Medicaid Management Information Systems Maine Integrated Health Management Solution

1.Introduction

The MIHMS Health PAS Online Portal (online portal) provides MaineCare providers with the tools to submit prior authorizations via the online portal. PA types that may be submitted through the online portal are:

• 
  Dental Services
  
• 
  Dentures
  
• 
  DME/Supplies
  
• 
  DME Urgent
  
• 
  EPSDT– OTS Services
  
• 
  EPSDT– OTS DME
  
• 
  EPSDT PDN OverCap
  
• 
  Hearing Aids
  
• 
  In-State Inpatient Procedures
  
• 
  In-State Outpatient Procedures
  
• 
  In-State Professional Services
  
• 
  OMS-OT
  
• 
  OMS-PT
  
• 
  Orthodontia
  
• 
  Orthotic/Prosthetic Devices– DME
  
• 
  Orthotic/Prosthetic Devices– DME Urgent
  
• 
  Out of State– Inpatient Procedures
  
• 
  Out of State– Inpatient Transplants
  
• 
  Out of State– Long Term Placement
  
• 
  Out of State– Outpatient Procedures
  
• 
  Out of State– Professional Services
  
• 
  Out of State– Transportation
  
• 
  Physician Administered Drugs
  
• 
  Private Duty Nursing– Under 21 Years
  
• 
  Radiology
  
• 
  TMJ Procedures
  
• 
  Vision
  

2.System Requirements

1. 
   Reliable Online connection
   
2. 
   Web browser- The latest version of Microsoft Internet Explorer is recommended. As versions of Internet Explorer become available it is recommended that these versions are used.
   
3. 
   The latest version of Adobe Acrobat Reader
   

3.Preparation for PA Submission Process

• 
  Patient history related to the requested service(s)- for medical necessity
  

• 
  MaineCare Member ID
  
• 
  Member Name
  
• 
  Member Date of Birth
  
• 
  Member Social Security Number (SSN)
  
• 
  Complete the criteria check list and prepare all the necessary documentation you will attach to the PA request you are submitting over the online portal. Paper documents may be scanned for the purposes of attachment.
  

4.Trading Partner

1. 
   From the online portal home page, click the Provider tab at the top of the screen.
   
2. 
   On the Provider tab, enter your user name and password, which you created when you registered your TPA, into the Trading Partner Sign In. See Figure 4-1: Trading Partner Sign In.
   
3. 
   Click the Sign In button.
   

Figure 4 1: Trading Partner Sign In

5.Prior Authorization Submission

• 
  Patient Roster. See Section 5.1: Patient Roster or Primary Care Roster for more information.
  
• 
  Primary Care Roster. See Section 5.1: Patient Roster or Primary Care Roster for more information.
  
• 
  Authorization Submission. See Section 5.2: Authorization Submission for more information.
  

Figure 5 2: Form Entry– Authorization Submission

5.1Patient Roster or Primary Care Roster

1. 
   Once you are logged in as a Trading Partner, click on either the Patient Roster or Primary Care Roster link under the Form Entry heading.
   
2. 
   The roster screen will display, as shown in Figure 5-2: Patient Roster or Figure 5-3: Primary Care Roster, depending on which roster you have chosen.
   
3. 
   Select the Billing Provider from the drop-down menu, if applicable. If there is only one Pay-To provider, this field will be grayed out.
   
4. 
   If you are using the Primary Care Roster, select the PCP from the drop-down menu.
   
5. 
   Select the member from the roster list by clicking the radio button, or
   
6. 
   Select the first letter of the member’s last name from the alphabetical list. If a letter is grayed out, there are no members assigned that have a last name which starts with that letter. If you are using the Patient Roster and the member does not appear, you will need to add the member to your Patient Roster before a submission can be completed. For instructions on adding new members, see the MHP Patient Roster User Guide at the following link:
   

7. 
   Once you see the correct member, select the radio button next to the member in the roster list.
   
8. 
   Click the Submit Authorization button to begin the authorization submission process.
   

Figure 5-2: Patient Roster

Figure 5-3: Primary Care Roster

9. 
   Go to Section 6: Submit Prior Authorization to complete the PA submission.