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