EXPRESSPATH PROVIDER PORTAL
USER GUIDE
OCTOBER 2011
© 2011-2020 Express Scripts, Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or
by any means, electronic or mechanical, including photocopy, recording or any information
storage and retrieval system, without the express written consent of Express Scripts, Inc.
All trademarks and service marks are the property of their respective owners.
This document is proprietary to Express Scripts, Inc.
Unauthorized use and distribution are prohibited.
October 2011
ExpressPAth Overview
ExpressPAth Overview ..................................................................................................1-3
Accessing ExpressPAth ..................................................................................................1-4
Creating a Desktop Shortcut for ExpressPAth ...........................................................1-5
Navigating .......................................................................................................................1-7
Printing ............................................................................................................................1-8
Accessing the User Guide ..............................................................................................1-9
Accessing Tutorials ........................................................................................................1-9
Using Support .................................................................................................................1-10
Logging In .......................................................................................................................1-12
Forgot Your User ID or Forgot Your Password .........................................................1-14
Forgot Your User ID? ..................................................................................................1-14
Forgot Your Password? ................................................................................................1-21
Logging Off .....................................................................................................................1-22
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ExpressPAth Overview
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ExpressPAth Overview
ExpressPAth Overview
The ExpressPAth Provider Portal is a web-based portal that can be used to request
prior authorization for drugs and services for patients who are covered under certain
health plan’s pharmacy and/or medical benefits. Prescribers and Providers can
complete registration and designate medical and non medical staff to request
authorizations on their behalf.
ExpressPAth is available to registered users 24 hours a day, 365 days a year. The
convenience of an online tool allows the user to begin and complete an authorization
request on their schedule. Also, following up on a request is as simple as entering in
the patient information and viewing the results as time allows during a busy work day.
Using ExpressPAth has other advantages for providers as well. Here are just a few:
• Increase efficiency by reducing paper forms and faxing time or time on the
phone
• Providers can manage their own information or designate others to request prior
authorizations on their behalf
• Manage appeal requests and renewal requests electronically
• Upload additional documentation, such as lab results or other clinical
information, to support the prior authorization request
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Accessing ExpressPAth
Accessing ExpressPAth
There are two ways to access ExpressPAth.
To access ExpressPAth:
Double-click the ExpressPAth icon located on your Desktop.
or
1.
Double-click
2.
In the Address field, type the ExpressPAth URL.
This URL is https://www.express-pa.com
Notes:
Do NOT add the ExpressPAth URL to your Favorites, or you may
have problems accessing the most current version of the Provider
Portal. You may add a shortcut. See instructions later in this
section.
Pop-up Ad Blocker must be turned OFF.
3.
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Press
Enter
ExpressPAth User Guide
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ExpressPAth Overview
Creating a Desktop Shortcut for ExpressPAth
To create a Desktop shortcut for ExpressPAth:
1.
Go to your Desktop.
2.
Right click your mouse in any blank area on your Desktop.
A menu appears when you right-click.
3.
Move your mouse to the “New” menu option.
A secondary menu appears.
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Creating a Desktop Shortcut for ExpressPAth
4.
On the secondary menu, select
The following box appears.
5.
Place your mouse inside the text box. Type the URL below.
is https://www.express-pa.com
6.
Click
7.
Type a name for the shortcut in the field provided. For this example, we will
use “ExpressPAth”.
8.
Click
The following box appears.
The box closes.
The Desktop shortcut is now ready.
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ExpressPAth User Guide
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ExpressPAth Overview
Navigating
You can navigate through ExpressPAth using several methods.
•
To access different sections of ExpressPAth, use the tabs that are located at the
top of each page.
•
Hyperlinks embedded into forms in the work area
And on the left side of pages
or
•
Buttons embedded into left menus and into work area forms.
•
The Stage Progress indicator at the top of the ExpressPAth work area checks
off steps as they are completed.
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Printing
Printing
To print:
1.
From any ExpressPAth page, right-click your mouse to display the following
menu.
2.
Click Print on the menu.
3.
The Print menu displays. Select the desired print settings to print.
4.
Click the Print button.
Note:
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Only the information that appears on your screen display is printed.
If the record is longer than your screen display, you must scroll up
or down in the record and repeat the process above if you want to
print information further up or down in the record.
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ExpressPAth Overview
Accessing the User Guide
You can access a PDF of the User Guide from a link within ExpressPAth.
To access the user guide:
1.
From any page, click Help.
A PDF of the ExpressPAth User Guide Table of Contents appears.
2.
Click the appropriate section listed in the left-side bookmarks panel to open
that document.
Accessing Tutorials
You can access ExpressPAth video training modules from a link within ExpressPAth.
To access the tutorials:
1.
From any page, click Tutorial.
A menu of tutorials displays.
2.
Click on the desired tutorial to select it.
Navigational arrows, play & pause buttons display on the tutorial.
3.
When the tutorial ends, you may replay it or click the red X to close it.
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Using Support
Using Support
You are able to request technical assistance by using the Support link.
To request technical assistance,
1.
Click the Support link.
An email form opens.
2.
Click the Priority dropdown arrow and select the priority of the issue. Press
Tab.
3.
In the User Id field, type your user ID. Press Tab.
4.
In the Enter your Email ID field, type the email address associated to your
ExpressPAth user ID. Press Tab.
5.
In the Subject field, type the subject address line.
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ExpressPAth Overview
6.
In the Description field, type a description of your ExpressPAth technical
issue.
Note: If your question is clinical, not technical, please contact the health
plan.
7.
If needed, in the Attachment file field click the Browse button and add an
attachment to the support request.
8.
In the Enter the code as shown in Image field, type the code as seen in the
spatter box.
9.
To submit your request for support, click
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Logging In
Logging In
Login area displays before a user logs into ExpressPAth and is also
used for registration.
Work area contains active information and forms while working in
ExpressPAth.
NIH News contains links to National Institute of Health news.
To log in to ExpressPAth:
1.
In the Enter your user Id field, type your previously selected User ID.
2.
In the Enter your password field, type your previously selected casesensitive password.
Note: Your password for ExpressPAth expires every six months.
3.
In the Enter the below text field, type the code number displayed in the
shaded security code area.
4.
Click the Sign In button or press Enter on your keyboard.
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ExpressPAth Overview
After you have registered or logged into ExpressPAth, the Prior Authorization Portal
for Physicians page displays.
Prior Authorization, Settings, and Logout tabs display after a registered
user logs into ExpressPAth. The active tab is yellow.
Prior Authorization Portal for Physician contains hyperlinks and buttons to
initiate, complete, search for a previously submitted PA request, or search for
prior authorizations about to expire.
Note: If ExpressPAth is inactive for 20 minutes, you will automatically be
logged out of the tool. ExpressPAth will show you as logged out, but
a Login link on the page allows you to immediately log back in.
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Forgot Your User ID or Forgot Your Password
Forgot Your User ID or Forgot Your Password
If you forget your ExpressPAth User ID or password, there are two ways to recover
your access.
Forgot Your User ID?
To recover your ExpressPAth User ID:
1.
On the ExpressPAth Login tab page left column, click on the Forgot your
User ID link.
The I am a field dropdown displays.
2.
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To identify your role in ExpressPAth, click the dropdown arrow.
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ExpressPAth Overview
Your choices are Prescriber, Agent, or Providing Facility.
3.
Select the role (which you chose during registration) that best describes you.
You are moved to the next step.
For Prescribers:
If you are a Prescriber, the form below displays.
1.
In the Who is a field, click the dropdown and select the correct descriptor
(which you chose during registration) that best describes you.
2.
You have a choice of which prescriber ID you enter. Select either the DEA,
NPI or SLID (State License ID) field and type the appropriate ID.
Note: Only your NPI is required during registration. DEA and State License
ID (SLID) are not required during registration. If DEA and State
License ID were not entered during registration, a search by DEA or
SLID will be unsuccessful.
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Forgot Your User ID or Forgot Your Password
3.
In the Email ID field, type your email address.
4.
Click
If your information does match the information in the system, Secret
Question and Answer fields display as part of the Forgot your User ID?
login.
5.
In the Answer field, type the correct answer to the Secret question.
6.
Click
A message displays indicating that your user ID has been sent to your email
address.
When you open your email, you will see an email message from ExpressPAth
stating, “The following User ID has been requested for (Requestor Name) :
abc123
The email contains a link to use “to continue, creating, modifying and
checking the status of prior authorizations with the User Id provided above.”
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ExpressPAth Overview
For Agents:
If you are an Agent, the form below displays.
1.
In the I work at a field, click the dropdown arrow and select the correct
descriptor (which you chose during registration) that best describes your
office location.
2.
In the NPI field, type the NPI of a prescriber or provider to whom you are
associated. This is a required field.
3.
First Name and Last Name fields are optional.
4.
Optional: In the PPI field, type the unique ExpressPAth Prescriber ID that
was sent to the Physician for whom you are an agent. This number is
available in the physician’s activation email.
5.
In the Email Id field, type your email address. This is a required field.
6.
Click
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Forgot Your User ID or Forgot Your Password
If your information does match the information in the system, Secret
Question and Answer fields display as part of the Forgot your User ID?
login.
7.
In the Answer field, type the correct answer to the Secret question.
8.
Click
A message displays indicating that your user ID has been sent to your email
address.
When you open your email, you will see an email message from ExpressPAth
stating, “The following User ID has been requested for (Requestor Name) :
abc123
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ExpressPAth Overview
For Providing Facilities:
If you are a Providing Facility, the form below displays.
1.
In the I work at a field, click the dropdown and select the correct descriptor
(which you chose during registration) that best describes your office location.
2.
You have a choice of which providing facility ID you enter. Select either the
DEA, NPI or SLID (State License ID) field and type the appropriate ID.
Note: Only your NPI is required during registration. DEA and State License
ID (SLID) are not required during registration. If DEA and State
License ID were not entered during registration, a search by DEA or
SLID will be unsuccessful.
3.
In the Email ID field, type your email address.
4.
Click
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Forgot Your User ID or Forgot Your Password
If your information does not match the information in the system, the
following message displays.
If your information does match the information in the system, Secret
Question and Answer fields display as part of the Forgot your User ID?
login.
Note: The example shown is for an agent, but is similar for all users.
6.
In the Answer field, type the correct answer to the Secret question.
7.
Click
A message displays indicating that your user ID has been sent to your email
address.
When you open your email, you will see an email from ExpressPAth stating,
“The following User ID has been requested for (Requestor Name) : abc123.
The email contains a link to use “to continue, creating, modifying and
checking the status of prior authorizations with the User Id provided above.”
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ExpressPAth Overview
Forgot Your Password?
After you have entered your user ID, if you are unable to recall your password:
1.
Click the Forgot your password? link.
2.
For your assigned role, follow the same instructions given for Forgot your
user ID?
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Forgot Your User ID or Forgot Your Password
Logging Off
You can log off at any time.
To log off, click the Logout tab.
A message displays that you have successfully logged out.
Note: You will automatically be logged out of ExpressPAth after 20 minutes
of inactivity.
A link displays to log back in.
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Section 2―ExpressPAth Registration and
Settings
Navigating the ExpressPAth Login ...............................................................2-3
Registering Prescribers and Providers ..........................................................2-4
Registering as a Prescriber/Provider .................................................................2-6
Setting Your User ID and Password .................................................................2-9
Registering Agents ...........................................................................................2-13
Registering as an Agent ....................................................................................2-13
Settings - Managing Your Profile Information - Providers ........................2-22
My Information (Providers) ..............................................................................2-22
My Practice Locations (Providers)....................................................................2-26
My Agents (Providers) ......................................................................................2-30
Adding an Agent ...............................................................................................2-31
Searching for an Agent......................................................................................2-32
Settings - Managing Your Profile Information - Agents .............................2-39
My Information (Agents) ..................................................................................2-39
My Physicians (for Agents) ..............................................................................2-41
My Physician Agents (for Agents) ....................................................................2-50
Creating a List of Favorite Rendering Providers (Providers and Agents) 2-52
Viewing Your Favorites ....................................................................................2-52
My Favorite Rendering Providers .....................................................................2-53
Changing Your Password (Providers and Agents) ......................................2-62
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Navigating the ExpressPAth Login
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Section 2―Provider Portal Registration
Navigating the ExpressPAth Login
The Login Page is where registered users will login or new users will register to use
ExpressPAth. On the right side, NIH (National Institutes of Health) news is displayed.
When you launch ExpressPAth, the first page you will see is the Login Page.
Some of the elements you will encounter on this page include:
Login tab
Login area is where registered users log in to ExpressPAth and new users
register to use the tool. A security code displays and must be entered during
every login. When login is complete, users click the Sign in button to
proceed.
ExpressPAth work area: ExpressPAth forms and work selections display
and are made in the work area. Initially it displays a brief description of prior
authorization tasks that may be performed in ExpressPAth.
Help area: Help, Tutorial, and Support links are located here.
NIH News Column contains National Institutes of Health article links
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Registering Prescribers and Providers
Registering Prescribers and Providers
These instructions are for registering the following ExpressPAth users:
•
•
•
•
Physicians
Pharmacists
Nurse Practitioners
Physician Assistants
•
•
•
•
Home Infusion Therapy Providers
Specialty Pharmacies
Outpatient Facilities
Dialysis Centers
To register as an ExpressPAth user:
1.
Go to the ExpressPAth website at https://www.express-pa.com.
2.
On the ExpressPAth Login tab page left column, click on the Click Here to
Register link.
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Section 2―Provider Portal Registration
During the registration process, the page display changes. This is the first
registration entry page.
Stage Progress indicator at the top of the ExpressPAth work area checks off
steps in the prior authorization process as they are completed.
Progress Bar displays on the left side of the page to visually indicate the
registration or prior authorization stage and the remaining steps.
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Registering Prescribers and Providers
Registering as a Prescriber/Provider
To register as a prescriber or provider, in the work area complete the Step 1: Please
enter your NPI or DEA or State Id number form, as follows:
1.
To the right of “I am a,” click the dropdown arrow.
Note: Fields followed by a red asterisk (*) are required.
2.
On the “I am a” dropdown list, select Prescriber
or
Select Providing Facility. (If you want to register as a person who works on
behalf of a licensed prescriber or providing facility, see Registering as an
Agent section.)
3.
Refer to the table below for assistance in populating these fields:
If you are
registering as a:
In the following
field:
Prescriber
Who is a
Providing Facility
I work at a
Select from the following:
•
•
•
•
•
•
•
•
•
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Physician
Physician Assistant
Pharmacist
Nurse Practitioner
Physician Office
Home Infusion Therapy
Agency
Specialty Pharmacy
Outpatient Facility
Dialysis Center
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Section 2―Provider Portal Registration
4.
In the NPI field, type your NPI number. This is a required field.
Note: If you are registering as an individual prescriber or provider, use your
individual NPI. If you are registering as a providing facility, use your
organizational NPI.
DEA and State License Id are optional fields.
5.
Click
The Step 2: About You form displays in the work area.
If your NPI is located in the CMS (Centers for Medicare and Medicaid
Services) database, your demographic information is pre-populated on the
form.
If your demographic information is not found in the CMS database, you can
enter it manually.
Note: If you manually update your demographic information in ExpressPAth,
you will need to contact CMS in order for your updates to be reflected in that
database.
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Registering Prescribers and Providers
To complete the Step 2: About You form:
1.
Verify that this information is correct (all fields are editable, if necessary).
or
Manually enter the data.
2.
In the Enter your Email ID field, type your email address.
You will be asked to enter your email address twice to validate this field.
Both emails must match.
3.
In the Specialty field, click the Specialty dropdown and select your specialty
or
In the Taxonomy Code field, enter your taxonomy code number. The Health
Care Provider Taxonomy codes are national specialty codes used by providers
to identify their specialty category. The codes are created by the National
Uniform Claim Committee (NUCC), which is chaired by the American
Medical Association.
When one of these fields has been populated, the other field auto-populates.
4.
Click
The Step 3: Login Information form displays in the work area. All fields
are required.
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Section 2―Provider Portal Registration
Setting Your User ID and Password
To complete the Step 3: Login Information form, including setting your User ID and
password:
1.
To enter your User ID, in the User Id field enter your own unique user ID,
then click the
button to confirm that ID is available
or
To have ExpressPAth suggest a unique User ID for you, click the
button.
2.
In the Password field, type your password.
Note: Passwords must be at least six characters long, and must contain at
least one upper case character, one lower case character, one digit and
one special character.
3.
In the Re-enter Password field retype your password.
4.
In the Secret Question field, click the dropdown arrow and select a secret
question.
5.
In the Answer field, type the answer to your secret question. If you forget
your password, this will be used to verify your identity.
6.
Click the
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Registering Prescribers and Providers
The Step 4: Legal form displays in the work area.
To complete the Step 4: Legal form:
1.
In the Image Verification Code field, type the code that you see in the picture.
2.
To upload your license from an electronic file, click the
button.
A copy of your license is required to validate your credentials.
3.
Locate the license file from your files and select it.
The file address will display in the
field.
Note: The file must be 4MB or less and must be in JPG, TIFF, GIF or PDF
format. The ExpressPAth Registration Validation team will validate
your credentials prior to sending your registration activation
confirmation email (within two business days of receiving a legible
copy of your credentials).
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Section 2―Provider Portal Registration
4.
To upload the file, click the
button.
Note: If you do not have an electronic copy of your license, you can
download a copy of the fax cover sheet by clicking on the hyperlink.
Fill out the information requested on the cover sheet and fax it along
with a copy of your license to the fax number 973-215-2222.
5.
Read the Service Agreement. You will need to scroll down to review the
complete agreement.
6.
To agree to the terms of the Service Agreement, click the Accept radio
button.
Note: The Register button is not enabled until you have accepted the terms
of the agreement.
Clicking the Decline radio button terminates the registration process.
7.
To complete the registration process, click the
button.
The Step 5: Registration Complete page displays in the work area.
A message displays that indicates that you will receive a
confirmation/activation email within two business days after the ExpressPAth
Registration Validation team has received a legible copy of your state
license/credential information.
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Registering Prescribers and Providers
IMPORTANT: Please add [email protected] to your list of email
contacts so that the activation confirmation email does not
go to your Spam/Junk email folder.
8.
Click the Close button to complete your registration.
9.
Once the confirmation/activation email is received, you can begin using
ExpressPAth for pharmacy and/or medical prior authorization requests for
patients with participating health plans.
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Section 2―Provider Portal Registration
Registering Agents
These instructions are for registering ExpressPAth users who are Agents. An Agent is
anyone who can perform Prior Authorization functions on behalf of a Prescriber or
Provider. Examples of Agents include medical or non-medical office staff such as:
• Office Managers
• Administrative Assistants
• Secretaries
• Nurses
Important: An Agent cannot register until their associated Prescriber or
Provider has completed the registration process in ExpressPAth.
The Prescriber/Provider does not have to be activated for the
agent to register.
To register as an ExpressPAth Agent:
1.
Go to the ExpressPAth website at https://www.express-pa.com.
2.
On the ExpressPAth Login tab, click on the Click Here to Register link on
the left-hand side.
The ExpressPAth Home Tab displays.
License Information is highlighted on the left and the form Step 1: Please
enter your NPI or DEA or State Id number displays in the center.
Registering as an Agent
To register as an agent, in the work area complete the Step 1: Please enter your NPI
or DEA or State Id number form, as follows:
1.
To the right of “I am a,” click the dropdown arrow.
Note: If you are registering as an Agent, an NPI is not required for you.
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Registering Agents
2.
On the I am a dropdown list, select Agent.
The work area changes and now displays the Step 1: PPI Information form.
3.
In the I work at a field, click the dropdown arrow.
4.
Select the appropriate agent work location description.
You must associate yourself to a physician or provider by one of the
following:
•
•
•
by NPI
by Facility Name
by First and Last Name
Note: PPI is a unique ExpressPAth ID that is sent to the Physician when
they register. This number is available in the physician’s activation
email and is not a required field.
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Section 2―Provider Portal Registration
To use the Search for an existing physician section fields to locate a prescriber or
provider:
1.
In the NPI field, type the prescriber or provider’s NPI number
or
In the Facility Name field, type the name of the providing facility
or
In the First Name field and the Last Name field, type the prescriber or
provider’s name.
2.
Click
If the physician is located, the Prescriber Search box displays.
3.
If the correct physician is displayed, in the Prescriber Name field click the
prescriber’s name link.
Note: If more than one record is returned, use the left and right arrows on
the bottom right to navigate back and forth within the records.
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Registering Agents
The Step 1: PPI Information form redisplays in the work area, with the PPI
and Name fields populated with the prescriber information.
4.
If you support more than one physician, you will repeat the search
information for additional physicians by clicking
You may add up to 10 prescribers/providers during registration.
Note: Additional prescribers/providers can be added by accessing the
Settings tab and adding them through the My Physicians link once
you have completed your registration.
5.
When all needed physicians have been added to your profile, click
The Step 2: About You form displays in the work area.
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Section 2―Provider Portal Registration
To complete the Step 2: About You form:
1.
In the First Name field, type your first name (required field).
2.
In the Last Name field, type your last name (required field).
3.
In the Enter your email address field, type your email address (required
field).
4.
In the Retype Email ID field, type your email address again (required field).
5.
Click
The Step 3: Login Information form displays in the work area. All fields
are required.
To complete the Step 3: Login Information form:
1.
In the User Id field you may enter your own unique user ID, then click the
button to confirm that ID is available.
or
To have ExpressPAth suggest a unique User ID for you, click the
button.
2.
In the Password field, type your password.
Note: Passwords must be at least six characters long, and must contain at
least one upper case character, one lower case character, one number
and one special character.
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Registering Agents
3.
In the Re-enter Password field retype your password.
4.
In the Secret Question field, click the dropdown arrow and select a secret
question.
5.
In the Answer field, type the answer to your secret question. If you forget
your password, this will be used to validate you.
6.
Click the
button.
The Step 4: Legal form displays in the work area.
To complete the Step 4: Legal form:
1.
In the Image Verification Code field, type the code that you see in the
picture.
2.
Read the Service Agreement. You will need to scroll down to review the
complete agreement.
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3.
To agree to the terms of the Service Agreement, click the Accept radio
button.
Note: The Register button is not enabled until you have accepted the terms
of the agreement.
Clicking the Decline radio button terminates the registration process.
4.
To complete the registration process, click the
button.
The Registration Complete page displays in the work area, shaded, with a
Thank you popup message in front. It describes how an email has been sent
to each of the designated physicians with instructions for them on how to
activate the Agent’s account.
5.
To exit, click
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Registering Agents
Prescriber/Provider Confirms Association to Agents
The last step to allow agents to perform Prior Authorization tasks on their behalf is for the
prescriber/provider to finalize the agent’s association request.
The prescriber/provider receives an Agent Authentication email that an agent has requested
association to them. Within the email there is a link to the Agent Authentication form.
To confirm an agent association to a prescriber/provider:
1.
Click the link provided in the email from ExpressPAth ([email protected]) or
paste it into your Internet Explorer address bar.
Note: You will need to login before you are taken to the agent authentication form.
The My Agent page displays.
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2.
Set the Agent Status field to Active.
Other Agent information fields become available.
The Start Date default is the date the prescriber/provider authorizes the association.
3.
To change the start date, in the Start Date field type the start date in the following
format: MM/DD/YYYY
4.
In the Deactivate Agent on field, change the date from today’s date to any date prior to
today.
5.
In the Assign Privileges area, select all of the privileges you want to apply to this
agent.
6.
When all of the desired check boxes are populated, click the
button
A pop-up confirmation message displays and an email is sent to the Agent to notify
them that they are now able to perform Prior Authorization tasks on behalf of the
prescriber/provider.
Note: The prescriber/provider’s account must have been validated and activated for the
agent to perform PA tasks for that prescriber/provider.
7.
Click
The Settings tab opens on My Agents, including the Agent that was just associated to
the prescriber/provider.
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Settings - Managing Your Profile Information - Providers
Settings - Managing Your Profile Information - Providers
By accessing the Settings Tab in ExpressPAth, you are able to manage your profile information,
including editing your information and changing your password. Providers and providing
facilities are also able to view, edit, or add practice locations and add agents, deactivate agents
and manage associated agents’ privileges.
My Information (Providers)
Viewing Your Credential Information
To view your credential information:
1.
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The Settings page displays in the work area with the Account Home menu open.
2.
Click the My Information link.
or
Click My Information
The My Credential Information page displays.
Locked fields display with gray text. These cannot be edited.
Editable fields display with black text.
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Settings - Managing Your Profile Information - Providers
Editing Your Credential Information
To edit your credential information:
1.
Click on the Settings tab.
2.
Click the My Information link.
The My Credential Information page displays.
3.
You may edit any editable field (those without greyed out text).
Note: The Address fields, Work Phone, Email, Specialty, Taxonomy Code and
Secret Question and Answer fields are required, as indicated by a red asterisk
(*).
4.
To save your edits, click
Note: If the email associated to you is shared by another user ID, a popup message
will display, asking “Are you sure you would like to continue to update the
system with this email address?”
Click
to continue.
or
Click
to end the action.
Note: Any Agent with Office Manager privileges is able to edit a provider’s My
Information page. They are not able to change the provider’s password or
secret question/answer.
Note: Any updates made to your profile in ExpressPAth will not be reflected in the
Centers for Medicare and Medicaid Services (CMS) database. Please contact
CMS to ensure your records on file are current.
E-mail Summary Opt-out
An email summary containing the number of prior authorizations approved, denied, or
withdrawn, and the number of prior authorizations requiring input from someone associated to
that Episode of Coverage (EOC), or specific prior authorization request, is sent daily.
To opt out of receiving this daily email summary:
1.
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On the Settings page, click the My Information link.
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The My Information page displays.
2.
Click the Opt out of Daily Email Summary checkbox.
If you do not opt out, you will receive an email every day that there is activity in any of
the listed categories.
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Settings - Managing Your Profile Information - Providers
My Practice Locations (Providers)
Viewing Practice Locations
To view existing practice locations associated to you:
1.
Click on the Settings tab.
2.
Click the My Practice Locations link.
or
Click My Practice Locations
A list of Practice Locations associated to you displays.
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Editing a Practice Location
To edit an existing location:
1.
Click on the Settings tab.
2.
Click the My Practice Locations link.
or
Click the My Practice Locations
A list of My Practice Locations associated to you displays.
3.
Click the Edit link associated to the desired location.
The existing location information displays as a form.
4.
Make edits to the location.
Note: Fields marked by a red asterisk (*) are required fields and must be
populated.
5.
To save your changes, click
or
To cancel without saving your changes, click
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ExpressPAth saves the changes to the selected practice location and returns
you to My Practice Locations.
Adding a Practice Location
To add a practice location:
1.
Click on the Settings tab.
2.
Click the My Practice Locations link.
or
Click the My Practice Locations
A list of Practice Locations associated to you displays.
3.
Click the Add link.
A blank location form displays.
4.
Enter information for the added practice location to the form.
Note: The Address Line1, City, State, Zip, and Type fields are required.
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5.
Click
ExpressPAth saves the new practice location and returns you to My Practice
Locations.
Deleting a Practice Location
To delete an existing location:
1.
Click on the Settings tab.
2.
Click the My Practice Locations link.
or
Click the My Practice Locations
A list of My Practice Locations associated to you displays.
3.
Click the Edit link associated to the desired location.
The existing location information displays as a form.
4.
Click
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ExpressPAth returns you to My Practice Locations. The deleted practice
location is no longer listed.
Note: Any Agent with Office Manager privileges is able to manage their
associated provider’s My Practice Locations profile. They are able to
add, edit or delete practice locations on behalf of the provider.
My Agents (Providers)
Registered Providers and their Agents designated as Office Managers are able to
initiate, confirm and manage agent associations in ExpressPAth. The My Agents page
is used to assign, edit, or remove agent privileges, and to add additional agents.
Viewing Agents
To view My Agents:
1.
Click on the Settings tab.
The Settings page displays with the Your Options menu open.
2.
To view your associated agents, click the My Agents link.
or
Next to My Agents click
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The My Agents page displays in the work area.
In the My Agents area, a list of agents to whom you are associated displays.
Note: The current privileges assigned to an agent are listed in the Privileges field.
Adding an Agent
You are able to initiate an association to an agent by locating the agent and adding the agent to
your agent list. The agent must be registered and associated to at least one other provider in the
ExpressPAth Provider Portal in order for the agent to return in the search results.
To add an agent:
In the upper right corner of the My Agents page, click the My Agents Add link.
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Settings - Managing Your Profile Information - Providers
The Search for an Agent popup box displays. You will search in the system
for the agent. You may search for an agent by first and last name or by email.
Searching for an Agent
To search for an agent:
1.
Populate the First Name and Last Name fields
or
Populate the Email field with the desired agent’s information.
2.
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If there are matches to the search, ExpressPAth displays the search results
beneath the search criteria.
3.
Click on the hyperlink of the agent’s name.
If the agent is already associated to you, the message “Agent Already
associated with Physician” displays.
The agent must be registered and associated to at least one other provider in
ExpressPAth in order for the agent to return in the search results. Otherwise,
the following message displays.
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If the searched-for agent is not associated to the physician and has registered
as an agent for any other physician in ExpressPAth Provider Portal, the agent
will be included in the search results.
When the agent has been selected by clicking on the hyperlink with their
name in the search results, the Assign Privileges to Agent pop-up box
displays.
4.
To assign privileges to the agent, click the checkboxes to select the desired
privileges.
5.
To confirm the assignment of privileges, click
or
To cancel the assignment, click
A message displays, indicating the Agent’s record has been updated.
ExpressPAth adds the selected agent to your My Agents list.
A confirmation email is sent to the agent’s registered email, containing login
instructions.
Note: Agents receive emails to inform them that they have activated by their
providers and that they are now able to perform assigned prior
authorization privileges on their behalf.
Note: Agents with Office Manager privileges are able to manage their
providers’ My Agents settings. Office Managers have the ability to
add agents, as well as edit their privileges, or deactivate agents on
behalf of their associated providers.
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Editing My Agents
You are able to edit privileges assigned to agents, to change the agent’s status, and to
amend the period of privileges.
To assign privileges to the agent:
1.
Click on the Settings tab.
The Settings page displays with the Your Options menu open.
2.
Click the My Agents link.
or
Next to My Agents click
The My Agents page displays in the work area.
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4.
Locate the agent for whom edits are required.
5.
Click the associated Edit link.
The My Agent (Edit Agent Information) page displays in the work area.
6.
To edit the agent’s privileges, click the Assign Privileges checkboxes to
select or deselect privileges.
7.
To edit the agent’s status, click the Agent status dropdown arrow.
If you are changing agent status from “Inactive” to “Active,” you must also
assign at least one privilege to the agent before you are able to save the edits.
8.
To edit the dates in the Deactivate Agent on field, click the calendar
or
Type the amended date in the Deactivate Agent on field (MM/DD/CCYY).
Note: In order to deactivate an agent immediately, the Provider must choose
a date prior to the current date in the Deactivate Agent On date field.
An agent can also be deactivated on any date in the future by selecting
that date. When that date arrives, the agent’s status will automatically
be changed to “Inactive” in ExpressPAth.
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9.
To save your edits, click
Note: If you assign the Office Manager privilege to more than three users,
subsequent office manager assignments will prompt a popup to
display. The popup indicates that at least three office managers have
been assigned and asks if you are sure you want to assign another.
10.
To proceed, click
ExpressPAth saves the privileges. .
Authorizing an Agent Request
When an agent has registered and associated themselves to the prescriber, the
prescriber receives email notification.
To authorize the agent:
1.
Open the Agent Activation email.
2.
Click the link embedded in the email
or
Copy and paste the URL address string into your Internet Explorer address
bar, and then click the Search icon.
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ExpressPAth displays the login screen.
3.
Log into ExpressPAth.
The My Agent (Edit Agent Information) page displays.
4.
To assign privileges to the agent, click to select the desired Assign Privileges
checkboxes.
5.
To activate the agent, click
ExpressPAth activates the agent and completes the association.
ExpressPAth sends an email to the agent, indicating the association is
complete.
The My Agent page redisplays with the changes displayed.
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Settings - Managing Your Profile Information - Agents
By accessing the Settings Tab in ExpressPAth, you are able to manage your profile
information, including editing your information and changing your password. Agents
are able to request association to additional providers/providing facilities, remove
association to providers/providing facilities and view other agents associated to their
providers/providing facilities.
My Information (Agents)
Agents are able to edit and update their settings in the ExpressPAth Provider
Portal.
To edit or update My Information:
1.
When you have logged into ExpressPAth, click on the Settings tab.
On the left side of the page, a list of Your Options displays.
2.
To edit your information, click the My Information hyperlink
or
Next to My Information, click
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You are able to edit the following fields: all Name fields, Email, Secret
Question, or Answer. You can also change your password here.
3.
Click the desired field and type the updated information in the desired field.
4.
When you are finished, click
E-mail Summary Opt-out
An email summary containing the number of prior authorizations approved, denied, or
withdrawn, and the number of prior authorizations requiring input from someone
associated to that EOC is sent daily.
To opt out of receiving this daily email summary:
1.
On the My Information page, click the Opt out of Daily Email Summary
checkbox.
If you do not opt out, you will receive an email every day that there is activity
in any of the listed categories.
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My Physicians (for Agents)
Viewing My Physicians
My Physicians is a repository for physicians to whom you are associated.
To view My Physicians information:
1.
Click on the Settings tab.
The Settings Home page opens, with the Settings menu displayed.
2.
Click on the My Physicians link.
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A list of physicians associated to the agent displays.
Adding My Physicians
To add physicians to your My Physicians list:
1.
Click on the Settings tab.
The Settings Home page opens, with the Settings menu displayed.
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2.
Click on the My Physicians link.
A list of physicians or providing facilities to whom you are associated
displays.
3.
Click the Add link.
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The “Search for an existing Physician” pop up box displays.
There are four ways to search for a physician or providing facility.
To search for a physician or providing facility by NPI number:
1.
In the Physician NPI field, type the physician’s or providing facility’s NPI
number.
2.
Click
To search for a physician by name:
1.
In the First Name field, type the first name of the physician.
2.
In the Last Name field, type the last name of the physician.
3.
Click
To search for a providing facility by name:
1.
In the Facility Name field, type the providing facility’s name.
2.
Click
To search for a physician by PPI number:
1.
In the PPI field, type the ExpressPAth ID number that was assigned to the
provider during their registration.
2.
Click
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Search results, if any, display beneath the search area.
If the desired physician or providing facility displays in the search results
area, to select the physician or providing facility:
1.
Click on the Prescriber Name, which is a link.
You will use the Prescriber Name link even if you are selecting a Facility. If
no name is associated to the Facility, it will say “Unknown, Unknown” in the
Prescriber Name field.
2.
The system adds the physician or providing facility to your My Physicians
list.
Note: An email is sent to the Physician or Providing Facility to inform them
that an Agent has requested association to them. The provider must
assign privileges and activate the agent through a link included in the
email before the Agent is able to perform prior authorization tasks on
their behalf.
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Settings - Managing Your Profile Information - Agents
Reminder to Activate
If a provider does not activate the agent in a timely manner, the agent is able to send an
email reminder requesting that the provider complete the activation.
To send a reminder to the physician to activate the agent:
1.
In ExpressPAth, click on the Settings tab.
The Settings tab menu displays.
2.
On the Settings tab menu, click the My Physicians link.
The physician or physicians to whom you have requested association display.
3.
Locate the physician who has not activated.
Note: Agent Status will be “InActive.”
4.
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Click the Send Reminder to Activate link.
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A message displays, indicating that a reminder has been sent.
5.
If the physician does not activate the agent in a few days, the agent can click
the “Send Reminder to Activate” link again and another email will be sent.
Disassociating from a Provider on your My Physicians List (Agent)
An agent who is associated to a provider is able to disassociate him/herself from the
provider by removing the physician from their My Physicians List.
As an Agent, to remove association from a provider:
1.
On the ExpressPAth Provider Portal Home page, click the Settings tab.
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2.
The Settings page displays in the work area with the Account Home menu
open.
3.
Click the My Physicians link.
The My Physician page displays.
Note: The system will display all Providers to which the Agent has
requested an association, even if they have not been activated yet.
The Agent has the ability to remove association for any provider listed
here.
4.
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For the desired physician, click the Remove link.
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A pop-up message displays, asking, “Do you want to remove this Physician?”
5.
To continue removing the physician, click Yes.
A second pop-up message displays, stating, “Physician disassociated
successfully.”
6.
Click OK.
Your My Physicians list redisplays. The disassociated physician is no longer
listed.
Note: When an Agent removes a Provider from their My Physicians list, an
e-mail is sent to the Provider.
Note: Once an Agent has disassociated from a provider, that Agent is no
longer able to perform prior authorization tasks on the provider’s
behalf.
An Agent may remove association to all providers, but they will not
be able to perform any prior authorization tasks in the ExpressPAth
Provider Portal once all associations are removed.
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Settings - Managing Your Profile Information - Agents
My Physician Agents (for Agents)
Viewing My Physician Agents
Physician Agents are other agents that an Agent’s physicians or providing facilities are
associated with in ExpressPAth. These other agents are also authorized to perform
specific prior authorization tasks on behalf of that physician or providing facility.
1.
Click on the Settings tab.
The Settings Home page opens, with the Settings menu displayed.
2.
Click on the My Physician Agents link.
A list of Physician Agents to whom your physicians or providing facilities are
associated displays.
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If your physician or providing facility is not associated to any other agents,
the message “No Registered Agents available” displays.
No action may be taken on this page.
Note:
3.
Agents with Office Manager privileges will see both a My Physicians
link for all of their associated providers and/or providing facilities, as
well as a My Agents link for all other agents that are also associated
to their providers/providing facilities.
To return to the Settings menu, click the Settings tab.
or
To exit ExpressPAth, click the Logout tab.
or
To manage your prior authorizations, click the Prior Authorizations tab.
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Creating a List of Favorite Rendering Providers (Providers and Agents)
Creating a List of Favorite Rendering Providers
(Providers and Agents)
In the ExpressPAth Provider Portal, you are able to create a list of up to twenty favorite
rendering providers, making it easier to select frequently used providers. Favorite
Rendering Providers may be added manually or by searching. They may also be edited
or removed.
Viewing Your Favorites
To view your list of favorites:
1.
Log into ExpressPAth.
2.
Click on the Settings tab.
The Settings page opens in the work area.
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3.
Click the My Favorite Rendering Providers link.
The My Favorite Rendering Providers summary page displays with your
current favorite providers, if any.
My Favorite Rendering Providers
To create your own list of favorite rendering providers, you will first need to search for
existing providers. If you are unable to locate the provider after searching, you will
need to add the provider. You are also able to edit rendering provider information.
Because there is a limit of twenty favorite providers, if you exceed your limit and want
to add a new rendering provider to your favorites, you will need to remove a provider
first and then add the new provider.
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Creating a List of Favorite Rendering Providers (Providers and Agents)
Searching for Favorite Rendering Providers
To search for existing rendering providers:
1.
Click on the Settings tab.
The Settings page opens in the work area, with the Settings menu open.
2.
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Click the My Favorite Rendering Providers link.
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The Search Rendering Provider page displays.
If you have no favorite rendering providers listed or if you want to add
another favorite provider to your list, start your search by locating providers
already in the system.
3.
Click Search.
The Search Rendering Provider form pops up.
There are three ways to search for a rendering provider.
To search for a rendering provider by NPI number:
1.
In the NPI field, type the rendering provider’s NPI number.
2.
Click
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Creating a List of Favorite Rendering Providers (Providers and Agents)
To search for a rendering provider by Facility Name:
1.
In the Facility Name field, type the name of the facility.
2.
Click
To search for a rendering provider by name:
1.
In the First Name field, type the first name of the provider.
2.
In the Last Name field, type the last name of the provider.
3.
Click
The Search results display beneath the search criteria area.
4.
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If the desired prescriber/provider displays, in the Provider Name field, click
the provider’s name. This is a hyperlink.
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The selected provider displays as one of your favorite rendering providers.
5.
If the desired provider does not display, click
You will need to manually add the provider.
Adding a Favorite Rendering Provider
If a favorite rendering provider is not located by searching, you are able to manually
add the rendering provider.
To add a Favorite Rendering Provider:
1.
On the My Favorite Rendering Providers home page, click Add.
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The Add new Rendering Provider pop-up displays.
2.
You must populate the mandatory fields indicated by a red asterisk (*) to
manually add a rendering provider.
Mandatory fields include:
•
•
•
•
•
•
•
• City
NPI
• State
First Name
• Zip
Last Name
• Work Phone
Address Line 1
Email Address
Specialty (Note: Selecting the Specialty automatically populates the
Taxonomy Code field)
Taxonomy Code (Note: Entering the Taxonomy Code automatically
populates the Specialty field)
3.
You may also populate the Facility Name, Address Line 2 and Fax Number
fields (optional).
4.
Click
The provider is added to your favorites.
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Editing a Favorite Rendering Provider
If any of the information for a retrieved provider needs to be updated, you will need
to edit it.
To edit the information for an existing provider
1.
Locate the provider on your Favorite Rendering Provider list and click the
Edit link.
The Edit Rendering Provider popup displays, with the selected provider’s
information.
2.
Update the provider’s information.
3.
Click
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Creating a List of Favorite Rendering Providers (Providers and Agents)
Removing a Rendering Provider
If you are attempting to add a rendering provider to your favorites, but you are
already at your maximum of twenty favorites, a popup displays. It states, “The
maximum number of Favorites has been reached. Only 20 Favorites may be
designated.”
To remove the popup, click
Note: You will need to remove a rendering provider from your existing
Favorites before you will be able to add another rendering provider
to your Favorites list.
Note: You are able to remove rendering providers from your Favorites list
at any time, regardless of whether you have reached your limit of
twenty favorite rendering providers.
To remove a provider from your favorites:
1.
On your list of My Favorite Rendering Providers, locate the provider to be
removed.
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2.
Click the Remove link.
A popup displays, stating: “Do you want to delete this provider from your
Favorites?”
3.
To remove the favorite provider from your favorites list, click
or
To keep the favorite provider on your favorites list, click
Once you click Yes, the provider is removed from your list of Favorite
Rendering Providers.
You are now able to add an additional provider to your favorites.
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Changing Your Password (Providers and Agents)
Changing Your Password (Providers and Agents)
To view or edit your password information:
1.
Click on the Settings tab.
The Settings page opens in the work area. (Shown is Provider view.)
2.
Click the My Information link.
or
Click My Information
The My Information page displays.
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The example shown below is for a provider.
The example shown below is for an agent.
3.
Click the Change Password link.
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Changing Your Password (Providers and Agents)
The Change Password page displays.
4.
In the Old Password field, type your old password.
5.
In the New Password field, type your new password.
Note: Your password must be at least six characters long. It cannot match
any of the five previous passwords used. It must contain at least:
•
One upper case alpha character
•
One lower case alpha character
•
One number
•
One special character
6.
In the Retype New Password field, retype your new password.
7.
Click
The Change Password confirmation popup displays.
8.
To exit the popup and confirm the password change, click
Note: Changing the password and changing the secret question/answer are
the only My Information fields that an Agent with Office Manager
privileges is not able to manage for their providers.
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Initiating a Prior Authorization Request ......................................................3-3
To complete Step 5: Additional Information: ...............................................3-12
Picking a different Rendering Provider ..........................................................3-17
Blue Cross Blue Shield of Massachusetts (BCBSMA) Providers ONLY:
Initiating a Prior Authorization Request for Home Infusion Therapy (HIT) .3-21
Step 6- Select a Dispensing Location displays in the work area. ................3-32
Completing a Prior Authorization Request Immediately Following Initiation of
the Prior Authorization ...................................................................................3-37
Attaching Supporting Documentation ........................................................... 3-40
Completing an existing Prior Authorization Request ..................................3-44
Checking the Status of a Previously Submitted PA Request .........................3-48
Withdrawing a Prior Authorization ..............................................................3-51
Copying and Updating a Prior Authorization ..............................................3-54
Initiating an Appeal ........................................................................................3-64
Initiating a Prior Authorization Renewal .....................................................3-68
Completing the Renewal– Filling in the Form ...............................................3-70
Updating Rendering Provider NPI ................................................................3-72
Updating Rendering Provider from an Email Link ....................................... 3-72
Editing the Provider ...................................................................................... 3-74
Picking from Favorites .................................................................................. 3-75
Searching for a Rendering Provider .............................................................. 3-77
Adding a New Provider ................................................................................. 3-79
Updating Rendering Provider from a Prior Authorization ............................ 3-80
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Contents
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Initiating a Prior Authorization Request
There are two parts to entering a prior authorization request in ExpressPAth.
The first part, Initiating a New Prior Authorization Request, includes selecting the
patient, drug/service and dispensing location, entering additional information for the
drug or service chosen, and verifying the prescriber and rendering provider.
The second part, Completing a Prior Authorization Request, includes answering
clinical questions based on the health plan’s policy and attaching any supporting
documentation.
To begin initiating a new prior authorization:
1.
Log into ExpressPAth.
2.
Click on the Initiate a new Prior Authorization request link
or
Click the Go button for “Initiate a new Prior Authorization request” from
the Home page.
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Initiating a Prior Authorization Request
There are eight steps to initiate a new prior authorization request, from
entering the patient information to verifying the prescriber and rendering
provider. These steps display on the left side of the page.
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The Step 1: Search for a Patient form displays in the work area. On the left
side of the page, your initiation progress is tracked.
3.
To view available health plan choices, click the Select Insurance dropdown
arrow.
4.
To select the patient’s health plan from those displayed on the Insurance List
dropdown, click on the desired health plan. This is a required field.
You may locate the patient one of two ways: Member ID or Name and Date
of Birth.
To locate a patient by member ID:
In the Member ID field, type the member ID found on the patient’s insurance
card.
Note: Depending on the health plan, you may need to search by the
pharmacy benefit member ID, medical benefit member ID, or either
the pharmacy or medical member ID.
To locate a patient by name (First Name, Last Name and Date of Birth are all required
name search fields.):
1.
In the Last Name field, type the patient’s last name. Press Tab.
2.
In the First Name field, type the patient’s first name. Press Tab.
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Next to the Date of Birth Field, the Calendar feature becomes available.
3.
Select the appropriate date from the Calendar feature
or
To bypass the calendar, press Tab again.
4.
In the Date of Birth field, type the birth date of the patient as
MM/DD/YYYY.
Note: You do not need to enter separators. ExpressPAth will supply the
separator between date fields for you.
5.
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Step 2: Patient Search Results displays in the work area.
6.
Confirm that the patient has active Pharmacy and/or Medical Eligibility
(depending on the health plan).
If the patient does not have either active Pharmacy or Medical Eligibility
(depending on the health plan), do not proceed.
7.
If the patient has a Pharmacy and/or Medical Eligibility Status of Eligible
(depending on the health plan), click on the patient’s name, which is a
hyperlink.
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Initiating a Prior Authorization Request
Step 3: Search and select drugs or ancillary services displays.
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8.
In the Search for Drug by NDC, Drug Name or HCPCS/CPT Code
section, in the appropriate fields type the desired drug NDC number, Drug
Name, or HCPCS/CPT code.
Note: Only one drug or service may be entered on a Prior Authorization at a
time.
To search for the desired drug NDC:
1.
In the NDC field, type the NDC of the drug.
2.
Click Search.
To search for a drug by Drug Name:
1.
In the Drug Name field, type the name of the drug.
2.
Click Search.
To search by HCPCS/CPT code:
1.
In the HCPCS/CPT code field, type the HCPCS/CPT code.
2.
Click Search.
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Based on the search requested, the Search Results pop-up displays.
3.
Click on the desired result, which is a hyperlink. (Shown above is the Drug
Name link result).
To search for a desired Ancillary service:
1.
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In the Search for Services section, click the Select a Service dropdown
arrow to view available services.
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2.
Click to select the desired service option from those listed. Click the Add
button.
After the drug or service is selected, the Episode of Coverage (EOC) ID is
created. At this point, the user can save the PA at any point and return to
complete it, starting at that step within the prior authorization, within five
business days.
If the selected health plan has formulary alternative options configured to the
plan, Step 4: Formulary Alternatives displays. If the health plan does not
have any formulary alternatives available in ExpressPAth, this step is
skipped.
Step 5: Additional Information displays in the work area.
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To complete Step 5: Additional Information:
1.
The New/On-going, Is this an Urgent Request? and Comments fields are optional.
2.
In the Route field, click the dropdown arrow to select the route of administration of the
drug. The default for this required field comes from Medispan.
3.
In the Start Date field, type the start date as MMDDYYYY or use the calendar feature.
The Start Date of Service defaults to the current date.
4.
In the Quantity field, type the valid drug quantity. This field is required. For example,
if the prescription is for twice daily for 30 days, the quantity will be 60.
5.
The No. of Refills field is optional.
6.
In the End Date field, type the end date as MMDDYYYY or use the calendar feature.
The end date of service defaults to the default authorization time period configured for
that clinical policy.
7.
In the Days Supply field, type the valid days supply. The days supply is the number of
days for which a prescription is filled. This is a required field.
8.
Duration is a calculation based on the Days Supply and the Number of Refills. When
the Duration changes, the End Date also recalculates.
9.
Directions is an optional field and include specific instructions on how the drug should
be administered for the patient.
10.
Click
Step 6: Select a dispensing location displays.
a
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To select a dispensing location:
1.
In the Dispensing Location field, click the dropdown arrow.
2.
From the locations displayed, select the appropriate location. This is a required field.
Note: The Dispensing Location may be limited to values of Sites of Care that are valid
only for this member and drug combination. (See example below).
Step 7: Verify Prescribing Physician or Nurse Practitioner displays in the work
area.
Prescribing Physician View
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Prescribing Agent View
There are two ways to populate Step 7: Verify Prescribing Physician or Nurse
Practitioner.
If you are logged in as the prescriber, to select a different prescribing location than your primary
(default) practice location:
1.
Click the Select different dispensing location of prescriber dropdown.
2.
From the list of associated locations, click on the desired prescriber dispensing location
to select it.
3.
Click
If you are logged in as an agent of a prescriber, select the appropriate prescriber/practice location
from the dropdown.
To manually enter or edit details for the prescriber:
1.
In the NPI field, type the physician’s NPI number.
Note: The State License ID and DEA fields are optional.
2.
In the Taxonomy Code field, type the physician’s taxonomy code number
or
Select the physician’s Specialty from the dropdown list. Once the Specialty or the
Taxonomy Code is selected, the other field auto-populates.
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3.
In the First Name field, type the physician’s first name.
Note: The Prefix and Middle Initial fields are optional.
4.
In the Last Name field, type the physician’s last name.
5.
In the Address Line 1, City, State, and Zip fields, type the physician’s address.
Note: Address Line 2 is optional.
6.
In the Work Phone field, type the 10-digit phone number.
Note: Fax Information is optional.
7.
In the Enter your Email Address field, type your email address.
8.
In the Retype Email Address field, type your email address again. The two email
addresses must match.
9.
To save the changes, click
10.
To continue to the next step, click
Step 8: Select/Change/Edit Rendering Provider displays in the work area.
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The Select/Change/Edit Rendering Provider page determines if this claim will be
submitted using the prescriber’s NPI or using a different NPI.
•
•
•
•
•
•
In the Options section there are several options:
Leave the provider as listed (using the prescriber’s NPI)
Select a different location for the prescriber/provider
Search for a different provider
If the provider is not available by search, Add a new provider
Pick a provider from your Favorites List
To use the prescriber’s NPI to submit this claim, click
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Picking a different Rendering Provider
To use a different NPI number to submit this claim:
1.
In the Options section, select the Add/Search for a different Provider radio button.
2.
The Add Provider and Search Provider links become available.
To select a different rendering provider from a list of providers:
1.
Click
The Search Rendering Provider form displays at the bottom of the work area.
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2.
Search for an existing rendering provider one of three ways:
By NPI number,
or
By First Name and Last Name,
or
By Facility Name
3.
When you have populated the desired fields, click
A list of providers matching your search displays in the blue section of the form.
4.
Scroll to the desired provider, then click the Provider Name link.
The rendering provider’s information displays in the Rendering Provider Details
section.
5.
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To submit this provider as the rendering provider, click
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To add a new provider and use this provider as the rendering provider:
1.
Click the Add Provider hyperlink.
The Add new Rendering Provider form displays at the bottom of the page.
2.
In the NPI field, type the provider’s NPI number.
3.
Click the Specialty field dropdown to select the provider’s specialty. Selecting the
Specialty will auto-populate the Taxonomy Code field.
a. or
b. In the Taxonomy Code field, type the provider’s taxonomy code number. This
will auto-populate the Specialty field.
4.
The Facility Name field is optional.
5.
The First Name, Last Name, Address Line 1, City, State, Zip, and Work Phone
number fields are required and must be populated.
6.
The Prefix, Address Line 2, Fax #1 and Fax #2 fields are optional.
7.
In the Enter your Email Address field, type your email address.
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8.
In the Retype Email Address field, type your email address again. The two email
addresses must match.
9.
When finished, click
To select a different rendering provider from your list of Favorites:
1.
Click the Pick Provider from Favorites List radio button.
2.
A dropdown selection box displays to the right of this choice.
3.
To view the favorites, click the dropdown arrow.
4.
If providers on your favorites list are available to be rendering providers for this patient,
they will display on the list.
5.
Click the provider to select it.
6.
To submit this provider as the rendering provider, click
Step 8: Select Rendering Provider redisplays, with your provider’s information in the
detail section.
7.
To submit this provider as the rendering provider, click
When you have successfully completed this step, you will receive a message indicating
that you have successfully initiated a prior authorization request.
To continue the process to complete the prior authorization:
1.
In the popup box, click
See Completing a Prior Authorization Request Immediately Following Initiation of the
Prior Authorization for instructions on completing the PA Request.
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Blue Cross Blue Shield of Massachusetts (BCBSMA) Providers ONLY:
Initiating a Prior Authorization Request for Home Infusion Therapy (HIT)
If a provider is registered as a Specialty Pharmacy, Home Infusion Therapy Agency, or a Dialysis
Center, or an agent thereof, additional HIT drug/service options are available when initiating a
prior authorization.
The Home Infusion Therapy (HIT) categories are most commonly used to initiate a HIT prior
authorization request.
The request process for a HIT prior authorization is the same as a non-HIT request until the 3rd
step.
To initiate a prior authorization request for a home infusion therapy product:
1.
On the Prior Authorization tab page, also known as the Prior Authorization Portal for
Physicians, click on the Initiate a new Prior Authorization request link.
or
To the right of this link, click
The Step 1: Search for a Patient form displays in the work area. On the left side of
the page, your initiation progress is tracked.
2.
To view available health plan choices, click the Insurance List dropdown arrow.
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3.
To select the patient’s health plan from those displayed on the Insurance List
dropdown, click on Blue Cross Blue Shield of Massachusetts (BCBSMA). This is a
required field.
Note: The patient must be a Blue Cross Blue Shield of Massachusetts (BCBSMA)
member and the ExpressPAth user must be registered as a Home Infusion
Therapy Provider, Specialty Pharmacy, Dialysis Center, or agent thereof to enter
a request for a prior authorization using this method.
4.
Locate the patient by searching by Member Id
or
Locate by searching with a combination of Last Name, First Name and Date of Birth.
5.
Enter the patient search criteria and click
Step 2: Patient Search Results displays.
Note: Based on the search criteria entered, one or more patient eligibility records will
display.
6.
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If multiple records display, locate the correct patient.
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7.
In the Medical Coverage Details section, confirm that the patient has active Medical
Eligibility.
If the patient does not have active Medical Eligibility, do not proceed.
HIT prior authorizations can only be requested for patients with BCBSMA medical
coverage and active eligibility.
8.
If the patient has a Medical Eligibility Status of Eligible and is the correct patient, click
on the Patient Name hyperlink.
Step 3: Search and select drugs or ancillary services displays.
If a provider is registered as a user who can perform HIT prior authorizations for
BCBSMA, additional drug/service options are available when initiating a prior
authorization.
To search for a Home Infusion Therapy category,
1.
In the Search for Home Infusion Therapy section, click the Select Category dropdown.
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A list of Home Infusion Therapy options available for this client displays.
The Home Infusion Therapy categories are most commonly used to initiate a HIT prior
authorization request.
2.
To select a Home Infusion Therapy category for the patient, click on the category.
3.
When a category has been selected, click
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A list of drugs included in the selected HIT category displays.
You can also search for a specific drug by NDC, Drug Name, or HCPCS/CPT Code
instead of using the HIT category list.
4.
To select the drug you are requesting for the patient, click the drug name.
Drug search results display for the selected drug.
5.
Locate the NDC for which you are seeking prior authorization. You may need to scroll
to find it.
6.
To add the drug to the request, click on its Drug Name hyperlink.
In the Search and Select drugs or ancillary services section, the selected drug displays
on the Selected Drugs/Services List.
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Initiating a Prior Authorization Request
When initiating a HIT prior authorization request, you have the option to request up to
twelve drugs and/or services on a single request.
The first drug or service selected displays at the top of the form.
To add another drug or service to the request, click
1.
Repeat the process for HIT selection to add drugs/services.
The next selection can be from the same category or from a different category.
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2.
In the Search for Home Infusion Therapy section, click the Select Category dropdown
arrow.
3.
Select the designated category.
4.
Click
5.
Search Results display the drugs/services in the selected category.
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6.
Locate the NDC for which you are seeking prior authorization. You may need to scroll
to find it.
7.
To add the drug to the request, click on its Drug Name hyperlink.
The second drug or service displays in the Selected Drugs/Services List.
Note: When multiple drugs/services are requested, you always have the option to
remove the item from the request.
To remove a drug or service from the request, deselect the checkbox of the item
to be removed.
8.
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When you have completed additions to the request, click
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If the patient’s benefit design is set for it, Step 4 – Formulary/Preferred Alternatives
displays.
If formulary alternatives are available, you have the option to replace the non-preferred
drug that was selected with a preferred alternative drug.
This step is bypassed when no preferred alternatives are available, depending on the
patient’s benefit design.
If Step 4 does not display or after Formulary Alternative choices have been made, if
appropriate, Step 5- Additional Information displays.
If the request includes multiple drugs/services, you must complete the Additional
Information section for each drug/service.
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To complete Step 5: Additional Information:
1.
In the New/On-going field, if this is a new prior authorization request, select New.
or
If this is not a new prior authorization request, select On-going.
2.
If you believe that the standard review timeframe may seriously jeopardize the life or
health of the patient or the patient’s ability to regain maximum function, choose Yes in
the Is this an Urgent Request field.
The default for this field is No.
3.
To add comments to this request, type your comments in the Comments free-form text
field.
4.
To select the method of administration of the drug, in the Selected Drugs/Services
section, click the Route dropdown.
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5.
Set the Date fields appropriately. The Start Date defaults to the current date. The End
Date is calculated based on the Duration field.
The Duration field displays a default value based on the product or service selected, but
will automatically re-calculate based on the data entered into the No of Refills and Days
Supply fields.
6.
In the appropriate fields, indicate the Quantity and Days Supply instructions for each
drug/service on the HIT prior authorization request.
The Quantity field refers to the total number of units prescribed for the selected
drug/dosage per the indicated Days Supply.
For example: For a drug that is prescribed for 2 tablets per day with a Days Supply of
7 days, you would enter 14 in the Quantity field.
7.
Days Supply refers to the total number of days that the supply of medication in the
Quantity field should last the patient for a single fill.
Once the field has re-calculated, you can manually enter the length in days you want the
prior authorization to be valid.
8.
In the No. of Refills field, enter the number of refills you are requesting. Do not include
the initial fill.
9.
In the Directions field, type specific drug administration directions.
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Note: To remove a drug/service from the request, click
The deselected drug or service is removed.
then click
Step 6- Select a Dispensing Location displays in the work area.
The Dispensing Location is the site where the requested drugs/services are
administered.
When requesting a HIT drug/service, the only dispensing location option is Home
Infusion.
Note: Non-HIT providers have additional dispensing location options available to
them.
To select Home Infusion as the Dispensing Location, click
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Step 7- Verify Prescribing Physician or Nurse Practitioner displays in the work area.
A Prescriber is licensed to write a prescription for a drug or service (such as a
Physician, Nurse Practitioner, Physician’s Assistant or a Pharmacist).
In this section, you add the prescriber’s information to the request.
To locate the prescriber’s information, click
The Search Prescriber box displays.
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To search for prescribers:
1.
In the NPI field you may type the prescriber’s NPI number
or
You may search by Prescriber First Name and Last Name,
or
You may search by Facility Name.
2.
Click Search.
The results of your search display at the bottom of the Search Prescriber box.
You may need to scroll to locate the appropriate prescriber.
Note: If you cannot locate the prescriber’s information, you have the ability to
manually add the prescriber’s information.
3.
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To add the prescriber to the request, click the Prescriber Name link.
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Step 7: Verify Prescribing Physician or Nurse Practitioner displays with the
prescriber’s details.
4.
Click
Step 8: Select the Rendering Provider displays in the work area.
A Rendering Provider is licensed to administer a drug or service (e.g. Physician’s
Office, Home Infusion Therapy Agency, Specialty Pharmacy, Outpatient Facility or a
Dialysis Center).
You may need to select a different provider or location information from the default
display.
Based on your selection, you may need to make changes to the Provider Details
section.
5.
To complete the initiation process, click the Submit button.
The HIT Prior Authorization Request is now initiated.
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A confirmation message displays.
The final 3 steps to complete this HIT request are:
•
•
•
Answer the Clinical Questionnaire
Attach Supporting Documentation
Submit the Prior Authorization request
This process is referred to as “Completing a Prior Authorization Request.”
You have five days to complete and submit the request.
6.
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To continue to the Completing a Prior Authorization Request process, click
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Completing a Prior Authorization Request Immediately Following Initiation of
the Prior Authorization
Once a prior authorization request has been initiated (as illustrated previously), the user will
arrive at the start of the three-step Completing a Prior Authorization Request process.
Request details display, including the Prior Auth (EOC) ID.
A prior authorization (PA) may be completed immediately after initiating the PA or it may be
completed at a later time.
To begin the Completing a Prior Authorization Request process,
1.
Click the Answer hyperlink to answer the clinical questionnaire.
2.
For HIT requests with multiple drugs/services, you may need to complete a separate
clinical questionnaire for each drug or service requested by clicking the Answer
hyperlink for each drug and/or service.
Note: When multiple drugs on the request belong to the same medical policy, the
clinical questionnaire will only need to be completed one time.
The completion process is the same for both HIT and non-HIT prior authorization
requests.
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Initiating a Prior Authorization Request
Step 1: Complete all the sections in the form below displays in the work area.
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The clinical questionnaire displayed in Step 1 must be completed before the prior
authorization can be completed. The responses are based on the clinical policies of the
health plan. All enabled questions require an answer.
Depending upon the response given, the questionnaire will enable or disable the
appropriate questions.
To complete Step 1 Complete Questionnaire, you will complete the sections of the form below:
1.
Complete all applicable sections of the questionnaire.
2.
To proceed, click
If an answer is missed, the following prompt displays.
3.
To continue, click
or
After responding to at least one clinical question, to save the questions and return to
complete within five business days, click
4.
Complete any unanswered questions and click
Step 2: Attach any supporting documents displays in the work area.
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Attaching Supporting Documentation
Attaching Supporting Documentation is an easy process.
The files that are uploaded into ExpressPAth must be in one of the following formats.
•
•
•
•
•
PDF -- Used for both images and text
BMP -- Used primarily for images
GIF -- Used primarily for images
JPG -- Used primarily for images with photographic images requiring high-color
resolution
TIFF -- Used for images that span multiple pages
IMPORTANT: File size cannot exceed 4 MB.
Because Word documents cannot be attached, you must convert Word documents before
attaching them.
To convert a Word document to a PDF:
1.
Locate and open the folder in which the Word document is located.
2.
Click once on the desired file, to select but not open it.
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3.
On the menu bar, select the File menu.
4.
On the File dropdown menu, click on Convert to Adobe PDF.
5.
Click Save.
To attach a document:
1.
To locate the document, in the Select file field, click
2.
Select the document by clicking on it.
3.
Click the Open button.
.
The file displays in the Select file field.
4.
In the Description field, enter an appropriate description for the file.
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5.
In the Document Type field, click the dropdown arrow and select the correct
description for the file document type.
6.
Click
.
A summary of the attachments displays.
7.
In the Comments and Additional Supporting Information freeform text box, enter
your comments or any additional information.
8.
When all files are attached, click
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A notification message indicates your answers will be submitted and you will be unable
to make changes.
9.
To proceed and submit, click Yes.
or
Depending on the health plan and if all clinical criteria have been answered according to
the health plan’s policy, you may see an automatic approval, as shown below.
Complete PA Form redisplays with an Approved link to the PA request.
Depending on the health plan’s policy, the authorization may need to be submitted to the
health plan for further clinical review.
After the submission, a link is included to check the status of a submitted PA request.
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Completing an existing Prior Authorization Request
Completing an existing Prior Authorization Request
A prior authorization (PA) that was not completed immediately after initiation may be completed
by clicking on the Complete existing Prior Authorization requests link on the Prior Authorization
Portal.
To complete an existing prior authorization request:
Click the Complete existing Prior Authorization requests hyperlink, or click
The Complete Prior Authorization page displays in the work area.
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This accesses the Open (or incomplete) prior authorization requests. If there are prior
authorization requests that need to be completed within 5 days of the date initiated, a
message displays indicating the number of PA’s to be completed.
Note: An Open PA that has been initiated but not completed within five days will be
removed from ExpressPAth.
To complete the next prior authorization request in your queue:
1.
Click the Get Next PA in Queue link.
The prior authorization opens at the point where it requires attention.
2.
Continue to complete the prior authorization.
To filter by patient to locate a prior authorization request:
1.
Click the Filter by Patient link.
Step 1: Search by Patient Details displays in the work area.
2.
To Search for the patient, at least one of the following fields is required:
First Name, Last Name, Date of Birth, Member/Insurance No., Group Number.
3.
Click
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Search Results display in the work area.
At this point you may take one of three actions: Withdraw the PA form, Complete the
PA request, or Edit the PA request.
4.
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To continue, click the corresponding link.
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Checking the Status of a Previously Submitted PA Request
Checking the Status of a Previously Submitted PA Request
To check the status of a previously submitted prior authorization request, on the Home page Prior
Authorization Portal for Physicians:
1.
Click on the Search for a previously submitted Prior Authorization request link
or
Click
.
Step 1: Search by entering Patient Details displays in the work area.
To search for a previously submitted prior authorization request:
1.
Populate at least one of the fields indicated by a red identifier at the field end.
Populating more fields with specific information filters the search results. For example,
if you know the patient’s member ID or Prior Auth (EOC) ID, the results will be specific
to your search
2.
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Populate any fields that will assist in the PA search.
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3.
To begin the search, click
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Step 2: Search Results – Click on patient name (OR) Status to view details displays
beneath the original search.
4.
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To view details of the desired prior authorization, click the Patient Name hyperlink.
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Withdrawing a Prior Authorization
If you get part of the way through an EOC and stop after the EOC is created and before it is
submitted, you have the option to withdraw the prior authorization.
To withdraw a prior authorization:
1.
In the ExpressPAth Provider Portal, click the Prior Authorization tab.
2.
Click the Complete existing Prior Authorization requests link.
3.
A list of Prior Authorization requests that require your attention to be completed by you
display in the work area. These requests all have a status of Open.
On the left side of the page a list of screen options and prior authorization options
displays.
4.
Locate the desired prior authorization on the list in your work area.
5.
To withdraw the prior authorization from the list of prior authorizations to be completed,
click the Withdraw hyperlink.
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A popup box displays with the EOC ID of the prior authorization and the name of the
patient.
6.
If you want the prior authorization to be removed and no longer accessible, in the popup
box, click Yes.
The prior authorization no longer displays on your Complete Prior Authorizations list.
Note: A prior authorization with a status of Open will only display for five days after
the prior authorization has been initiated. If the prior authorization has not been
submitted within five days of initiation, it will automatically be removed from
the list of Open prior authorizations and will no longer be accessible to the user.
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Copying and Updating a Prior Authorization
Copying and Updating a Prior Authorization
ExpressPAth has a Copy and Update feature for PA Requests that saves time when additional
PA requests are needed for the same patient.
To start the copy and update process:
1.
Search for a previously submitted request by clicking the Search for a previously
submitted Prior Authorization request link.
Step 1: Enter Search Criteria and Click Search displays in the work area.
2.
Enter the desired patient’s information in the Search fields.
Note: If you search by unique fields (Member ID or EOC ID) or by entering
information in multiple fields, the search results will be more refined and
accurate.
3.
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Step 2: Search Results displays beneath the search criteria.
The Copy and Update link displays in the upper right corner of the Search Results on
prior authorizations in Approved status.
Copy and Update is designed as a shortcut for creating a PA request for the same
patient. It allows you to change any of the information except the patient’s profile.
4.
Click Copy & Update PA hyperlink of the desired patient.
A popup displays to remind you that a copy of this prior authorization will be created.
5.
To continue with the copy and update process, click
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Step 3: Search and select drugs or ancillary services displays in the work area.
6.
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To change or add a drug or service, click the Add/drug service link.
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7.
Enter the information in the appropriate fields below and click
or
To keep the same drug or service, click
8.
To enter a service, if needed, click on the Select a Service dropdown.
9.
For the desired drug or service, click on the appropriate hyperlink.
The selected drug now displays in the Selected Drug/Service List.
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Note: To edit the drug or service if there was a problem, click
10.
To continue with the Copy and Update, click
If the selected health plan has formulary alternative options configured to the plan, Step
4: Formulary Alternatives displays. If the health plan does not have any formulary
alternatives available in ExpressPAth, this step is skipped.
Step 5: Additional Information displays in the work area.
The process follows the same steps as Initiating a PA.
11.
Complete the Step 5 form by providing all the information required for this request.
Note: A change in Duration will recalculate the End Date. Likewise, a change in the
End Date will recalculate the Duration.
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If there is a change that affects the Dates, a notification message displays.
12.
With all required information entered, click
Step 6: Select a dispensing location displays in the work area.
13.
If needed, in the Dispensing Location field, click the dropdown to select a different
dispensing location.
14.
Click
Step 7: Verify Prescribing Physician or Nurse Practitioner displays in the work area.
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A Prescriber is any person who is licensed to write a prescription for a drug or service,
such as a Physician, Nurse Practitioner, Physician's Assistant or a Pharmacist.
15.
Verify or Edit Prescribing Physician, as needed.
A Provider is a person or a facility that is licensed to administer a drug or service, such
as a:
• Physician's Office
• Home Infusion Therapy Agency
• Specialty Pharmacy
• Dialysis Center
• Outpatient Facility
16.
Verify or Edit Rendering Provider as needed.
A message displays to indicate that the request has been successfully initiated.
17.
Click
Complete PA Form Step 1: Complete Questionnaire displays.
You are in the Complete PA Form section, and the first step is to Complete
Questionnaire. At this point you will answer clinical questions, attach supporting
documents, review and submit.
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To complete the Clinical Criteria questions,
1.
Click the Answer hyperlink.
Step 1: Complete all the sections in the form below displays with details of the prior
authorization request and a list of questions.
Your responses to the questions will affect whether subsequent questions are available
or deselected for response.
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2.
Complete the Clinical Criteria questions.
3.
To save your answers and come back to this form later (within five days), click
4.
To continue, click
Step 2: Attach any supporting documents displays in the work area.
Note: See Attaching Supporting Documentation for details on attaching documents to a
prior authorization.
A list of the attached documents displays in the Documents attached so far area.
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5.
In the Comments and Additional Supporting Information freeform text box, enter
your comments or any additional information.
6.
When all files are attached, click
A notification message indicates your answers will be submitted and you will be unable
to make changes.
7.
To proceed and submit, click Yes.
Depending on the health plan and if all clinical criteria have been answered according to
the health plan’s policy, you may see an automatic approval, as shown below.
or
Depending on the health plan’s policy, the authorization may need to be submitted to the
health plan for further clinical review.
After the submission, a link is included to check the status of a submitted PA request.
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Initiating an Appeal
Initiating an Appeal
If a prior authorization is in denied status, an appeal request may be submitted to have the denial
re-evaluated.
To begin the appeal process:
1.
On the Prior Authorization Portal for Physicians page, click the Search for a previously
submitted PA request hyperlink
or
Click
Step 1: Enter Search Criteria and Click Search displays in the work area.
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2.
Populate the fields to locate the patient.
3.
Click
Step 2: Search Results displays at the bottom of the work area.
4.
Confirm that this is the correct patient. This prior authorization has a status of Denied.
5.
To appeal this status, click
6.
To begin the appeal, click the Appeal hyperlink.
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Initiating an Appeal
The Initiate an Appeal Request page displays in the work area, with the details of the
PA.
7.
Review the details of the prior authorization.
8.
Enter any comments or additional information related to this prior authorization request.
9.
Click
A message indicates you have successfully initiated First Level of Appeal request.
10.
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Initiating a Prior Authorization Renewal
Initiating a Prior Authorization Renewal
A prior authorization which will expire in 90 days or less may be renewed, using the Prior
Authorization Renewal process.
To begin the PA renewal process:
1.
On the Prior Authorization Portal for Physicians page, click the Renew a Prior
Authorization request hyperlink
or
Click
.
Step 1: Search for Prior Authorizations eligible for renewal displays, with PA’s
expiring in the next 90 days displays. This is the default.
2.
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For the desired prior authorization, click
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Step 2: Initiate a Renewal Request displays in the work area.
3.
Review the Renewal Request fields for this prior authorization.
4.
Enter comments or additional information, if needed.
5.
Click
A message displays to confirm that you have successfully initiated a Renewal request.
6.
Click
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Completing the Renewal– Filling in the Form
After the Renewal has been initiated, the Completing the Renewal stage begins.
A renewal may have a different set of clinical questions than the initial request or it may ask some
of the initial questions again to determine if the information has changed since the original PA
request. This is dependent upon the plan benefit set-up.
To complete the renewal:
1.
Complete PA Form Step 1: Complete all the sections in the form below displays in
the work area.
This is exactly the same as completing any other prior authorization. You should
complete the questionnaire and update fields as necessary, related to this renewal.
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2.
To complete the questionnaire, click
3.
When you have completed the questionnaire, click
Step 2: Attach any supporting documents displays in the work area.
4.
Attach any supporting documents to the prior authorization. For more information on
this, see Attaching Supporting Documents.
5.
When the documents have been attached, click
A notification message indicates your answers will be submitted and you will be unable
to make changes.
6.
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Updating Rendering Provider NPI
Updating Rendering Provider NPI
If the rendering provider information on a submitted claim does not match the rendering provider
information on the prior authorization, the claim rejects.
If this happens, providers and agents associated to the approved authorization may receive an
email from the member’s health plan, requesting an NPI update. The link in the email brings the
authorized users to the exact authorization that requires the update. The authorized users then
have the ability to update the rendering provider NPI so that claims submitted using the
authorization will process appropriately.
Another way to update the rendering provider NPI is to locate the episode of coverage (EOC). If
the status of the EOC is “Approved” and the health plan has requested that users associated to the
prior authorization on the ExpressPAth update the NPI, an Update NPI link displays. After
clicking the Update NPI hyperlink, the prior authorization page displays the current rendering
provider information and contains links to change the rendering provider.
Updating Rendering Provider from an Email Link
If you have received an email requesting an update to the Rendering Provider Information, you
are able to begin your update from the email. The email may contain the updated NPI that should
be associated to the rendering provider. If the NPI is not included in the email, you need to
update the NPI to the billing NPI the provider is using on the claim.
To start the Rendering Provider NPI Update from the email link:
1.
Click the link embedded in the text of the NPI update email.
Note: If the EOC in question is being used by another ExpressPAth user, you will
receive a message that the record is locked. You will need to wait for the EOC
to be unlocked to make changes to it. You cannot continue at present.
or
If the EOC is available and the Rendering Provider NPI has already been
updated, ExpressPAth will return a message that this information has already
been updated. There is no need to continue.
2.
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If the EOC is not locked and the Rendering Provider NPI has not been updated, log into
the ExpressPAth Portal after clicking the hyperlink in the Update NPI email.
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3.
Log into the ExpressPAth Portal.
ExpressPAth displays the previously submitted prior authorization request requiring an
NPI update.
Current Rendering Provider Information is shown, including NPI information.
Note: If the updated NPI was provided by the member’s health plan, the system returns
the Rendering Provider information, including current and updated NPI
information.
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Updating Rendering Provider NPI
Editing the Provider
To change the NPI by editing the Provider:
1.
If the desired Provider displays but the NPI information is incorrect, in the Change
Rendering Provider area click the Edit Provider Link.
The Edit Rendering Provider box displays.
2.
In the NPI field, update the NPI number.
3.
Click
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4.
The Rendering Provider page redisplays with current and updated NPI information.
5.
To update the information, click
ExpressPAth redisplays the page with the updated NPI information.
To cancel the update, click
Picking from Favorites
To change the Rendering Provider by selecting from your Favorite Rendering Providers list:
1.
Click the Pick From Favorites link.
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The My Favorite Rendering Provider(s) list displays as a pop-up box.
2.
Locate the provider on your My Favorite Provider(s) list.
3.
Click the Provider Name link.
The selected favorite rendering provider displays on the Change Rendering Provider
area of the page.
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4.
To update the prior authorization with this rendering provider, click
or
To cancel this provider selection, click
If the desired rendering provider is not on your My Favorite Rendering Provider(s) List,
you are able to search for the provider from all the providers in ExpressPAth.
Searching for a Rendering Provider
To search for a rendering provider:
1.
Click the Search Provider link.
The Search Rendering Provider form displays. You are able to search for an existing
rendering provider using this form.
2.
In the NPI field, type the NPI number of the rendering provider.
or
In the First Name and Last Name fields, type the name of the rendering provider.
or
In the Facility Name field, type the name of the rendering facility.
3.
Click
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The results of the Rendering Provider search display.
4.
To select a rendering provider from the search results for the desired provider, click the
Provider Name link.
The selected rendering provider is displayed in the Change Rendering Provider area of
the page.
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5.
To update the prior authorization with this rendering provider’s NPI, click
or
To cancel this provider selection, click
Adding a New Provider
To change the Rendering Provider by adding a provider:
1.
Click the Add new Provider link.
The Add new Rendering Provider(s) form displays as a pop-up box.
2.
You must enter the Provider details in the following required fields, marked with a
red asterisk (*):
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•
•
•
•
•
•
•
•
•
•
•
3.
NPI
Specialty
Taxonomy Code
First Name
Last Name
Address Line 1
City
State
Zip
Work Phone
Email address
When the required fields are populated, click
The added provider displays in the Change Rendering Provider area of the page.
4.
To update the prior authorization with this rendering provider, click
or
To cancel this provider selection, click
Updating Rendering Provider from a Prior Authorization
To start the Rendering Provider NPI update from the Prior Authorization:
1.
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Log into the ExpressPAth Portal.
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The Portal Landing page displays with the Prior Authorization tab open.
2.
Click the Search for a Previously Submitted Prior Authorization Request link.
or
Click
Step 1 - Enter Search Criteria displays with the Search by entering Patient Details
form open.
3.
To search for the previously submitted prior authorization request, enter search criteria
in at least one of the following fields:
•
First Name
•
Last Name
•
Date of Birth
•
Member ID
•
Group Number
•
Prior Auth (EOC) ID
•
External Case Number
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4.
Click
Note: If search results are not found, in the Search Results area the message, “No data
available” displays.
5.
Click
6.
To search again, re-enter Search criteria.
If search results are found, the list of patient prior authorizations displays.
The Status of the prior authorization determines what links display. It must have a
status of Approved for the Update NPI link to display.
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7.
Click the Update NPI link.
The Update previously submitted requests area displays with the current NPI
information for this prior authorization.
To change the NPI using your Favorites:
1.
If the desired Provider is on your list of Favorites, in the Change Rendering Provider
area click the Pick from Favorites link.
If you clicked Pick from Favorites, the My Favorite Rendering Provider(s) box
displays with a list of your favorite rendering providers.
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Updating Rendering Provider NPI
2.
Click on the Provider Name of the desired favorite provider.
The Rendering Provider page redisplays with current and updated NPI information.
3.
To update the information, click
ExpressPAth redisplays the page with the updated NPI information.
To cancel the update, click
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