Jiva FAQs: Entering and Managing Requests in the Provider Portal

Inpatient means the member is in a facility like a hospitalization, skilled nursing facility stay, long term care, etc. Everything else is outpatient—consults/follow ups, procedures, x-rays, ECM/CS, PAD, etc.

The Code Type is required due to Jiva configurations that cannot be changed. The common code types include HCPC, CPT or CUS (for Custom). HCPC codes are alphanumeric, starting with a letter followed by numbers, such as G0181 for Home Health. CPT codes are fully numeric codes, such as 33016 for heart surgery. If it is a CUS code type, you will need to enter the first few letters of the code to get dropdown choices. Custom codes include Acupuncture (ACUVISITS); Dental Anesthesia (DENTALANESTHI); MRI; Referrals (CON to bring up choice of Consultor Consult with Follow-up Visit; FOL to bring up Follow-Up Visit only); Palliative Care (PLTVCR); ECM (ECM01, ECM02) and CS (CS01 – CS08).

Yes.

PCP Referral or Specialist to Specialist Referral choices are only for requests for referrals (Office Visits), not for OP Services. If you have selected the Reason for Request OP Services and the Service Type Referral when entering the specific service, then you will get an error because the selections are contradictory.

You have to manually enter your phone and fax number. You can use your own information if that is the correct information for us to contact.

Yes. From the Add Request dropdown, choose Outpatient. Then, in the Reason for Request dropdown, choose OP Pharmacy. Choose RX-Physician Administered Drugs in the Service Type dropdown and enter the service code as usual. Continue to enter other medication through Medi-Cal Rx.

When entering new requests for DME from the Add Request dropdown, choose Outpatient. Then, in the Reason for Request dropdown, choose OP Services. In the Service Type dropdown, choose the appropriate DME selection (DME-Equipment, DME-Medical Supplies, DME-Orthotics, DME-Prosthetics). The code type and the service codes remain the same. DME codes are almost always HCPC codes.

Yes. When entering new requests for ECM/CS services from the Add Request dropdown, choose Outpatient. Then, in the Reason for Request dropdown, choose ECM or ECM CS. In the Service Type dropdown, choose Enhanced Care Management (ECM) or Community Supports. The code type is CUS (for Custom) and the service codes remain ECM01 and ECM02 for ECM and CS01 – CS08 for CS. For the Medically Tailored Meals community support, use the code type HCPC and the codes S5170 or S9977 and S9740.

In the Service/Specialty/Drug Request field.

J codes are HCPC codes. You enter them in the same place but change the Code Type to HCPC.

When completing the request, there is a dropdown to answer Reason for Request. Or, you can add details in the notes at the bottom of the page.

It is mandatory to have at least one diagnosis. You may enter as many as you need.

You can only attach one document when submitting a new request. However, additional documents can be added immediately after submitting the request. Click on the Episode Type (IP or OP) to return to the episode screen. On the right side, click Add Document and you may add additional documents. There is no size limitation when attaching documents.

Yes, as long as the Alliance has not yet closed (made our determination on) the authorization and if the request was linked to your providers when the request was entered. From the Search Request screen, choose Auth Number and enter the authorization number. Open the episode using the gear (action) icon and Choose Add Document from the Documents section on the right side of screen.

Enter the first modifier in the service request screen in the Modifier field and add other modifiers in the notes section.

The Alliance does not need to know this. Use the CUS custom MRI codes to select a range of codes so that contrast can be used or not used as needed per the provider.

Use Outpatient Request, Reason = OP Services, Service Type = Diagnostic, Service Code Type = CUS, Code = type in MRI and choose from dropdown list. Only use PCP Referral for office visit requests (consults and follow ups) coming from the PCP.

If consults/follow-ups/office visits are for pathology only, then it’s a referral. If it’s actual procedures with CPT/HCPC codes, then it’s an authorization request and should use the Reason for Request OP Services.

When entering a request, the first question is a dropdown that includes post-service as a choice.

If it is a request type that gets auto-approved, then it should be auto-approved regardless of being a retro request.

No, but one year is the standard. If older than one year, it needs justification on why it is so late. Otherwise, it will be denied for being over one year since services rendered.

All retro requests require relevant documentation, which is the same standard as pre-service requests. We need the documents to determine if they meet medical necessity.

Reason = OP Services, Service Type = Rehab Therapies, Code Type = CPT, Code (enter CPT code). All other steps should be identical to any other request.

Once the request is submitted and a decision is made (approved or denied), the status will change to closed. In this case, your request met “auto-approval” requirements and was immediately approved and therefore closed.