Process a treatment plan

To process a treatment plan, review the treatment plan detail and associated documentation, and then follow your organization's steps to complete the authorization.

Note: A treatment plan in a status of Pending Eviti Review is not yet ready for your review.
To process a treatment plan, follow these steps:
  1. Access the Payer Dashboard, and then choose a tab; for example, the All Records tab.

    The system displays each treatment plan in its own row.

  2. In the second column, click a treatment plan link to view all of the details that the provider submitted in the treatment plan, including the drugs and dosage instructions. As a payer, you also see the drug costs and a complete history of the treatment plan. For example, you see when we approved or rejected the treatment plan, and if the treatment plan was modified and when.
    Note: If you see a small icon next to the treatment name, point to it to display its meaning. These icons indicate that the treatment plan contains drugs that you flagged for some reason; for example, the drug is a pharmacy drug.
  3. In the Payer Actions row, click Review Summary to view any notes, medical records, and a summary of the peer to peer, if applicable. You can also view the notes that other users in your office entered when they approved or denied a treatment plan, as well as patient insurance information and a deviation report, if available.
  4. In the Payer Actions row, click Add/View Payer Comments to view comments that users in your office entered about this treatment plan. If your health plan uses payer actions, you can return to this screen later to update the status of the treatment plan and enter your comments.
  5. After you finish reviewing the treatment plan, and you decide the status of your final authorization, follow your organization's steps to complete the authorization. For example, enter the approval or denial into your internal system, and send the appropriate letters or faxes to the provider and patient.
  6. If your site enabled payer actions, update the status of the treatment plan on your dashboard:
    1. On the Payer Actions row, click Add/View Payer Comments.
    2. In the Action menu, choose the action that best describes the current status of the treatment plan. For example, Entered into Medical PA System, or Sent Member/Provider Letter.
    3. In the Comment box, enter your comments, and then click Save.

    The dashboard displays the current status of the treatment plan in the Payer Action column, based on the action you chose.