IRFs are required to make their review choice selection within the free, secure internet portal Novitasphere.
For Cycle 1, IRFs have a 30-day choice selection period that ends two weeks prior to the start of the demonstration in their state to make their review choice selection.
For subsequent cycles, IRFs have a 2-week choice selection period that ends two weeks prior to the start date of the subsequent cycle to make their review choice selection.
IRFs can change their choice selection as often as they wish during the selection period. Once the review choice selection period ends, IRFs will not be able to change the review choice selection until the next review choice selection period for the next cycle.
If you are not enrolled in the portal, you are encouraged to begin the enrollment process as soon as possible to avoid potential delays with the choice selection process. If you are enrolled in the portal, ensure you have individual user access. For complete Novitasphere portal instructions, refer to the Novitasphere Enrollment eGuide. If you require assistance with Novitasphere enrollment, please contact us at 1-855-880-8424 from 8:00 a.m. – 5:00 p.m.
All users with access to the organization in Novitasphere will have the ability to make the review choice selection.
For complete Novitasphere portal information, access the Novitasphere web page.
For details on the Novitasphere features , access the Novitasphere User Guide.
Enter your User ID and password. Agree to the terms & conditions and select sign In.
After completing the verification process and acknowledging the security message, you will be taken to the home screen.
Or, if you have access to more than one organization, you will be presented with the organization, provider, and NPI selection box. Select the organization, provider, and NPI from the dropdown options. All organizations that you have access to will be listed in the dropdown options. After making the necessary selections, you will then be taken to the redesigned home page.
After successfully logging into Novitasphere, you will be on the home page.
From the home page, select “Prior Auth” from the top menu and click on “Review Choice Demo – IRF” from the submenu to get a menu of choices related to the RCD.
During the RCD, the options available include:
Choice Selection
Submit RCD Docs
History
Cycle Stats
From the list of RCD options, select Choice Selection:
During the choice selection period, you will be able select your review choice selection for the initial cycle and all subsequent cycles after under Choice Selection.
Note - Depending on your affirmation rate and past claim selections, you may see different choice selection options.
Selective Postpayment Review
A random sample of claims will be chosen for review every six months.
Spot Check Prepayment Review
Every six months, 5 percent of claims are randomly chosen for review.
Pre-claim Review (PCR)
Pre-claim is a process through which a request for provisional affirmation of coverage is submitted for review before a final claim is submitted for payment.
To continue in the PCR option for the remaining cycles of the demonstration without the need to select a choice for each cycle, select the check box that displays under the PCR option.
Postpayment Review
Once the claim is submitted, the MAC will process the claim for payment then ask via an Additional Documentation Request (ADR) for the IRF to submit medical records.
The choice selection period will remain open until the last day of the choice selection period displayed with the choice selection screen. After the selection period ends, IRFs will not be able to change the review choice selection until the next review choice selection period for the next cycle.
Choice selection options for Cycle 1 and subsequent review cycles for IRFs not meeting the affirmation/approval rate threshold:
Select one of the radio buttons for your review choice and then click save.
Reminder: If no selection choice is made before the review choice selection period ends the default is choice 2: Postpayment review.
After you click save, you will receive a choice selection confirmation message that your selection is successfully saved.
After clicking Ok for the confirmation, the choice selection page will repopulate showing your choice selection.
Choice selection options for subsequent review cycles for IRFs meeting the affirmation/approval rate threshold:
Select one of the radio buttons for your review choice and then click save.
Reminder: If no selection choice is made before the review choice selection period ends the default is choice 3: Selective postpayment review.
After you click save, you will receive a choice selection confirmation message that your selection is successfully saved. After clicking Ok for the confirmation, the choice selection page will repopulate showing your choice selection.
Three days prior to the end of the choice selection period, the office approver and backup office approver will receive a reminder email from Novitasphere which will provide your current choice selection or N/A if a selection has not yet been made.
After the choice selection period ends, you will be able to view your Choice Selection, but the options will be locked and no longer available to edit. IRFs will not be able to change the review choice selection until the next review choice selection period for the next cycle. Users can review the choice selection option at any time to view the choice selection that was made.
The office approver and backup office approver will receive a choice selection verification email from Novitasphere portal the day after the choice selection period has ended.
Note: This will not be in the portal mailbox.
The History feature allows you to view the history of your review choice selection per cycle.
Select the cycle from the given dropdown menu. The results will display: Cycle Number, Date Range of that cycle, Choice selection, Choice made by and Choice made on.
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