Welcome

• For new IDT requests -  please start requesting IDT through Qualitrac with the new, updated code of H2019 HT. Remember that this is a 15-minute code, so the units will be doubled from what you have previously been entering.
• For existing prior-authorizations - The Department is working to update all existing IDT PAs from 99368 to H2019 HT. All PAs will have the same authorization number and start and end date that you originally received. All PAs will have double the amount of units that you previously had. Once we have completed entering all PAs, you will receive an email letting you know that the PAs have been updated. Please do not email us prior to receiving this email to let us know that some of the kids do not have PAs and some do not.

Telligen, in collaboration with the Department of Health and Welfare, has created a comprehensive FAQ list for Children's Habilitation Intervention Services.  Please find them here.

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.

https://youtu.be/jG6SOTk3UGs

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.

Thank you,

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 12^th, 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 1^st, 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 (swilson@telligen.com) 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.