3/1/2024 0 Comments Done first portal![]() Pharmacy Benefit Manager ( PBM) – PBMs may be designated by the payer to review Level 1 Medication PARs.Medical Review Organization ( MRO) – A payer may designate a medical review organization to review their PARS, however the medical review organization must first complete the online Medical Review Organization Medical Portal registration process.The payer is ultimately responsible for the review of PARs. Payers – The claim administrator (insurer, self-insured entities, or third–party administrator) access is granted using organizational profiles based on eClaims Trading Partner information.Individual reviewers will also use a dashboard to respond to their assigned requests.įor all PAR types other than Medication: If the Level 1 Reviewer for the payer does not approve the request in full, then it is automatically escalated to the Level 2 Reviewer. The payer, PBM and MRO will be responsible for designating and maintaining Workload Administrators and Level 1 and Level 2 review contact information, as appropriate.Īll submitted requests will be visible via a dashboard that will contain high-level information about each PAR and can be used by the Workload Administrator to assign the request to individual reviewers. There are different levels of review for all PARs, mirroring the automatic routing and escalation processes used by the Drug Formulary today. Requests in accordance with the new Official New York Workers’ Compensation Durable Medical Equipment (DME) Fee Schedule (new PAR type). Request for non-formulary medication(s), including medical marijuana. Requests for treatment costing $1000 or less for Non-MTG body parts (new PAR type). Requests for treatment costing over $1000 for Non-MTG body parts previously done on Form C-4 AUTH. Requests, which only include the 12-MTG related requests on the Attending Doctor's Request for Authorization Carrier's Response (Form C-4 AUTH). ![]() Requests (previously done using the Attending Doctor's Request for Approval of Variance and Carrier's response (Form MG-2)). Requests (previously done using the Attending Doctor's Request for Optional Prior Approval and Carrier's/Employer's response (Form MG-1)). What PARs Will Be Included? MTG Confirmation Payers can also receive email updates notifying them that there is a PAR in the system that needs their response. ![]() When a payer logs into OnBoard, their dashboard "home screen" will display all active requests in need of a response. ![]() When a health care provider submits a PAR, OnBoard will automatically forward the request to the appropriate claim administrator for review. Included is the prior authorization request ( PAR) process for medication, durable medical equipment and medical treatment/testing. OnBoard: Limited Release is the first phase of OnBoard, designed to move several key processes for health care providers and payers from paper to online. Payer access to the Medical Portal is granted using organizational profiles based on eClaims Trading Partner information. Payers and their designated pharmacy benefit managers ( PBM) and medical review organizations ( MRO) use the Medical Portal to access the MTG Lookup Tool, Drug Formulary Lookup Tool and OnBoard. The Drug Formulary Prior Authorization request process is now handled through OnBoard, and is referred to as a Medication PAR. The Medical Portal is intended to create more efficient processes and enable greater levels of self-service and tracking, and ultimately improve the performance of the NYS workers’ compensation system overall. The NYS Workers’ Compensation Board Medical Portal is a web-based application that enables users to view and submit medical and Workers’ Compensation Board information electronically.
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