FAQ

Is Telligen doing reviews for all of Medicaid, including Managed Care?

Telligen is contracted to review services and equipment for the Fee For Service Medicaid clients. This does NOT include clients covered by Nebraska Medicaid Managed Care.

Is there a list of what requires prior authorization for Nebraska Medicaid on the Telligen website or portal?

No, you will need to refer to the Nebraska Medicaid Provider Handbook specific to the service for which the prior authorization is being requested.  Please check the DHHS Medicaid website.  http://dhhs.ne.gov/medicaid/Pages/med_provhome.aspx

For DME/POS and hearing aids, please see the fee schedules, as they indicate the codes that need prior authorization.  See the website above.

Will Telligen’s system be updated for ICD-10?

Telligen’s electronic portal is ICD-10 compliant and is able to accept ICD-10 codes as well as ICD 9 codes.

How soon should we receive our login information?

We are currently working on getting all completed registration submissions loaded into our system, we will get them loaded in the system as timely as possible. Please allow 5-7 business days for the registrations to be loaded and working. Once your information has been loaded, you will receive email notification with further instructions.

Are all Nebraska physicians already loaded into the web portal or will we need to call and have you add the ones we use?

Please obtain the necessary information required to complete the prior authorization request before entering it into the Telligen website.  This includes physician information. If this information is incomplete, please contact the physician for the needed information. We receive an electronic transmission from Nebraska Medicaid weekly that provides us with all the Nebraska Medicaid physicians and other providers, as well as any Nebraska Medicaid out-of-state providers.  This will be used to verify the information submitted.

Will we receive a different validation number for each service we request?

Yes, for each service you request, you will receive a different validation number.

How will I know what the authorization number is?

In the determination letter you receive, you will see a validation number (s). This IS your authorization number. These validation numbers are transmitted daily to Nebraska Medicaid. Your validation number is the authorization number that you will submit with your billing.  You may also check the Telligen website for this information by logging on to the portal through: Telligen.nemedicalauth.com.

Is there a printable version of each of your questionnaires?

Yes, if you go to Telligen.nemedicalauth.com, click on the Services tab, and you will see a listing of all the different questionnaires which you are able to print.

What is the turnaround time for authorization requests?

The turnaround times are based on the type of review and if we receive all the necessary documentation. The requests are entered into our queue according to the time of completion. All requests are a priority to the staff at Telligen.  If all necessary information is submitted, the review determination is completed within contract required days.

If we need to correct either the diagnosis or number of units that was previously submitted, would we need to resubmit a new case? Can it be corrected on line?

You will need to submit a new request with the new diagnosis and/or new units being requested. This is considered a new service and will require a new authorization.

The original authorization will be valid for services up to the time the diagnosis or other changes are requested.  For questions on this time period you must refer to the assigned prior authorization number.  When addressing claims issues with the Medicaid claims staff, please use this number. Once the new request has been approved and a new validation number is issued, you will need to use the new validation number.  For questions on this authorization you must refer to this prior authorization number.  When addressing claims issues with the Medicaid claims staff, please use this number. 

Will we be issued an authorization number that can be used on the claim to Medicaid?

Yes, once your request has been reviewed and is approved, you will receive a letter that will have a validation number; this validation number is your authorization number. The validation number with other identifying information is sent to Nebraska Medicaid daily.

You must refer to this number when addressing claims issues with the Nebraska Medicaid Claims staff.

We currently do not have our paper documents to be sent as PDF for uploading, are we able to fax paper documentation in addition to filing a request online or should we do either a fax or online?

If you have a copy/fax machine with scan capabilities, you can scan paper documents and they will email to your email in a pdf file that can be uploaded when submitting a web portal request.

If you are unable to do this, then you will need to fax in your request and supporting documentation. You will receive the validation number via mail with the determination letter. Please note, when submitting a request through fax, you will not receive an email confirming your request has been successfully submitted, nor will you receive an email that your review is completed. You will also not be able to track via the web portal the progression of your review request.

What is the difference between the ordering provider and treating provider?

The ordering provider is the provider who is ordering the service. The treating provider is the provider who is performing or providing the service.

 

Home Health Services and Private Duty Nursing

 

When requesting services should we be submitting by visit or units?

For home health services and private duty nursing, please submit by units. When requesting a Home Health Agency or Private Duty Nursing visit use the appropriate procedure code and indicate the length of the visit in 15 minute increments. When requesting a Home Health Agency or Private Duty Nurse hourly service use the appropriate code and indicate the service in hourly increments. 

Is a recertification for home care services a new authorization or ongoing with the same authorization number?

Recertifications must be completed every 60 days and requiresa new authorization, for which a new authorization number will be issued.

 

How do I distinguish between a RN service and a LPN service when submitting a request?

Please refer to 471-000-509 Nebraska Medicaid Home Health Agency Fee Schedule. It depends if you are using G codes or S codes and associated modifiers.   Please see the DHHS website

http://dhhs.ne.gov/medicaid/Pages/med_provhome.aspx

 

Our software is not able to upload a 485 form to another software. How do we get these to you if it cannot be attached?

Try scanning in the document. Print off the document and if you have a scanning capability on your computer, scan the document and it should come to your email address as a PDF file, you can then save and upload it through the web portal submission.  

 

For home health services how soon do we need to have the request submitted? For new requests and recertifications?

Timely prior authorization requests are very important.

Prior to providing services

*Prior Authorizations must be submitted prior to the service beginning. That is the great thing about the Telligen Portal, it is available 24/7.  When the Security Administrator of your organization is setting up users for the Portal, they may want to consider who is available on weekends to submit the authorization.

Weekends and Holidays

With that being said, we also recognize, resource limitations on the weekends, so if a patient is started on services Friday afternoon, we would expect to have the request to Telligen by Monday.

Retroactive Authorizations

If a client’s Medicaid eligibility is established after the services are provided and is made retroactive, the services may be eligible for retroactive authorization.  The services may only be authorized for the time period when the client is Medicaid eligible.  The client’s eligibility may be made retroactive back 90 days. 

It is the provider’s responsibility to verify eligibility in a timely manner so that the service authorization request can be made timely.  Failure to request these authorizations in a timely manner may result in no authorization of service resulting in nonpayment of claims.

Recertifications

For recertifications, understanding that there are updates needed to made, we would expect the recertification request to be submitted within 5 days of the start of the recertification period.

Please note all services must be authorized.  Failing to obtain timely authorizations may result in non-payment of claims, even if services have been provided. 

 

On our 485 forms, we do not have a physician signature right away. Do you require a physician signed 485 form?

The 485 must be submitted with each authorization request. We do not require the physician signature on the 485 form prior to submitting a request; however if you must submit the completed 485 form without the signature you must providean indication that the service was ordered by a physician, such as a hospital physician order, order on a prescription pad from the physician or a verbal order from the physician.

When requesting authorization for nursing visits, do we need to specify RN and LPN.

Yes, you do need to distinguish between RN and LPN, by the appropriate HCPC code or HCPC modifier.  For example is using S codes, there is a specific code for RN and LPN services. If you are using G codes use the G0154 HCPC code with either the modifier TD for RN service and TE for LPN service.

When Medicaid is pending at start of care for home health, will Telligen provide retro authorization to start of care when Medicaid is approved?

See answer to #18

Are the in-home therapies of speech, physical, and occupational supposed to be entered under home health care in the Telligen portal?

When submitting a request for a therapy through the secure Telligen website portal, for Level of Care you will enter home care, then when selecting the Authorization type you will select the therapy type you are requesting under Medical Care-Therapy.

What documentation do you require initially for home health and private duty nursing authorization requests? Previously we submitted the plan of care (485 form) is this enough?

All requests for prior authorization must be accompanied by sufficient documentation that supports the need for the services.  In addition to the  completed 485 form, you may upload any additional documentation to assist in supporting the medical necessity of your request.  Also the questionnaire must be completed.

 

Durable Medical Equipment and Prosthetic, Orthotics, Supplies (DME/POS)

 

What is the difference between the ordering provider and treating provider?

The ordering provider is the provider who is ordering the service. The treating provider is the provider who is performing or providing the service.

Does Telligen require the MS-78 form for speech generating devices?

No, The MS-78 form is not required, however you are required to complete the Communication Device Questionnaire. If requesting through our secure, electronic portal, this questionnaire is part of the portal request process. If you are submitting a fax request, you must go to our website: Telligen.nemedicalauth.com, go to services, and download the Communication Device Questionnaire, complete and upload with the rest of your documentation.

Do all hearing aids require prior authorization?

For Adults, those 21 years of age and older, hearing aids over $500 need authorization. All those under 21 years of age, ALL hearing aids require prior authorization.  For the RIC /RITE & accessories, See the Hearing Aid Services Fee Schedule.