CareCore National: Web Certification Help

Overview
Instructions
Definitions

Overview

CareCore now provides a secure WEB based process to initiate clinical notification for diagnostic imaging requests. The automated system guides the user through a series of computer screen prompts to collect routine demographic data. Each WEB initiated request is evaluated promptly by CareCore clinical review staff. A short return call from CareCore to the requester completes the notification process. This eliminates the need for a call to CareCore's Intake staff and allows the user to enter multiple clinical notification requests at their convenience.

Instructions

Once logged into the CareCore National, LLC Web Pre-Certification site you will be prompted to choose a Referring Provider as well as an Address and Health Plan to begin the Pre-Certification process:
- PLEASE CHOOSE A REFERRING PROVIDER - A provider who has been signed up with a specific ID can be chosen from the drop down list. Once the provider is selected the Address section will be populated.
- PLEASE CHOOSE AN ADDRESS - this drop down will have a list of all addresses that the Referring Provider who was chosen can request a Pre-Certification for. This field is only populated once a Provider has been selected. NOTE: Only addresses which have been signed up to a specific ID will be listed.
- PLEASE CHOOSE A HEALTH PLAN - This field will be populated once an Address has been selected. It will display all Health Plan that the Referring Provider at the Address chosen can request a Pre-Certification for. This field is only populated once an Address has been selected.
- CONTINUE - Select this button to continue the Pre-Certification process once the referring provider, address, and health plan information has been selected
All required fields on this form must be completed. Definitions for any fields are available in "Definitions" (Roman Numeral III at top of this HELP page) or by clicking on the question mark closest to the field in question.
Patient Lookup - This button will allow searches in the eligibility tables. Searches may be run using Patient ID (RECOMMENDED), Patient Member Code (which must be entered with a Patient ID), or by Patient Name. Use the character "*" without the quotes as a "wildcard" character. (Ex. searching Patient Name O*DONNEL will return results of ODONNEL, O'DONNEL, OLDMCDONNEL etc.)
Once the information has been looked up and the correct patient has been found, you can select the patient by clicking anywhere on the record that has been returned. Once the record is selected you will see the patient information populate into the appropriate fields. When the POPULATE button is selected the information will be transferred back to the working Pre-certification page.
The list of CPT Codes are populated once a patient is selected. The codes available are Health Plan Specific. CPT codes can be selected from the drop down list or entered directly into the CPT code field. (Ex. Typing the numbers 7 - 0 - 5 - 5 - 1. Will actually display the CPT Code 70551.)
The CPT Code description appears in the Procedure field and are populated once a patient is selected. Again, the codes are Health Plan specific. CPT Code descriptions can be selected from the drop down list or entered directly into the Procedure field.You can type in the Procedure List fields once you have gained focus on it. (Ex. Typing MRI will then display the Procedures that start with MRI as their description.)
Local Site Lookup - We have designed a Site lookup that will display all quality facilities that are conveniently located close to your office, or near the Patient.
Site Lookup - This button will allow searches of all available radiology providers. Searches may be run using Site ID (RECOMMENDED), Site Name, City, or Zip Code (or any combination). Use the character "*" without the quotes as a "wildcard" character.
Once the information has been looked up, and the correct Site has been found, you can select the Site by clicking anywhere on the record that has been returned. Once the record is selected you will see the information populate into the appropriate fields. When the POPULATE button is selected the information will be transferred back to the working Pre-certification page.
Diagnosis Code Lookup. Selecting this button will allow searches of available Diagnosis Codes. Searches by the code or description are available. The "*" wild card character can be used here as well.
Save - This will save all entered information to the CareCore database.
Clear - Use this button to clear all manually entered fields.
Close - This selection will return the user to the initial page where the Provider, Address, and Health Plan can be re-selected.
Once a case is saved, if the requested exam requires Clinical Notes, you will be offered the option to download a Clinical Notes Form that can be filled out and faxed back to CareCore National, LLC.
Duplicate - This functionality has been permanently removed.

Definitions

Provider's Name:
The {rpvoder who will be considered the referring provider for the exam requested. The maximum length is 50 characters. This is a mandatory field.: The {rpvoder who will be considered the referring provider for the exam requested. The maximum length is 50 characters. This is a mandatory field.

Phone (Provider):
The phone number where the provider can be contacted. This is a mandatory field.: The phone number where the provider can be contacted. This is a mandatory field.

Fax (Provider):
The fax number where the provider can be contacted. This is a mandatory field.: The fax number where the provider can be contacted. This is a mandatory field.

Who To Contact:
The person who will be responsible to have the clinical information necessary to complete the request.: The person who will be responsible to have the clinical information necessary to complete the request.

Ext.:
The extension where the person who is identified as the "contact person" can be reached. The maximum length is 25 characters.: The extension where the person who is identified as the "contact person" can be reached. The maximum length is 25 characters.

Patient ID:
The ID number of the patient. This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button. This is a mandatory field.: The ID number of the patient. This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button. This is a mandatory field.

Mem Code:
The member code of the patient. This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button.: The member code of the patient. This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button.

Patient DOB:
The patient's date of birth. This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button.: The patient's date of birth. This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button.

Patient Name:
The patient's name (Last,First). This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button.: The patient's name (Last,First). This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button.

Patient Sex:
The patient's gender. This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button.: The patient's gender. This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button.

Address (Patient):
The patient's address (both address lines 1 and 2). This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button.: The patient's address (both address lines 1 and 2). This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button.

City, State, Zip (Patient):
The patient's city, state and zip code. This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button.: The patient's city, state and zip code. This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button.

Phone (Patient):
The patient's phone number. This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button.: The patient's phone number. This field can only be populated from the "Eligibility Lookup" screen, which is accessed by the "Eligibility Lookup" button.

CPT Code:
The CPT Code that corresponds with the exam requested. When the CPT Code is selected, the Procedure (exam description) is automatically populated to the appropriate field. This is a mandatory field.: The CPT Code that corresponds with the exam requested. When the CPT Code is selected, the Procedure (exam description) is automatically populated to the appropriate field. This is a mandatory field.

Procedure:
The description of the CPT Code that corresponds with the exam requested. After this is chosen, the CPT Code is automatically populated to the the appropriate field.: The description of the CPT Code that corresponds with the exam requested. After this is chosen, the CPT Code is automatically populated to the the appropriate field.

Site Name:
The name of the facility where the patient will have the test performed. This field can only be populated from the "Site Look Up" screen, which is accessed by the "Site Look Up" button. This is a mandatory field.: The name of the facility where the patient will have the test performed. This field can only be populated from the "Site Look Up" screen, which is accessed by the "Site Look Up" button. This is a mandatory field.

Address (Site):
The address of the facility where the patient will have this tes performed (both address lines 1 and 2). This field can only be populated from the "Site Look Up" screen, which is accessed by the "Site Look Up" button.: The address of the facility where the patient will have this tes performed (both address lines 1 and 2). This field can only be populated from the "Site Look Up" screen, which is accessed by the "Site Look Up" button.

City, State, Zip (Site):
The city, state and zip code of the facility where the patient will have the test performed. This field can only be populated from the "Site Look Up" screen, which is accessed by the "Site Look Up" button.: The city, state and zip code of the facility where the patient will have the test performed. This field can only be populated from the "Site Look Up" screen, which is accessed by the "Site Look Up" button.

Phone (Site):
The phone number of the facility where the patient will have the test performed. This field can only be populated from the "Site Look Up" screen, which is accessed by the "Site Look Up" button.: The phone number of the facility where the patient will have the test performed. This field can only be populated from the "Site Look Up" screen, which is accessed by the "Site Look Up" button.

Fax (Site):
The fax number of the facility where the patient will have the test performed. This field can only be populated from the "Site Look Up" screen, which is accessed by the "Site Look Up" button.: The fax number of the facility where the patient will have the test performed. This field can only be populated from the "Site Look Up" screen, which is accessed by the "Site Look Up" button.

Diagnosis Code:
The Diagnosis Code for this case. If this is manually typed in, the Diagnosis will automatically be updated to the description of the chosen Diagnosis Code. This is a mandatory field.: The Diagnosis Code for this case. If this is manually typed in, the Diagnosis will automatically be updated to the description of the chosen Diagnosis Code. This is a mandatory field.

Diagnosis:
The description of the Diagnosis Code chosen for this case. This will automatically be updated to the description of the chosen Diagnosis Code every time the Diagnosis Code is changed (whether manually or through the lookup).: The description of the Diagnosis Code chosen for this case. This will automatically be updated to the description of the chosen Diagnosis Code every time the Diagnosis Code is changed (whether manually or through the lookup).

At Work:
Specifies if this study is requested due to an injury that occurred at work. This is a mandatory field.: Specifies if this study is requested due to an injury that occurred at work. This is a mandatory field.

During An Auto Accident:
Specifies if this study is requested due to an injury that occurred as a result of an auto accident. This is a mandatory field.: Specifies if this study is requested due to an injury that occurred as a result of an auto accident. This is a mandatory field.

Additional Comments:
Any additional comments that should be attached to this request. This should include any additional information that would help the CareCore clinical reviewer and provider reviewers to establish the medical necessity of the exam.: Any additional comments that should be attached to this request. This should include any additional information that would help the CareCore clinical reviewer and provider reviewers to establish the medical necessity of the exam.