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HOW TO SUBMIT Prior Authorizations and Referrals Questions? Call 1-877-762-3515 or go to www.devoted.com/providers

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Page 1: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

HOW TO SUBMIT Prior Authorizations and Referrals

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers

Page 2: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

SECTION 1

Log in

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers

Page 3: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

1 Go to Availity at www.availity.com.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 3

Section 1: Log in

Page 4: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

2 Click the “Login” button on the top right to log into Availity with your User ID and Password.

If you do not have an Availity account, click “Register Now” and/or reach out to your internal team to set up your account.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 4

Section 1: Log in

Page 5: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

3 On the top bar, under “Patient Registration,” select “Authorizations & Referrals.”

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 5

Section 1: Log in

Page 6: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

4 On the “Authorizations & Referrals” page, select “Authorizations.”

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 6

Section 1: Log in

Page 7: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

5 For “Payer,” select “DEVOTED HEALTH.” The Organization will automatically populate. Then click “Submit.”

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 7

Section 1: Log in

Page 8: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

6 The Devoted Provider Portal will open in another tab in your browser.

Please make sure to always allow for pop-ups.

Shown for Chrome browsers. Other browsers could vary.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 8

Section 1: Log in

Page 9: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

SECTION 2

Submit a referral

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers

Page 10: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

Referral Requirements

• Acupuncturist• Addiction psychiatrist• Allergist (immunologist)• Anesthesiologist• Audiologist• Cardiac electrophysiologist• Certified diabetes educator (CDE)• Certified nurse-midwife• Certified nursing assistant (CNA)• Certified professional midwife• Certified registered nurse anesthetist (CRNA)• Chiropractor• Critical care medicine specialist• Dentist• Dermatologist (visits 1-5)• Emergency medicine specialist• Family medicine physician• Forensic pathologist• General practitioner• Geriatric medicine specialist• Gynecologist• Hospitalist• Licensed mental health counselor• Licensed nurse (LPN or LVN)• Nurse practitioner (NP)• Obstetrician• Optician• Optometrist• Pathologist• Perinatologist• Pharmacist• Physician assistant (PA)• Podiatrist• Psychiatric nurse• Psychiatrist• Psychologist• Radiologic technologist• Radiologist• Recreational therapist• Registered dietitian (RD)• Registered nurse (RN)• Respiratory therapist (RT)• Social worker

Need Referral NO Referral Needed

• Cardiologist• Cardiovascular surgeon• Colon and rectal surgeon• Dermatologist (visit 6 and beyond)• Endocrinologist• Gastroenterologist• Genetic counselor• Gynecologic oncologist• Hand surgeon• Hematologist• Hepatologist• Hospice and palliative medicine specialist• Infectious disease specialist• Interventional cardiologist• Medical geneticist• Nephrologist• Neurological surgeon• Neurologist• Occupational medicine specialist• Occupational therapist (after initial eval)• Oncologist• Ophthalmologist• Oral surgeon (maxillofacial surgeon)• Orthopedic surgeon• Otolaryngologist (ear, nose, and throat

specialist)• Pain management specialist• Physiatrist• Physical therapist (after initial eval)• Plastic surgeon• Pulmonologist• Radiation oncologist• Reproductive endocrinologist• Rheumatologist• Sleep disorders specialist• Speech therapist (after initial eval)• Spinal cord injury specialist• Sports medicine specialist• Surgeon• Thoracic surgeon• Urologist• Vascular surgeon

Page 11: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

1 Click “New Authorization/Referral” in the center of the screen.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 11

Section 2: Submit a referral

Page 12: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

2Search members by Devoted ID or last name and date of birth, then select the member.

The Devoted Health member ID is 6 digits, beginning with the letter “D.”

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 12

Section 2: Submit a referral

Page 13: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

3 Avoid submitting duplicate requests by reviewing the members’ authorizations and referrals first.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 13

Section 2: Submit a referral

Page 14: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

4 Click “+ Referral” to start.

Referrals should only be used when a member’s PCP is referring them to an in-network specialist.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 14

Section 2: Submit a referral

Page 15: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

5Select “No” for the question “Is this a notice of emergency admission or observation?” In the “Type of Service” dropdown select “Referral to Specialist (Visits & Consults).”

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 15

Section 2: Submit a referral

Page 16: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

6 Complete the referral form.

Referrals to out-of-network providers or facilities must be faxed. If you do not find the provider in the provider search, that means they are not part of the Devoted Health network.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 16

Section 2: Submit a referral

Page 17: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

7 Review the summary of the request before submitting the request.

Click “Submit” once you are done completing the form.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 17

Section 2: Submit a referral

Page 18: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

8 Your referral has been successfully submitted.

Referrals from the member’s PCP will be automatically approved.

Devoted Health will reach out with a determination or to request additional information as applicable. If you have any edits or changes to make, please contact Devoted Health.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 18

Section 2: Submit a referral

Page 19: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

SECTION 3

Submit a prior authorization

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers

Page 20: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

1 Click “Authorization Check” from the landing page.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 20

Section 3: Submit a prior authorization

Page 21: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

2 Search by service name or CPT code to see which services require an authorization.

Once check is complete, click on the Devoted logo on the top navigation to go back to the landing page.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 21

Section 3: Submit a prior authorization

Page 22: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

3 Click “New Authorization/Referral” on the landing page.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 22

Section 3: Submit a prior authorization

Page 23: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

4 Search members by Devoted ID or last name and date of birth, then select the member.

The Devoted Health member ID is 6 digits, beginning with the letter “D.”

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 23

Section 3: Submit a prior authorization

Page 24: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

5 Avoid submitting duplicate requests by reviewing the members’ authorizations and referrals first.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 24

Section 3: Submit a prior authorization

Page 25: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

6 Click “+New Request” to start.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 25

Section 3: Submit a prior authorization

Page 26: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

7 Selecting Inpatient Elective or Outpatient Requests

If this is for an Inpatient Elective Authorization, select “No” to the question “Is this a notice of emergency admission or observation?” Then in the “Type of Service” dropdown, select “Inpatient Elective Authorization.”

If this is for Outpatient Services, select “No” to the question “Is this a notice of emergency admission or observation?” Then in the “Type of Service” dropdown, select “Outpatient Services.” (box around two questions on the left)

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 26

Section 3: Submit a prior authorization

Page 27: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

8 Select the type of service from the “Service Type” dropdown.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 27

Section 3: Submit a prior authorization

Page 28: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

9 Clinical documentation required

You must include clinical documentation when you submit prior authorization requests. If we don’t receive sufficient information, we may deny your request.

Devoted Health’s standard response times

Part B Drug Requests:

• Expedited: within 24 hours• Standard: within 72 hours

All Other Requests:

• Expedited: within 72 hours• Standard: within 14 calendar days

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 28

Section 3: Submit a prior authorization

Page 29: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

10 Complete the authorization form.

Outpatient or Inpatient Authorization requests can be sent to out-of-network providers and facilities. If you do not find the provider or facility in the search, search out-of-network providers and facilities by NPI.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 29

Section 3: Submit a prior authorization

Page 30: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

11 Review the summary of the request before submitting the request.

Click “Submit” once you are done completing the form.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 30

Section 3: Submit a prior authorization

Page 31: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

12 Your authorization has been successfully submitted.

Devoted Health will reach out with a determination or to request additional information as applicable. If you have any edits or changes to make, please contact Devoted Health.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 31

Section 3: Submit a prior authorization

Page 32: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

SECTION 4

Submit an inpatient notification

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers

Page 33: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

1 Click “New Authorization/Referral” on the landing page.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 33

Section 4: Submit an inpatient notification

Page 34: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

2 Search members by Devoted ID or last name and date of birth, then select the member.

The Devoted Health member ID is 6 digits, beginning with the letter “D.”

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 34

Section 4: Submit an inpatient notification

Page 35: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

3 Avoid submitting duplicate requests by reviewing the members’ authorizations and referrals first.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 35

Section 4: Submit an inpatient notification

Page 36: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

4 For an Inpatient Emergency Authorization, select “Yes” to the question “Is this a notice of emergency admission or observation?”

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 36

Section 4: Submit an inpatient notification

Page 37: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

5 Complete the authorization form.

For observation, choose “Observation” from the Level Of Care dropdown.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 37

Section 4: Submit an inpatient notification

Page 38: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

6 Review the summary of the request before submitting the request.

Click “Submit” once you are done completing the form.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 38

Section 4: Submit an inpatient notification

Page 39: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

7 Your notification has been successfully submitted.

Observation and Emergency Admission Notifications will be automatically approved.

Devoted Health will reach out with a determination or to request additional information as applicable. If you have any edits or changes to make, please contact Devoted Health.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 39

Section 4: Submit an inpatient notification

Page 40: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

SECTION 5

Check the status of a request

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers

Page 41: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

1 Click “Dashboard” from the landing page.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 41

Section 5: Check the status of a request

Page 42: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

2 Search the Dashboard by Authorization ID or Devoted Member ID.

If you need to update or edit a request, please contact Devoted Health.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 42

Section 5: Check the status of a request

Page 43: HOW TO SUBMIT Prior Authorizations and Referrals...2 Click the “Login” button on the top right to log into Availity with your User ID and Password. If you do not have an Availity

3 To filter the results of “Type” and “Status,” click on the icon in the column.

Questions?Call 1-877-762-3515 or go to www.devoted.com/providers 43

Section 5: Check the status of a request