Step Requesting Provider Information data. 2 Click Next to continue. Step Enter in Service Provider Information. If not known, click the Search button. 3 To search for facility information, click the search button. Type in a keyword into the search field or enter Provider ID and click Find. Select the Provider from the search results. Step Complete the drop down fields for Service Detail. 4 Note: The Attending Physician section is optional. Step Select the Request Type from the drop down menu. 5 Step Fill in the required information for Procedure Codes (CPT) 99199 6 Enter the Start Date and End Date using the calendar dropdowns. Enter the quantity and select the number of Units, Hours, etc. from the dropdown, rate and model number. Enter the modifier(s), to a maximum of three If a new code to be added, delete the original entry and add the new one. Search for the code using the Code Starts With or Description fields. Find. Select the appropriate CPT code to be added. Step Add Diagnosis Code (ICD 9) by clicking the Add New Code button. 7 Like the CPT Codes, search, locate, and attach Diagnosis Codes by using the search function. Search by Code Starts With or Description. Click Search. Select the appropriate ICD 9 code. At least one diagnosis code must be attached to the case. If there are more than one, one must be selected as the primary. If a new code to be added, delete the original entry and add the new one. Step Enter any clinical notes in the text field. 8 Click Next to continue. Step Attach clinical documentation by clicking the browse button. 9 Browse and find the file and click Open to attach. Once attached, click Submit. Step The indicator icons on the left of the screen should be visible in all service request areas to show 10 that all required data has been inputted. Step Questionnaires (if applicable) 11 Step Click the checkbox at the bottom of the page and click either Save for Later or Submit. 12 You will not be able to proceed if you do not click the checkbox. An error message will appear as shown to the right. Step The Request Overview is displayed. 13 END OUTPATIENT PROCESS FLOW Questionnaires Step If a review 1 requires the completion of a
Step 2 Requesting Provider Information data. Click Next to continue. Step 3 Enter in Service Provider Information. If not known, click the Search button. To search for facility information, click the search button. Type in a keyword into the search field or enter Provider ID and click Find. Select the Provider from the search results. Step 4 Complete the drop down fields for Service Detail. Note: The Attending Physician section is optional. Step 5 Select the Request Type from the drop down menu. Step 6 Fill in the required information for Procedure Codes (CPT) 99199 Enter the Start Date and End Date using the calendar dropdowns. Enter the quantity and select the number of Units, Hours, etc. from the dropdown, rate and model number. Enter the modifier(s), to a maximum of three If a new code to be added, delete the original entry and add the new one. Search for the code using the Code Starts With or Description fields. Find. Select the appropriate CPT code to be added. Step 7 Add Diagnosis Code (ICD 9) by clicking the Add New Code button. Like the CPT Codes, search, locate, and attach Diagnosis Codes by using the search function. Search by Code Starts With or Description. Click Search. Select the appropriate ICD 9 code. At least one diagnosis code must be attached to the case. If there are more than one, one must be selected as the primary. If a new code to be added, delete the original entry and add the new one. Step 8 Enter any clinical notes in the text field. Click Next to continue. Step 9 Attach clinical documentation by clicking the browse button. Browse and find the file and click Open to attach. Once attached, click Submit. Step 10 The indicator icons on the left of the screen should be visible in all service request areas to show that all required data has been inputted. Step 11 Questionnaires (if applicable) Step 12 Click the checkbox at the bottom of the page and click either Save for Later or Submit. You will not be able to proceed if you do not click the checkbox. An error message will appear as shown to the right. Step 13 The Request Overview is displayed. END OUTPATIENT PROCESS FLOW Questionnaires Step 1 If a review requires the completion of a