Illinois Provider Portal Prescriber Webinar What is the Provider Portal? Secure, Web-based Portal for Prescribers to: View Participants Eligibility View Participants Profile Approved Prior Authorizations Medication Profile (Illinois Medicaid) View Illinois Medicaid's Formulary View Preferred Drug List (PDL) Preferred/Non-Preferred Status, Including Potential Alternatives Four Prescription Policy Inclusion/Exclusion Submit Prior Authorization (PA) Requests Electronically Upload Supporting Documents
Illinois ViewProvider Real-Time Statuswith of federal Priorand Authorization Note: The Portal is compliant state accessibility Requests requirements, including the Illinois Technology Accessibility Act (ITAA) and the Americans with Disabilities Act (ADA). 02/03/2020 2
Registration All providers currently registered with IMPACT will receive an e-mail with enrollment instructions. If you have not registered for IMPACT, you need to do so. Note: Access to the Illinois Provider Portal is limited to authorized pharmacists and prescribers. IMPACT Home: http://www.illinois.gov/hfs/impact/Pages/default.aspx 02/03/2020 3
Registration Once your new registration for IMPACT has been processed, you will receive an email to Finish Registration. This will take approximately ten (10) days. Note: Office Workers must create a single sign on User ID in IMPACT and be associated with a Pharmacy. After the initial registration for the primary user, all other users will receive an e-mail when their Pharmacy administrator grants them access to the Provider Portal. 02/03/2020 4 Registration General Questions: Providers with general questions about IMPACT or
provider enrollment should contact: Email: [email protected] Phone: 1877782 -5655 (select option #1) Login Issues: Providers that are having trouble logging in to the IMPACT system should contact: Email: [email protected] Phone: 1-888-618-8078 Please contact the IMPACT project team with any questions or comments regarding provider enrollment. If the IMPACT team cannot directly address your question, the project team will coordinate with staff from HFS, IDoA, DCFA and the UIC DSCC to ensure you receive the information you need. 02/03/2020 5
Logging In To Login to the Illinois Provider Portal, go to: https://ilrxportal.illinois.gov Click on the ILLINOIS Rx Portal icon or text link to enter the Provider Portal. From the Login screen, enter your User ID and Password. Read the Terms and Condition, and click to add a checkmark to accept the terms. Note: The application is set to lock out after five failed login attempts. If this happens, please contact HFS:
Scroll to the bottom of the page and click the Login button. Email: [email protected] 02/03/2020 6 Forgot Password If you forgot your password, select the Forgot Password hyperlink from the Login screen. The application will direct you to enter the registered email address. Enter your email address and click Reset. You will receive an email with a hyperlink to reset the password. Note: The reset hyperlink is valid only for 15 minutes. 02/03/2020
7 Change Password You can reset your password by clicking on the menu item titled User Preferences. Under User Preferences, click Change Password. Enter your new Password, verify Password (e.g., enter new Password again), and click Save. 02/03/2020 8 Dashboard Menu Bar
Once logged into the Illinois Provider Portal, you will see the Dashboard screen. At the top of the Dashboard screen you will find access to the following menu items: 02/03/2020 Dashboard Create PA User Preferences Worker Management Help
Ability to View Status of All PAs Submitted in Last 45 Days Includes Faxed or Electronic Status Pending, Approved, Denied, Deferred and Abandoned Unique Ticket ID for Every PA Request Use for Correspondence/Follow-Up on Request 10 Dashboard - Participant Name Participants Name hyperlink, allows you to view the participants profile, which includes: Demographics
Third Party Liability (TPL) Eligibility (Medicaid/Medicare) Claim History (Drug Profile Hyperlink) Provider Restrictions Approved PA History (PA Profile Hyperlink) Managed Care Organization (MCO) Note: You can also retrieve a participants information by clicking on the Participant menu option. You can search by Illinois Medicaid ID number, Social Security Number (SSN), or a combination of last name, first name, and date of birth (DOB). 02/03/2020
11 Dashboard - View PA Details Clicking the View (magnifying glass) hyperlink takes you to the PA Details screen. Note: Prescribers are notified by fax when a PA request is approved, denied, deferred, or abandoned. The system uses the fax number associated with your account in IMPACT. Make sure your fax number is correct so you receive notifications in a timely manner. 02/03/2020 12 Dashboard - View PA Details Screen The PA Details screen provides the PA
Tracking number and an image of the PA submitted (Web PA). Note: To view the entire PA, click the View PA as Image button or Open in new window hyperlink. You can also view PA Info, documents that have been submitted (uploaded) and review the Most Recent Determination Letter Sent. 02/03/2020 13 Dashboard Determination Letter Clicking the View (magnifying
glass)hyperlink opens the most recent determination letter. Prescribers are notified by fax when a PA request is pending, approved, denied, deferred, or abandoned. The system uses the fax number associated with your account in IMPACT. Make sure your fax number is correct so you receive notifications in a timely manner. 02/03/2020 14 Dashboard Upload Reference Info
Once the PA has been created, you can upload reference information to support the PA request (i.e., lab results, chart notes, or other documentation requested from the Dashboard). Step 1. Identify the PA request and click the magnifying glass or upload reference info action button. Step 2. Click the Upload Reference Info button. Note: This step skipped if selecting upload reference info action button from Dashboard. Step 3. Select the ref info from your files, and click the Upload button.
Confirmation: After the reference information has been uploaded, a message regarding the status appears on the screen. 02/03/2020 Note: Files size cannot exceed 1 MB. 15 Prior Authorization Workflow Request PA via Provider Portal HFS Adjudicates/ Determines PA
Response Letter Mailed to Participants/Faxed to Prescribers Status of PAs and Determination Letter Available on Dashboard Approved PA Available for Claim Adjudication 02/03/2020
16 Creating a New PA (Create PA) STEP 1. GETTING STARTED, P. 1 Click on the Create PA tab to begin a new prior authorization request. Use the Lookup toggle buttons to search for: Lookup Drug Lookup Participant Lookup Pharmacy (Optional) Lookup Diagnosis
The Prescriber section of the PA form will be auto-populated. Note: Throughout PA form, blank fields can not be typed in where a Lookup toggle button is present. 02/03/2020 17 Creating a New PA (Create PA) STEP 1. GETTING STARTED, P. 2 Required Fields 02/03/2020
Required fields include Drug, Participant, Prescriber, Pharmacy (optional if prescriber is completing; required from pharmacy); Contact Info (Contact Name and Contact Number); and Quantity/Days Supply (not fill # is defaulted). Most required fields on a PA form have an asterisk (*) next to them (not all fields though are marked such as Contact Info and Contact Number).
If a required field is not completed, upon submitting a PA, you will receive an error. Fields containing an error will have a hyperlink that will direct you to the field that needs to be completed (Example provided in Step 2. Drug Info Populated in PA slide). 18 Creating a New PA STEP 2. LOOKUP DRUG Click the Lookup Drug toggle button to get to the Formulary Search screen. Enter the National Drug Code (NDC) number or at least the first three characters of a brand name or generic drug and click the Search button.
02/03/2020 19 Creating a New PA STEP 2. FORMULARY SEARCH RESULTS, P.1 Two lists display. The top list contains drugs that meet the entered search criteria and outlines the drugs by Name, Description, Route (of Administration), Over-The-Counter (OTC) Code, Brand/Generic (BG) Code, Packaging type, Preferred Drug List (PDL) Status, 4 RX (Prescription) and the option to Request PA. *PDL Status identifies whether the drug is Preferred/Non-Preferred, including those preferred requiring a PA.
*4 RX will identify whether the drug is included (reject or not reject) or excluded from the 4 RX Policy. Click on the drug name to display the clinical criteria about the drug. 02/03/2020 20 Creating a New PA STEP 2. FORMULARY SEARCH RESULTS, P.2 The lower list displays other formulary drug alternatives. 02/03/2020
21 Creating a New PA STEP 2. SELECT DRUG/REQUEST PA Select Drug: From either the Formulary Search or Drug Information screen, you can select the drug by clicking on the Request PA button. Select PA Form: Based on the drug and type of request, you may have multiple forms to choose from (see PA Form Selection). From the drop-down box, choose the appropriate PA and click the Select Form button. 02/03/2020
22 Creating a New PA STEP 2. DRUG INFO POPULATED IN PA Once the appropriate drug and PA form have been selected, the Drug Name, Strength, and Package fields are auto populated in the PA request. Required Fields Quantity Days Supply Note: Entering Dosage Instructions is optional. 02/03/2020 Error: If Quantity or Days Supply is not populated, upon submitting the PA, you will receive an error.
Fields containing an error will have a hyperlink that will direct you to the field that needs to be completed. 23 Creating a New PA STEP 3. LOOKUP PARTICIPANT Click the Lookup Participant in the Web PA form (Required Field). Your search criteria needs to be specific enough that only the one participant you are looking for appears in the search results. You can search by Illinois Participant ID number, Social Security Number (SSN), or a combination of last name, first name, and date of birth (DOB). Note: As you choose the participant, pharmacy, and diagnosis, you will can see the Currently Selected above the menu bar. 02/03/2020
24 Creating a New PA STEP 3. LOOKUP PARTICIPANT - ERROR If you put in only the participants, you will receive an error message (see below). The Illinois Provider Portal will display a maximum of one participant record in response to a Participant Search. 02/03/2020 25 Creating a New PA STEP 3. PARTICIPANT SEARCH RESULTS
Clicking the Illinois Participant ID hyperlink or the Select button to go to the participants profile. 02/03/2020 26 Creating a New PA STEP 3. PARTICIPANT PROFILES Click on the PA Profile to view the participants prior authorization history. Click on the Drug Profile to view the participants RX history. Click the Return to Participant Profile to return to the participant profile screen. Click Select to populate the participants
information into the PA form. 02/03/2020 27 Creating a New PA STEP 3. PARTICIPANT SELECTED Once the participant is selected, their information populates in the PA form. Note: To deselect a participant, click the Clear button on the Participant Profile screen. *The Clear function is a common feature for Participant, Pharmacy, Formulary, and Diagnosis. 02/03/2020 28
Creating a New PA STEP 4. CHANGE PROVIDER As the Prescriber, your information should auto-populate into the PA form fields. If your staff works for more than one physician (Office Manager/Office Worker) they can click the Change Provider button to select the correct location in Provider Management 02/03/2020 29 Creating a New PA STEP 5. LOOKUP PHARMACY Click the Lookup Pharmacy button in the Web PA form (Not Required).
To locate a pharmacy, enter: The National Provider Identifier (NPI) number, or at least the first three characters of a pharmacy name, or a City and State combination. Click the Search button. Depending on the search criteria, a single pharmacy or a list of pharmacies will display, with addresses and phone numbers, will display. 02/03/2020 30 Creating a New PA STEP 5. PHARMACY SEARCH RESULTS Clicking the Pharmacy Name hyperlink or the Select button to go to the pharmacys profile. Clicking the Select button to select the pharmacy.
02/03/2020 31 Creating a New PA STEP 5. PHARMACY SELECTED Once the Pharmacy is selected, their information populates in the PA form and above the menu bar. 02/03/2020 32 Creating a New PA STEP 6. LOOKUP DIAGNOSIS
Click the Lookup Diagnosis in the Web PA form (Not Required). Enter the ICD-10 code, ICD-9 code (if the date of service is prior to October 1, 2015), or at least three characters of a diagnosis description and click the Search button. The results list displays, containing the ICD-10 or ICD-9 code, a diagnosis description, and an option to select the Diagnosis to appear on the PA form. 02/03/2020 33 Creating a New PA STEP 6. DIAGNOSIS SEARCH RESULTS Clicking the Code hyperlink or the Select button to go to view Diagnosis information.
Clicking the Select button to select the Diagnosis code. 02/03/2020 34 Creating a New PA STEP 6. DIAGNOSIS SELECTED Once the Diagnosis code is selected, the information populates in the PA form and displays at the top of the screen. 02/03/2020
35 Creating a New PA STEP 7. CONTACT INFORMATION While not marked with an asterisks (*), you must verify that you Contact Name and Contact Number are entered (Required). If one or the other is missing, you will receive an error message upon submitting. 02/03/2020 36 Creating a New PA STEP 8. DRUG INFORMATION
If you did not use the Lookup Drug button at the start of the Create PA process, click the Lookup button to find drug information (previously covered in Creating a New PA - Step 1). To complete the Drug Information section, enter the Quantity and Days Supply (Required) 02/03/2020 37 Creating a New PA STEP 9. CLINICAL INFORMATION Depending on which PA form is in use, the lower section requires various types of information. You may be required to provide clinical information (medical necessity) to justify the PA request. These are text fields where you can type in related information that will assist the clinical pharmacist in making a
determination on the PA. Note: Based on the form chosen (i.e., General PA Form), the override selection is optional. Once the PA form has been completed, click the Submit button. If there were no errors, you will receive a notification that it has been submitted. 02/03/2020 38 Creating a New PA STEP 10. SUBMITTED PA - DASHBOARD Your PA will be submitted to the HFS prior authorization team to adjudicate
and determine your PA request. Within a few minutes of submitting the PA form, the status of the PA request will appear on your Dashboard. You can refresh the page to monitor the status or log out/log back in to check on your request. 02/03/2020 Status Types: Pending: PA request is in process. Approved: A request has been approved, PA number assigned.
Denied: PA request has been denied. Deferred: PA request is waiting on additional information from the provider before determination. Abandoned: Deferred PAs that receive no additional information from the provider are closed after 20 days. 39
Dashboard Upload Reference Info Once the PA has been created, you can upload reference information to support the PA request (i.e., lab results, chart notes, or other documentation requested from the Dashboard). Step 1. Identify the PA request and click the magnifying glass or upload reference info action button. Step 2. Click the Upload Reference Info button. Note: This step skipped if selecting upload reference info action button from Dashboard. Step 3. Select the ref info from your files, and click the
Upload button. Confirmation: After the reference information has been uploaded, a message regarding the status appears on the screen. 02/03/2020 Note: Files size cannot exceed 1 MB. 40 Dashboard Upload Reference Info, MIME Types The main file types allowed are listed below:
02/03/2020 Microsoft Excel Files (.xsl, .xslx) Microsoft Word (.doc, .docx) Rich Text format (.rtf, .rtfx) Text files, such as from notepad (.txt) Graphics files such as the following: Bitmaps (.bmp) .Jpeg
.Pjpeg .Tiff, .x-tiff .png Internet Explorer files (.html) Adobe Acrobat files (.pdf) Open Office formats (.xml) 41 User Preferences The User Preferences tab enables you to make changes to passwords. 02/03/2020 42
Address Preference Prescribers often practice in multiple locations. The Address Preference option gives prescribers the option to select a specific location to be used as the default location. The selected location auto-populates the PA form. 02/03/2020 43 Change Password The Change Password button on the User Preferences screen provides the ability to change the login password. Changes take effect immediately. 02/03/2020
44 Worker Management The Worker Management tab gives prescribers a way to grant permission to office workers to submit PA requests on their behalf. Click the User button to change the user from Office Worker to Office Manager. Click the Change User icon to move the user from Office Manager to Office Worker. Click the red X to delete the office worker. Note: Once you have removed an Office Worker from all associated providers, he or she no longer has access to the Illinois Provider Portal. 02/03/2020
45 Provider Management Office Manager/Worker Tool The Provider Management button gives Office Workers who are associated with multiple prescribers the option to enter PA requests for each prescriber. Note: Each worker must be enrolled in IMPACT and associated with each prescriber. 02/03/2020 46 Help The Help tab contains information about the Illinois Provider Portal and provides you with a
hyperlink to the User Guide, User Tutorials, and important contact information. 02/03/2020 47 Conclusion You have completed the Provider Portal webinar. 02/03/2020 48
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