AuthentiCare® New Mexico

1 AuthentiCare . New Mexico User Manual Prepared by: Version 1. January 1, 2021. Table of Contents TABLE OF CONTENTS .. 2. DOCUMENT 10. INTRODUCTION .. 12. COMMON 12. OVERVIEW OF AUTHENTICARE .. 15. ORGANIZATION OF THE DATA .. 16. AUTHENTICARE USERS .. 16. SECURITY .. 17. USING THIS WEB APPLICATION .. 18. USING THIS 20. GETTING 21. ESTABLISHING A USER ACCOUNT .. 21. NMCC SDCB Support Broker 22. LOGGING IN TO AUTHENTICARE .. 23. LOGGING OUT OF AUTHENTICARE .. 24. ADDING NEW USERS .. 25. NMCC SDCB Support Brokers Adding EOR Users .. 30. DISABLING A USER .. 31. Providers .. 31. New Mexico Centennial Care Administrative Users .. 33. CHANGING YOUR PASSWORD .. 33. AN INTRODUCTION TO NAVIGATING AUTHENTICARE .. 38. HOME PAGE .. 38. 2. January 1, 2021. PROVIDER DASHBOARD .. 42. Unsubmitted Claim Status .. 43. WORKER 45. Checked In On Time .. 47. Scheduled Not Due .. 47. Late or Missed .. 47. SETTING EARLY, LATE AND MISSED VISITS THRESHOLDS .. 48. Steps to Set New Early, Late and Missed Alerts.

2 49. Thresholds Exceptions/Notifications Scenarios: .. 50. EXCEPTIONS DASHBOARD .. 51. SEARCH AND VIEWING PEOPLE AND/OR AGENCIES .. 53. SEARCHING FOR PEOPLE AND/OR AGENCIES .. 53. Viewing Providers .. 55. Viewing Clients .. 56. MANAGING PROVIDER INFORMATION .. 58. EDITING PROVIDER INFORMATION .. 58. Adding Negotiated Rates for Each Service by MCO .. 60. ELECTRONIC REMITTANCE ADVICE (835) FROM NMCC MCOS .. 66. Uploading the 835 into 66. MANAGING WORKER 69. ADDING A WORKER .. 69. DELETING A WORKER .. 73. EDITING WORKERS .. 78. SUSPENDING/INACTIVATING/END-DATING WORKERS .. 78. CREATING A WORKER FOR CONSUMER-DIRECTED ADMIN FEE .. 81. 3. January 1, 2021. SDCB SUPPORT BROKERS/EORS CREATING A WORKER .. 82. MANAGING CLIENT INFORMATION .. 82. EXTERNAL CLIENT ID .. 85. NO TECH ZONE INDICATOR .. 87. HIGH RISK CLIENT INDICATOR .. 88. SEARCH AND VIEW AUTHORIZATIONS .. 89. AUTO END-DATING OF AUTHORIZATIONS .. 92. NMCC MCO DELETION OF AUTHORIZATIONS .. 92.

3 AUTHORIZATIONS WITH ZERO UNITS .. 92. SCHEDULING .. 93. USING THE CALENDAR .. 94. Daily .. 95. Weekly .. 97. 99. SEARCHING FOR SCHEDULED EVENTS IN THE CALENDAR .. 101. SCHEDULING SERVICE VISIT EVENTS .. 102. Scheduling A Non-recurring (Single) Event .. 103. Scheduling a Recurring Event .. 109. EDITING AN EVENT .. 115. DELETING AN EVENT OR A SERIES AFTER IT IS SCHEDULED .. 119. ACKNOWLEDGING MISSED VISITS .. 122. UPLOADING WORKER SCHEDULES .. 126. THE AUTHENTICARE IVR .. 128. IVR FLOW .. 128. SAFEGUARD - WORKERS WITH MORE THAN ONE WORKER ID .. 129. 4. January 1, 2021. ACTIVITY CODES FOR PERSONAL CARE 129. CHECKING-IN/OUT FROM AN UNAUTHORIZED PHONE NUMBER .. 130. Worker Instructions - Using the IVR .. 131. THE AUTHENTICARE MOBILE APPLICATION .. 133. INTRODUCTION ANDROID MOBILE APPLICATION .. 133. Service Zones .. 133. Core AuthentiCare Preparation .. 134. Application Setup Done by Providers .. 134. AuthentiCare Mobile App Fundamentals .. 136.

4 The Worker ID and Password Screen .. 139. To Find a Device ID from the Settings Menu .. 141. Clearing Data to Change from One Environment to Another .. 142. To Log In to the Mobile App First Use .. 144. To Log Out of the Mobile App .. 145. To Access the Calendar .. 147. Worker Check-In at Client Location .. 148. Lookup Client - Enter the Client's ID Number or Last Name .. 150. Worker Check-Out from Client's Location .. 152. AuthentiCare Mobile App Menu Basics .. 153. Two Different Menu Displays .. 154. WORKER INSTRUCTIONS FOR USING THE MOBILE APP ANDROID .. 155. THE AUTHENTICARE MOBILE APPLICATION - IOS .. 156. Introduction iOS Mobile 156. Service Zones .. 156. Core AuthentiCare Preparation .. 156. 5. January 1, 2021. Application Setup Done by Providers .. 157. AuthentiCare Mobile App Fundamentals .. 159. The Worker ID and Password Screen .. 161. To Find a Device ID from the Settings Menu .. 164. Clearing Data to Change from One Environment to Another.

5 165. To Log in to the Mobile App First Use .. 167. To Log Out of the Mobile App .. 168. To Access the Calendar .. 169. Worker Check-In at Client Location .. 170. Worker Check-Out from Client's Location .. 175. AuthentiCare Mobile App Menu Basics .. 176. Two Different Menu Displays .. 178. WORKER INSTRUCTIONS FOR USING THE MOBILE APP - IOS .. 179. MANAGING CLAIMS .. 180. SEARCHING AND VIEWING CLAIMS .. 181. EDITING A CLAIM (CLAIMS CORRECTION) .. 187. Correcting a Check-in/Check-out .. 187. Changing/Correcting a Default Payer .. 189. ADDING AN INDIVIDUAL (STANDARD) CLAIM .. 190. GROUPING CLAIMS .. 195. ADDING MULTIPLE CLAIMS (EXPRESS ENTRY) .. 196. DELETING A CLAIM .. 197. CONFIRMING A CLAIM FOR EXPORT DUAL CONFIRMATION .. 199. CONFIRMING A SINGLE CLAIM FOR EXPORT .. 201. CONFIRMING CLAIMS IN 207. 6. January 1, 2021. UNCONFIRMING CLAIMS FOR FURTHER EDITING .. 207. ADDING NOTES CLAIM EDIT/ENTRY DOCUMENTATION .. 208. AUTO CLAIMS CREATION-CONSUMER-DIRECTED ADMIN FEE.

6 208. CREATE A CONSUMER-DIRECTED ADMIN FEE WORKER .. 210. Processing Consumer-Directed Admin Fee Claims .. 210. Filing Source of NMCC's Automated Claims .. 210. PERSONAL CARE CONSUMER DIRECTED SERVICE (99509) .. 211. Authorizations: Personal Care Consumer Directed .. 212. Visit Service Claims and Billing Service Claims .. 213. Generic Worker Creation BillingService Worker .. 217. Caution: Claims for Same Date of Service .. 217. STIPEND CLAIMS .. 217. CREATING WEB CLAIMS: T1019- 99509V- G9006U1-U2 .. 220. PAYER CLAIMS REVIEW PROVIDERS .. 222. Creating Web-Based Claims for Payer Review .. 222. Confirming Web-Based, Payer-Reviewed Claims .. 226. Resolving a Denied Claim - Provider .. 226. PAYER CLAIMS REVIEW PAYERS .. 227. Reason Codes and Claim Notes .. 231. Resolving a Denied Claim - Payer .. 232. Information for 99509V and 99509 .. 233. Final Payer Notes .. 233. REPORTING .. 234. CREATING A REPORT .. 234. VIEWING A REPORT .. 238. 7. January 1, 2021.

7 DELETING A REPORT FROM THE VIEW REPORTS SECTION .. 240. USING REPORT TEMPLATES .. 241. Creating Report 241. Running a Report from a Template .. 244. Editing a Report Template .. 244. Deleting a Report Template .. 246. SCHEDULING A 247. REPORT 249. Authorizations Report without Claim 249. Authorizations Report with Claim Detail .. 251. Authorization History Report .. 252. Billing Invoice 253. Calendar Report .. 255. Claim Data Listing 257. Claim Details Report .. 260. Claim History Report .. 262. Eligible Client Data Listing Report .. 264. Exception Report .. 265. Late and Missed Visits Report .. 268. Overlapped Claim Report by Client .. 269. Overlapped Claim Report by Worker .. 270. Provider Activity Report .. 273. The Remittance Advice Report: .. 276. Remittance Data Listing Report .. 277. Time and Attendance Report .. 279. 8. January 1, 2021. Unauthorized Location Report .. 281. Worker Activity 286. Worker by Provider Report .. 287. MULTI-BRANCH PROCESS.

8 290. TO ASSIGN AN AUTHORIZATION .. 291. TO REASSIGN AN AUTHORIZATION TO A DIFFERENT BRANCH .. 291. ONGOING USER SUPPORT AND TRAINING .. 293. APPENDIX : SERVICE CODES NEW Mexico CENTENNIAL CARE .. 294. APPENDIX : ACTIVITY CODES FOR THE FOLLOWING SERVICES: .. 295. APPENDIX : CLAIM EXCEPTION CODES AND CLAIM STATUS .. 296. APPENDIX : DESCRIPTION OF PROVIDER ROLES .. 305. APPENDIX : SERVICE PLAY BACK ORDER ON THE IVR .. 307. APPENDIX : SDCB SERVICE CODES .. 307. APPENDIX : SDCB ACTIVITY CODES .. 308. 9. January 1, 2021. Document History This document is controlled through the Document Management Process. To verify that the document is the latest version, please contact First Data Client Support at Date Version Responsible Reason for Revision April 24, 2014 First Data Initial Submission First Data Updated Submission May 14, 2014. August 1, 2014 First Data Updated Submission November 18, First Data Updated Submission 2014. April 16, 2015 First Data Updated Submission June 26, 2015 First Data Updated Submission September 29, First Data Updated Submission 2015.

9 March 24, 2016 First Data Updated Submission July 27, 2016 First Data Updated Submission March 10, 2017 First Data Updated Submission April 1, 2018 First Data Updated Submission April 9, 2018 First Data Updated Submission September 28, First Data Updated Submission 2018. March 28, 2019 First Data Updated Submission 10. January 1, 2021. January 1, 2021 Fiserv Includes SDCB changes 11. January 1, 2021. Introduction New Mexico Centennial Care utilizes AuthentiCare for six (6) specific services provided to clients assessed as eligible to receive one or more of the services provided through New Mexico Centennial Care providers. New Mexico Centennial Care is comprised of three different Managed Care Organizations (MCOs): Blue Cross and Blue Shield of New Mexico , Presbyterian Health Services, and Western Sky Community Care. Providers of selected services (procedures) are required to use AuthentiCare to capture and bill for services provided to New Mexico Centennial Care members who are known in AuthentiCare as clients.

10 (See Appendix for the list of included services.). AuthentiCare is web-based electronic visit verification, scheduling, tracking, reporting and billing system that: Automatically captures and invoices accurate services provided to clients Provides the ability to automate scheduling, time and attendance, billing and reporting functions Assists in identifying and responding to unmet client needs (missed and late visits). Provides New Mexico Centennial Care MCOs data to assist in making policy decisions regarding the delivery of services Common Terminology/Acronyms Users must be familiar with the terms and acronyms used in AuthentiCare in order to take full advantage of the functionality and follow the instructions in this User Manual. These include: Term/Acronym Meaning/Use 835 The 835 is the electronic remittance advice (RA) that applicable New Mexico Centennial Care MCOs provide to providers reporting the adjudication status of each claim submitted.