Dental Case Management
Overview
These instructions are for the Case Management being performed by Dental3 and their stakeholders for the dental treatment of their members.
Jump to:
Adding/Editing Tracking Data Information
Entering a Case for a Non-Enrolled Member Under 'Prospective Member'
Transferring a Case from 'Prospective Member' to an Enrolled Member
Transferring a Case to an Updated Delivering Provider
Creating a New Case
1. Navigate to the Member in CIM
A. Go to the 'Member Tab' of 'Demographic Manager'
1) Hover over the left side panel where the icons are located
2) Under the 'Members' section, click 'Demographic Manager'
B. Enter the Member ID into the 'ID #' field
1) You can also enter the Member's Last Name, First Name, and DOB in the respective fields
C. Click on the applicable, active D3 Carrier
D. Click on the 'Add new type of care ...' link
2. Enter Parameters for Case
A. Care Type Screen
1) Click 'START' to begin Program Enrollment
B. Care Sub-Type & Dates Screen
1) Enter Date Range
2) Click 'START' to begin Case Management
C. Care Details Screen
1) Select Auth Type
A) For Medical Training International (MTI), select 'Other Treatment Case'
B) All Other Entities, select 'BSS Treatment Case'
2) Select Urgency
3) Enter the Referring Provider
4) Enter the Delivering Provider
5) Leave Facility at default
A) Facility = blank
6) Click 'CONTINUE'
D. Services & Limits Screen
BSS Treatment Case Other Treatment Case
1) Select the Diagnosis Code Group
A) The options available will depend on if BSS Treatment Case or Other Treatment Case was selected (see image above); click 'BACK' to change selection
2) Leave the 'Limits' section at default
A) Max Dollars = Blank
B) Max Units = Blank
3) Click 'CONTINUE'
E. Additional Information Screen
1) Enter any applicable comments into the 'Comments' field
2) Attach Documents if applicable
A) Click on the '+' button
B) Navigate to the file and select it
C) Click on 'Open'
3) Select from the available 'Options' as necessary
4) Leave the 'Submitting Office' at default
5) Click 'CONTINUE'
F. Review & Submit Screen (Note: the Tracking Data is entered after the Case is submitted)
1) Review and verify entered information
2) Click 'FINISH'
A) A Pop-Up window will appear indicating the Case was created
1. Check the box, 'Notify me of Auth status changes'
2. You can go directly to the Case by clicking 'REVIEW REFERRAL/AUTH'
A. This will open Referral Manager in a new tab
3. Take note of the 'Reference ID' number as this can be used to go directly to the Case in Referral Manager without having to go through Demographic Manager
Adding/Editing Tracking Data Information
1. Open the Case for the Member, There are Two Methods to Open an Already Created Case
Note: if you know how to open the Case or already have it open, Skip to Step 2.
A. Open the Case from Referral Manager (recommended)
1) Go to the 'Search Tab' of 'Referral Manager'
A) Hover over the left side panel where the icons are located
B) Under the 'Referrals & Authorizations' section, click 'Referral Manager'
2) Enter the Reference ID number of the Case into the 'Ref #:' field
Note: when searching by Reference ID number, CIM ignores the 'Submitted From:' and 'Submitted To:' fields
A) You can also enter the Member ID into the 'Patient ID' field and modify the 'Submitted From:' date
3) Click on the Reference ID number for the applicable Case in the Left Panel
A) This will open the Case in the Right Panel
B) If there is only one search result, it will automatically open up in the Right Panel
4) Proceed to Step 2.
A) If you don't have the Reference ID for the Case, you can continue at Step 1. B. to bring up the Case
B. Open the Case from Demographic Manager
1) Go to the 'Member Tab' of 'Demographic Manager'
A) Hover over the left side panel where the icons are located
B) Under the 'Members' section, click 'Demographic Manager'
2) Enter the Member ID into the 'ID #' field
A) You can also enter the Member's Last Name, First Name, and DOB in the respective fields
3) Click on the applicable, active D3 Carrier
4) Click on the 'Auths' link
5) Click on the Reference # of the Case
A) The Case will open in a new tab in Referral Manager
2. Add or Edit Tracking Data Information
A. Scroll to the bottom of the Case and click on the 'Edit' link in the 'Tracking Data' box
1) A pop-up window will open
B. Enter or change information as necessary, but only in the following fields:
1) Medical Training International (MTI)
A) Fields 19-23 (only the fields within the Orange Box in the image above)
2) All Other Entities
A) Fields 1-18 (only the fields within the Blue Box in the image above)
1) Changing previously entered information will overwrite previous information
2) If a history of changes need to be recorded, the comments section of the Case can be used
A) Click on the 'Edit' link in the 'Additional Information' box
1. A pop-up window will open
B) Enter information into the Comments section
Adding/Reviewing Notes
1. Open the Case for the Member, There are Two Methods to Open an Already Created Case
Note: if you know how to open the Case or already have it open, Skip to Step 2.
A. Open the Case from Referral Manager (recommended)
1) Go to the 'Search Tab' of 'Referral Manager'
A) Hover over the left side panel where the icons are located
B) Under the 'Referrals & Authorizations' section, click 'Referral Manager'
2) Enter the Reference ID number of the Case into the 'Ref #:' field
Note: when searching by Reference ID number, CIM ignores the 'Submitted From:' and 'Submitted To:' fields
A) You can also enter the Member ID into the 'Patient ID' field and modify the 'Submitted From:' date
3) Click on the Reference ID number for the applicable Case in the Left Panel
A) This will open the Case in the Right Panel
B) If there is only one search result, it will automatically open up in the Right Panel
4) Proceed to Step 2.
A) If you don't have the Reference ID for the Case, you can continue at Step 1. B. to bring up the Case
B. Open the Case from Demographic Manager
1) Go to the 'Member Tab' of 'Demographic Manager'
A) Hover over the left side panel where the icons are located
B) Under the 'Members' section, click 'Demographic Manager'
2) Enter the Member ID into the 'ID #' field
A) You can also enter the Member's Last Name, First Name, and DOB in the respective fields
3) Click on the applicable, active D3 Carrier
4) Click on the 'Auths' link
5) Click on the Reference # of the Case
A) The Case will open in a new tab
A. Click on the 'Notes' drop-down
B. Click on 'View MMC Note'
1) A new window will open
A) A note can also be added from this screen by clicking 'New Note'
3. Add Note for the Case
A. Click on the 'Notes' drop-down
B. Click on 'Add MMC Note'
1) A new window will open
C. Fill out the information for the note
1) Subject(s) - use the drop-down to select the most appropriate Subject(s) (more than one can be selected)
2) Visibility - select as appropriate
A) Private - Visible only to the Health Plan and the author's office
B) Public - Visible to anyone with access to this Treatment Case
3) Status - determines if follow-up note can later be added to this note
A) Closed - once saved, the note will be saved, cannot be changed, and additional information cannot be added to the note; additional information will need to be saved in a new note
B) Open - once saved, the note will be saved, cannot be changed, but additional information can be added to the note
4) Priority - leave at default
5) Text - enter Case note
D. Click 'Save'
Creating/Editing Task List
1. Open the Case for the Member, There are Two Methods to Open an Already Created Case
Note: if you know how to open the Case or already have it open, Skip to Step 2.
A. Open the Case from Referral Manager (recommended)
1) Go to the 'Search Tab' of 'Referral Manager'
A) Hover over the left side panel where the icons are located
B) Under the 'Referrals & Authorizations' section, click 'Referral Manager'
2) Enter the Reference ID number of the Case into the 'Ref #:' field
Note: when searching by Reference ID number, CIM ignores the 'Submitted From:' and 'Submitted To:' fields
A) You can also enter the Member ID into the 'Patient ID' field and modify the 'Submitted From:' date
3) Click on the Reference ID number for the applicable Case in the Left Panel
A) This will open the Case in the Right Panel
B) If there is only one search result, it will automatically open up in the Right Panel
4) Proceed to Step 2.
A) If you don't have the Reference ID for the Case, you can continue at Step 1. B. to bring up the Case
B. Open the Case from Demographic Manager
1) Go to the 'Member Tab' of 'Demographic Manager'
A) Hover over the left side panel where the icons are located
B) Under the 'Members' section, click 'Demographic Manager'
2) Enter the Member ID into the 'ID #' field
A) You can also enter the Member's Last Name, First Name, and DOB in the respective fields
3) Click on the applicable, active D3 Carrier
4) Click on the 'Auths' link
5) Click on the Reference # of the Case
A) The Case will open in a new tab
A. Click on the 'Case' drop-down
B. Click 'Encounter'
1) The Task List will open in a new window
C. Click 'Add A New Task'
1) The right panel will populate with the options to select and modify a new task
A) Use the 'Task"' drop-down to select the Task
B) Enter a Due Date and Time into the 'Date:' field
C) Enter a Reminder as applicable
D) Enter reason for the Task List in the 'Reason:' drop-down
E) Set the status of the Task List with the 'Status:' drop-down
F) Add notes regarding Task List in the 'Add Notes:' field
G) Click 'Save'
Entering a Case for a Non-Enrolled Member Under 'Prospective Member'
A Case can be started for a person who does not yet have eligibility but is expected to in the future. Since this member is not yet entered into CIM, a Case cannot be entered under their account. Instead, a Case will be entered under 'PROSPECTIVE MEMBER' (a placeholder in CIM used for this specific purpose). Once the member is enrolled and entered into CIM, the Case created under 'PROSPECTIVE MEMBER' can be transferred to the member's account without the need to re-enter the information. See Transferring a Case from 'Prospective Member' to an Enrolled Member for instructions.
1. Navigate to 'Prospective Member' in CIM
A. Go to the 'Member Tab' of 'Demographic Manager'
1) Hover over the left side panel where the icons are located
2) Under the 'Members' section, click 'Demographic Manager'
B. Enter the 'Member' as the Last Name and 'Prospective' as the First Name
C. Click on the line of eligibility
D. Click on the 'Add new type of care ...' link
2. Enter Parameters for Case
A. Care Type Screen
1) Click 'START' to begin Program Enrollment
B. Care Sub-Type & Dates Screen
1) Enter Date Range
2) Click 'START' to begin Case Management
C. Care Details Screen
1) Select Auth Type
2) Select Urgency
3) Enter the Referring Provider
4) Enter the Delivering Provider
5) Leave Facility at default
A) Facility = blank
D. Services & Limits Screen
BSS Treatment Case Other Treatment Case
1) Select the Diagnosis Code Group
A) The options available will depend on if BSS Treatment Case or Other Treatment Case was selected (see image above); click 'BACK' to change selection
2) Leave the 'Limits' section at default
A) Max Dollars = Blank
B) Max Units = Blank
3) Click 'CONTINUE'
E. Additional Information Screen
1) Enter any applicable comments into the 'Comments' field
2) Attach Documents if applicable
A) Click on the '+' button
B) Navigate to the file and select it
C) Click on 'Open'
3) Select from the available 'Options' as necessary
4) Leave the 'Submitting Office' at default
5) Click 'CONTINUE'
F. Review & Submit Screen (Note: the Tracking Data is entered after the Case is submitted)
1) Review and verify entered information
2) Click 'FINISH'
A) A Pop-Up window will appear indicating the Case was created
1. Check the box, 'Notify me of Auth status changes'
2. You can go directly to the Case by clicking 'REVIEW REFERRAL/AUTH'
A. This will open Referral Manager in a new tab
3. Take note of the 'Reference ID' number as this can be used to go directly to the Case in Referral Manager without having to go through Demographic Manager
Transferring a Case from 'Prospective Member' to an Enrolled Member
A Case can be started for a person who does not yet have eligibility but is expected to in the future. Since this member is not yet entered into CIM, a Case cannot be entered under their account. Instead, a Case will be entered under 'PROSPECTIVE MEMBER' (a placeholder in CIM used for this specific purpose). Once the member is enrolled and entered into CIM, the Case created under 'PROSPECTIVE MEMBER' can be transferred to the member's account without the need to re-enter the information. See Entering a Case for a Non-Erolled Member under 'Prospective Member' for instructions.
1. Open the Case for Prospective Member, There are Two Methods to Open an Already Created Case
Note: if you know how to open the Case or already have it open, Skip to Step 2.
A. Open the Case from Referral Manager (recommended)
1) Go to the 'Search Tab' of 'Referral Manager'
A) Hover over the left side panel where the icons are located
B) Under the 'Referrals & Authorizations' section, click 'Referral Manager'
2) Enter the Reference ID number of the Case into the 'Ref #:' field
Note: when searching by Reference ID number, CIM ignores the 'Submitted From:' and 'Submitted To:' fields
A) You can also enter 'Member' as the Last Name and 'Prospective' as the First Name and modify the 'Submitted From:' date
1. This will bring up all Cases created for Non-Enrolled members
3) Click on the Reference ID number for the applicable Case in the Left Panel
A) This will open the Case in the Right Panel
B) If there is only one search result, it will automatically open up in the Right Panel
2. Transfer Case from 'Prospective Member' to Now Enrolled Member
A. Click on the Member ID number
1) A pop-up window will appear
B. Enter the Name and Member ID of the newly enrolled member
C. Select the appropriate carrier from the drop-down
D. Click 'Search'
D. Select the appropriate line of eligibility and click 'Save'
Transferring a Case to an Updated Delivering Provider
A Case can be created with a Delivering Provider entered, but then the Delivering Provider may need to be updated for any number of reasons. When such a situation occurs, the Case will need to have the status updated, have the Delivering Provider updated, and have a notification email sent.
1. Open the Case for the Member, There are Two Methods to Open an Already Created Case
Note: if you know how to open the Case or already have it open, Skip to Step 2.
A. Open the Case from Referral Manager (recommended)
1) Go to the 'Search Tab' of 'Referral Manager'
A) Hover over the left side panel where the icons are located
B) Under the 'Referrals & Authorizations' section, click 'Referral Manager'
2) Enter the Reference ID number of the Case into the 'Ref #:' field
Note: when searching by Reference ID number, CIM ignores the 'Submitted From:' and 'Submitted To:' fields
A) You can also enter the Member ID into the 'Patient ID' field and modify the 'Submitted From:' date
3) Click on the Reference ID number for the applicable Case in the Left Panel
A) This will open the Case in the Right Panel
B) If there is only one search result, it will automatically open up in the Right Panel
4) Proceed to Step 2.
A) If you don't have the Reference ID for the Case, you can continue at Step 1. B. to bring up the Case
B. Open the Case from Demographic Manager
1) Go to the 'Member Tab' of 'Demographic Manager'
A) Hover over the left side panel where the icons are located
B) Under the 'Members' section, click 'Demographic Manager'
2) Enter the Member ID into the 'ID #' field
A) You can also enter the Member's Last Name, First Name, and DOB in the respective fields
3) Click on the applicable, active D3 Carrier
4) Click on the 'Auths' link
5) Click on the Reference # of the Case
A) The Case will open in a new tab
2. Change the Status of the Case
A. Click on 'Set Status'
B. Hover over 'Information'
C. Select 'Transferred'
3. Update the Delivering Provider on the Case
A. Go to the Case Details section
1) It may be called either Referral Details or Preauthorization Details
B. Click on the name of the Delivering Provider
1) The name will be a clickable, blue link
C. Select the new Delivering Provider
Note: if the Member's Eligibility terms (they no longer have OHP), make the new Delivering Provider match the Referring Provider
1) Type the name of the New Delivering Provider
2) Click Search
3) Select Provider and click OK
4. Send Email Through the Case
A. Click on the email link
1) A pop-up window will open
B. Enter the address for the New Delivering Provider
1) Make sure to remove the default 'TO' address
2) You can also CC yourself if you would like a copy; however, the email will be saved as an MMC Note
C. Enter all pertinent information in the body of the email, including, but not limited to the following:
1) Reason for the transfer
2) Effective Date of the transfer
3) Important member information as applicable (e.g. member was in middle of treatment, member term date, etc.)
D. Click 'Send'