To access Physician Decision Support please click on the following: www.beaconlbs.com/lbs-web

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Insights / October 19, 2018 / by beaconlbs

Managing Authorizations and Notifications

New to the BeaconLBS platform? Learn about the major features in the portal in this blog.

 

 

The BeaconLBS Physician Decision Support platform gives you one place to help you more efficiently manage your UnitedHealthcare notifications and prior authorizations for both the Lab Benefit Management (LBM) Program, currently in Florida, and the national Genetic and Molecular Lab Testing Notification/Prior Authorization programs. These features are available to both ordering provider teams and labs.

Confirm Eligibility – The first step is to confirm if the member is covered under either program. To do this, click on Member Search to find the patient by subscriber (policy) number or search by first and last name and date of birth.

Member Not Found – If the member is not found, verify that you typed the search text correctly. If the member is still not found, the patient is most likely not covered by either program. If, for some reason, you believe this in error, you can call our Help Desk at 800-377-8809. Customer service representatives can verify the status of the member with UnitedHealthcare  and get back to you with confirmation of the member coverage status.

Member excluded from the Molecular Prior Authorization program for all tests except BRCA- If the member’s plan is excluded from the Molecular Prior Authorization program, this message will appear. If you are looking for a prior authorization for a test containing BRCA gene analysis, a link is made available to more information and the required forms for that process. If the test you are interested in is not BRCA, no further action is needed.

Member Found – If the member is selectable in the system, this means that the patient is covered by the Genetic and Molecular Lab Testing program and notification or prior authorization, for in-scope services, is required within 90 days of specimen collection and before the claim is billed.

Member Covered by Lab Benefit Management Program – If this message appears, this member is covered under the program currently in Florida, and, for in-scope services, notification or prior authorization is required within 10 calendar days of specimen collection and before the claim is billed.

For Ordering Provider Teams – Once the member is confirmed and selected to be covered by one of UnitedHealthcare’s lab programs, notification or prior authorization can be handled from the same screen. Once completed, it will show under the Manage menu in the Molecular Program.

In the LBM program in Florida, if you click Cases at the top of the screen, you will see the following menu options:

Incomplete – If you use PDS-Q, the automated reminder system that lets you know after the order is placed that notification or prior authorization is required; any cases that need to be completed will show here. They will also be color-coded to let you know which are most urgent. Or, any cases started but not finished will also show.

Complete – This is where all of your completed notifications are searchable and the status is shown.

Prior Auth – This is where all of your prior authorizations are searchable. They may have been: approved, non-certified, or be pending clinical review .

Clicking anywhere on the line of the desired test will open a PDF of the Outcome Summary.

 

For Lab Teams – click on the Decision Support Inbox link at the top of the screen.

Decision Support – This is where all of your completed notifications are searchable.

Prior Auth – This is where all of your completed prior authorizations are searchable.

Clicking anywhere on the line of the desired test will open a PDF of the Outcome Summary.

Under each of these menus, you also have the ability to Export to CSV. This is a file type that can be opened with Excel so if you want to compare the orders received to the notifications/authorizations done, the Excel files provide an easy way to do this.

PDS-Q – This is an automated email reminder system to warn ordering provider teams that testing they ordered did require notification or prior authorization but that it was not conducted. If you are interested in finding out more about this and to determine your lab’s eligibility, please contact our Help Desk at 800-377-8809 or email LabSupport@BeaconLBS.com.

Lab Direct – This is a new option available when labs provide services for UnitedHealthcare genetic and molecular program members for in-scope services. For some testing, the notification can be initiated by the lab on behalf of the ordering provider. To get more information or request that Lab Direct be enabled for your lab, please contact your BeaconLBS representative or email LabSupport@BeaconLBS.com.

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