Completing the IP procedure prescreening
Complete the Procedure Prescreen immediately to learn the classification of IP procedure(s) request. This is part of the comprehensive Inpatient workflow.
The procedure prescreen functionality immediately provides the classification of an inpatient procedure. If required, you can proceed with the workflow. If not required, or if another business evaluation occurs, a message informs you of the next action to take.
You might see messages while completing the Procedure Prescreen section. For more information about the messages, see Prescreen messages.
To complete the Procedure Prescreen section:
1. Enter the Service start date in the format mm/dd/yyyy or use the date picker. The procedure start date will automatically default to the admission date entered on Admission prescreen. This date may be edited with the inpatient length of stay time frame From and End dates labeled in the Inpatient Summary section.
2. Enter the Service end date in the format mm/dd/yyyy or use the date picker. The procedure end date will automatically default to the admission date entered on Admission prescreen. This date may be edited with the inpatient length of stay time frame From and End dates labeled in the Inpatient Summary section.
3. From the Member's Applied Eligibility menu, make a selection.
This field auto-completes when the member’s eligibility is on record.
4. Select the service type from the Service Type menu.
5. Select the place of service from the Place of Service menu.
6. Specify the information for the Servicing Provider search box using the following steps:
a. Enter a minimum of two characters in the Search by Provider name or Search by Provider NPI and select Search.
b. If the characters you enter have a unique match, the fields are filled in automatically and you can skip the next step.
This search is checked against the full TruCare provider database. If you search using the dashboard provider filter, you are limited to only those facilities associated with your user account.
7. Select the provider specialty fro m the Provider Specialty menu (optional).
If the provider does not have a speciality, this field is not displayed. If the provider has only one specialty, the field is automatically populated with it.
8. If necessary, select Clear to start over.
9. In the Requested Units field, type the number of requested units or use the scroll arrows to enter requested days.
The count must be at least 1 (one).
10. From the Unit Type menu, make a selection.
11. Specify the procedure:
a. Enter a minimum of two characters in the Search by Procedure name or Search by Code, optionally choose a code set from the drop-down menu, and select Search.
Use precise criteria to get the best search results; only 50 data entries are shown for each search.
If the characters you enter match a single record, the fields are filled in automatically and you can skip the next step.
If your search did not result in a match, a slider opens with search results. To refine your search, select Name contains or Name starts with, enter your new search term in Search by Procedure name or Search by Code, optionally select a code set, and select Search.
b. Choose the correct record (procedure name, code, code set) in the search results, scrolling through the list if needed.
The code set includes the procedure coding schemes defined in TruCare.
If necessary, select Clear to start over.
You might see a message about a procedure code being expired. For more information about expired codes, see Expired diagnosis or procedure codes.
Note: Select + to add another inpatient procedure that has the same dates of service, service type, and servicing provider. If there is a different date of service, service type, or servicing provider, you can add another service from the review page. For additional information, see Adding an IP Service.12. Select Next.
The Procedure prescreen information is processed. If you can proceed with the Inpatient procedure(s) requested, you automatically continue to the Procedure Details page where you can add more details.
You might see a message with additional information about the Inpatient Procedure requested. Click Next again to continue to the Authorization Details page.
Sometimes the results of the prescreen evaluation prevent you from continuing with the Inpatient Procedure requested, for one of the following reasons and the message will display with a red font:
• Authorization is not required
• Duplicate request
• Review needed by a third party
• Member ineligibility
When one inpatient procedure is requested and results with one of the above results, Select Cancel/Back to Review Summary so that you may continue with the Inpatient Authorization request.
In the example below, there are multiple prescreen results where one result is "IP Auth is required" (dark gray text) and the other result is "IP Auth is not required" (red text). In order to proceed with the authorization, you need to remove the "IP Auth is not required" procedure. Hint text appears when you hover over the information icon or any part of the message. The Next button is disabled until you remove the procedure that is not required. Click the trashcan icon to remove the procedure not requiring authorization. The Next button is then enabled.