service team at 866-538-9510.
Your Telligen Team
The Telligen/Idaho Provider Call Center and Help Desk will have reduced hours during the Christmas holiday. They will be available from 8:00 AM until 5:00 PM MST on Christmas Eve and closed on Christmas Day.
Telligen Provider Portal Changes - Training Notification. Details are listed here.
If the date of service change is for an Outpatient procedure that has already been approved and the procedure has happened, send a secure email with the Reference ID, Authorization Number, and actual date of service, to MedicaidQIO@dhw.idaho.gov.
At the request of Idaho Medicaid, and to streamline the process for reviewing genetic tests, all genetic codes except the following will be reviewed by Telligen effective Monday, March 12th, 2018:
81225 Cyp2c19 gene analysis common variants;
81226 cyp2d6 gene analysis common variants;
81227 cyp2c9 gene analysis common variants;
81230 Gene analysis (cytochrome P450 family 3 subfamily A member 4) for common variant;
81231 Gene analysis (cytochrome P450 family 3 subfamily A member 5) for common variant; and
81355 vkorc1 gene analysis common variants.
In order to ensure a smooth transition with this new process, the Division of Medicaid’s Medical Care Unit will redirect providers to the Qualitrac portal where they can submit genetic testing requests to Telligen. This redirection and notice will be sent to the submitting provider until April 1st, 2018, at which point submission through Telligen should be considered the standard method of submitting requests.
An updated list of codes requiring Telligen review can be found here.
As always, Telligen’s Idaho Medicaid page is a source of current information regarding the reviews Telligen conducts on behalf of Idaho Medicaid.
Thank you to everyone that attended the training for continued stay review submission changes. If you missed the training. You can access a copy of the training slides and the recorded webinar session on our Education and Training Page under Continued Stay Review and Telligen Updates.
Let Stephanie Wilson (firstname.lastname@example.org) know if you have any questions about this training or any of the information included in the presentation.
Periodically, Telligen gathers information about its services. This feedback is important as it provides opportunities for Telligen to improve the services provided to customers and other stakeholders. Please take a few minutes of your time to provide your feedback by clicking the link below and completing the online survey. This survey will remain active through 6pm MST on 2/16/18.
Survey link: https://www.surveymonkey.com/r/DV783YX
Telligen is providing training on a change to how Continued Stay Reviews can be submitted in the Telligen Provider Portal. This training will cover a change to the system on how users can more easily and quickly submit a continued stay review. Each training session is scheduled for an hour. Both will cover the same information, so you only need to attend one. Please plan to attend one of these sessions to learn about the new features.
- Open Internet Explorer
- To register for the February 20th session:
Click here or copy and paste the following link to a browser:
To register for the February 22nd session:
Click here or copy and paste the following link to a browser:
- Click on the Register link in the Event Status line or on the Register button at the bottom of the page.
- Enter the required information
- Upon registering, you will receive a confirmation email with all the necessary information to join the event.
- If you experience any difficulties in registering or joining this event, please contact the Telligen WebEx Support Line at (515) 440-8555.
Effective January 29, 2018 - A new Provider Manual has been added to the Document Library.
Effective January 2, 2018 - There has been an important change regarding the way Inpatient Psychiatric Reviews are processed by Telligen. Previously, Inpatient Psychiatric Reviews were submitted to Telligen on the first billed day. Effective immediately, all Inpatient Psychiatric Reviews exceeding three consecutive days should be submitted to Telligen for a review due on the fourth consecutive billed day. These Reviews are no longer required to be submitted on the first billed day. This change has been made to more closely align the Inpatient Psychiatric Review Requirements with those of General Inpatient Hospital Reviews where the inpatient procedures do not otherwise require a prior authorization. If you have any questions or comments, please contact Telligen at 1-866-538-9510.
Effective July 25, 2017 - Continued Stay/Concurrent Review Changes: For anyone submitting continued stay reviews through the Provider Portal, there has been a change to the process. Previously, when you selected the review timing of concurrent, the system would ask you if this review was a continuation of a previous review and to submit the Authorization number. These questions have now been removed from the system. To make sure that concurrent/continued stay reviews are linked with previously submitted reviews for the same stay, you will need to make sure that the Admission date remains the same for each review. We are aware that admission dates may change from what was submitted for the prior authorization review. If the actual admission date is different from the date submitted for the prior authorization review, please contact Brandi Lavarello at email@example.com to have the prior authorization date changed to reflect the actual admission date prior to submitting the concurrent/continued stay review.
July 19, 2017 - The Telligen Provider Portal will enforce password changes every sixty days starting August 1, 2017. Please review the instructions on how to change a password in the system. The attachment also provides information to the Telligen Help Desk if you need assistance or have any questions.
November 2, 2016 - Slides for the 10/27 and 11/3 online training sessions can be found here.
August 29, 2016 - Updates have been made to the Document Library page. See the additional information available including manuals, forms, and important links.
August 4, 2016 - Telligen hosted four Provider Orientation sessions across Idaho on July 19 - 21. Anyone that was not able to attend one of our session either in person or online can listen to the information that was shared by listening to one of the recorded sessions. This recording has been posted to the Education and Training page on our website. You can find it here.
Telligen announces upcoming training session in August. Learn more about Telligen, the Telligen Provider Portal, and
the registration process to allow access to the portal.
To learn more about these training session go to our Education and Training page.
Welcome to the Telligen website supporting Utilization Management for the State of Idaho. This website is currently being developed and more information will be added as it becomes available. We did want to provide you with information from our recent orientation trainings that took place in Idaho on July 18 through July 21st. You can find the slide deck, a recording of one of the meetings, and answers to questions that were asked during the sessions by following the links below: