Provider Portal Clause Samples
Provider Portal. The Contractor shall dedicate a section of its website to Provider services and is encouraged to promote the use of the Provider portal among Providers. At a minimum, the Contractor’s Provider portal must provide the following capabilities for Providers:
a. Ability to submit inquiries and receive responses;
b. Access to a copy of the Provider Manual;
c. Access to newsletters, updates, and Provider notices;
d. Access to a searchable Provider Directory;
e. Ability to link to the State’s PDL;
f. Ability to submit Prior Authorization requests and view the status of such requests (e.g., approved, denied, pending);
g. Information about the process Providers must follow when requesting inpatient Prior Authorization;
h. Ability to submit, process, edit (only if original submission is in an electronic format), rebill, and adjudicate claims electronically. To the extent a Provider has the capability, the Contractor shall submit electronic payments and remittance advices to Providers. Remittance advices must be provided within one (1) to five (5) business days of when payment is made.
Provider Portal. The Contractor shall dedicate a section of its website to Provider services and is encouraged to promote the use of the Provider portal among Providers. At a minimum, the Contractor’s Provider portal must provide the following capabilities for Providers:
a. Ability to submit inquiries and receive responses;
b. Access to a copy of the Provider manual;
Provider Portal. The Provider Portal is accessed via a website and is used by Childcare Providers to submit funding claims, update information about childcare services and complete Early Years Census forms.
Provider Portal. After six (6) months’ notice, in writing, from the Department, the Contractor shall establish and maintain a secure Provider Web Portal which shall include population health, quality, utilization and claims information for PCP Enrollee populations. Department retains the right to define minimum content requirements for the Provider portal.
Provider Portal. Prior to the Effective Date, Contractor shall establish and maintain a secure Provider web portal, which shall include population health, quality, utilization, eligibility verification, prior authorization, and claims information for PCP Enrollee populations. The Department retains the right to define minimum content requirements for the Provider portal.
Provider Portal. The Contractor shall dedicate a section of its website to Provider services and is encouraged to promote the use of the Provider portal among Providers. At a minimum, the Contractor’s Provider portal must provide the following capabilities for Providers:
a. Ability to submit inquiries and receive responses;
b. Access to a copy of the Provider Manual;
c. Access to newsletters, updates, and Provider notices;
d. Access to a searchable Provider Directory;
e. Ability to link to the State’s PDL;
f. Ability to submit Prior Authorization requests and view the status of such requests (e.g., approved, denied, pending);
g. Information about the process Providers must follow when requesting inpatient Prior Authorization, including name and number of the Division’s inpatient Prior Authorization vendor, and how to notify the Contractor of an inpatient admission; and
h. Ability to submit, process, edit (only if original submission is in an electronic format), rebill, and adjudicate claims electronically. To the extent a Provider has the capability, the Contractor shall submit electronic payments and remittance advices to Providers. Remittance advices must be provided within one (1) to five (5) business days of when payment is made.
Provider Portal. Funding claims will be processed via the provider portal. Each provider will register one or more staff members to use the provider portal by completing and returning a Provider Portal Access Form for each user. Login details should not be shared between users and it is the user’s responsibility to keep their login details secure. Autocomplete options that remember passwords should not be used. If a provider portal user leaves the setting or changes roles, you must contact the Early Help Team to remove the user’s access from the system. If the device you use to access the portal (laptop, tablet, mobile phone etc.) is lost or stolen you must contact the Early Help Team immediately so that you password can be reset.
Provider Portal. The STAR+PLUS MMP must provide a Provider portal that supports functionality to reduce administrative burden on Network Providers at no cost to the Providers. A Provider portal brings information together from diverse sources in a uniform way. The Provider portal functionality must include the following: 453
2.17.3.3.1.1. Enrollee eligibility verification; 453
2.17.3.3.1.2. Submission of electronic Claims; 453
2.17.3.3.1.3. Prior Authorization requests; 453
2.17.3.3.1.4. Claims Appeals and reconsiderations; and 453
2.17.3.3.1.5. Exchange of clinical data and other documentation necessary for prior authorization and Claims processing. 453
Provider Portal. Beginning July 1, 2024, the PH-MCO must maintain a Provider portal that complies with 40 P.S. 991.2153.
Provider Portal. ▪ The ProviderOne Provider Portal is the launching point for all Provider activities. ▪ The Provider Portal contains the following elements: o My Inbox Tabs o Welcome bar o Links Menu o Help/Logout Icons o Path o Context Information o Online Services o Reminders and Alerts The Welcome Bar displays your Username and current Profile. Knowing your current profile is useful in situations where you are prevented from viewing information or executing actions in ProviderOne because you are not logged in with the necessary profile. The Links Menu is for DSHS Staff use. The Path displays all ProviderOne pages you have opened to get to current page. Click on any page in the Path to return to that page. If you are currently entering information into ProviderOne make sure to Save before navigating to another screen using the Path. This area will display information relevant to the current page being viewed or action being taken. The example above was taken from the Client Benefit Level page. It displays the Client Id and Name of the Client being viewed. This area contains links to all ProviderOne Provider activities. Use the Online Services menu to access the tasks you need to execute. Click the task name hyperlink to launch the task page. Depending on your screen resolution you may need to scroll down to view all options available in this section. Additional details about these options are covered elsewhere in this manual.