Identification Problems
1. What do I do if the website is not functioning properly?
2. Why isn’t the member in the HealthHelp database?
3. What should I do if I cannot find the CPT procedure code in the HealthHelp database?
4. Why can’t I find the ordering practitioner in the HealthHelp database?
5. Why can’t I find the rendering imaging facility in the HealthHelp database?
Time sensitivity for procedure approval
6. What should I do if the scan is emergently needed?
7. What should I do if a scan was performed without a HealthHelp consult?
8. What if the scan has been requested but waiting for approval would endanger the member’s health?
Questions/Concerns with the procedure consultation
9. What should I do if the ordering practitioner disagrees with the HealthHelp Radiologist?
10. Can the ordering practitioner talk directly with the HealthHelp radiologist?
11. What if the scan is an integral part of an Oncology Procedure set?
Consultation Process
12. What is the expected time for the HealthHelp consultation process?
13. What is the expected time for peer to peer telephonic consultation?
14. What is the process when I know that the ordering physician will not be able to respond within the 48-hour time frame for case continuation?
15. During the review process, who will be contacted for follow-up?
Identification Problems
1. What do I do if the website is not functioning properly?
Contact HealthHelp customer service at 1-888-265-0072 to report the problem. Please describe the problem and provide contact information.
2. Why isn’t the member in the HealthHelp database?
The member may be newly eligible (less than 30 days) or ineligible. Contact HealthHelp at 1-888-265-0072 who will confirm eligibility status. If the member is newly eligible, HealthHelp will take the demographic and health plan information from you and process the request.
3. What should I do if I cannot find the CPT procedure code in the HealthHelp database?
If the code or name is not recognized by the HealthHelp system, this procedure may not apply. Re-check the scan code to ensure proper coding. If the code is still not identified as part of the program, consultations from HealthHelp are not needed for this procedure. Please contact the St. John’s Precert Office at 417-820-3182 or 1-800-330-8305.
4. Why can’t I find the ordering practitioner in the HealthHelp database?
The ordering practitioner may not be contracted with St. John’s Health Plans. Contact the St. John’s Precert Office at 417-820-3182 or 1-800-330-8305.
5. Why can’t I find the rendering imaging facility in the HealthHelp database?
The rendering facility may not be contracted with St. John’s Health Plans. Contact the St. John’s Precert Office at 417-820-3182 or 1-800-330-8305.
Time sensitivity for procedure approval
6. What should I do if the scan is emergently needed?
Contact HealthHelp by telephone at 1-888-265-0072. Ask for a ‘Stat’ consult request. They will process stat requests within 30 minutes. The ordering practitioner should schedule the service and the rendering facility should provide the service as needed.
7. What should I do if a scan was performed without a HealthHelp consult?
A 30 day retro process is in place to obtain HealthHelp approval for emergent requests after the service is rendered. The ordering practitioner is responsible for contacting the HealthHelp call center (during business hours) to complete the request within 30 days.
8. What if the scan has been requested but waiting for approval would endanger the member’s health?
HealthHelp has a stat request process. If the original request was not requested as a stat request, the ordering practitioner is responsible for contacting the HealthHelp call center to request a stat consult. Please provide your original procedure tracking number to the HealthHelp representative when you call. The ordering practitioner should schedule the service and the rendering facility should provide the service as needed. If you still believe this will take too long for the situation, proceed with the test and submit a retro-consult when time allows.
Questions/Concerns with the procedure consultation
9. What should I do if the ordering practitioner disagrees with the HealthHelp Radiologist?
HealthHelp radiologists are available to provide clinical guidance and expertise, not to issue denials of service. When ordering a scan, the ordering practitioner may “agree to disagree,” and HealthHelp will provide a consultation number for the requested scan.
10. Can the ordering practitioner talk directly with the HealthHelp radiologist?
Yes, if a provider wishes to speak to a radiologist, they may call the dedicated number at 1-888-265-0072 and make their request. The call cannot be directly transferred to a radiologist, but a radiologist will return their call. They may also ask to speak to a HealthHelp medical director. Business hours are: Monday – Friday 7:00 a.m to 7:00 p.m., Saturday 7:00 a.m. to 4:00 p.m.
11. What if the scan is an integral part of an Oncology procedure set?
When the ordering physician's office contacts HealthHelp for an imaging procedure with an expected series of imaging, it is best for the caller to state that this is a series of reoccurring exams that follows a protocol. The client service rep will then go into a separate module specifically created for this type of scenario. This is available only for oncology patients. These cases can only be processed via phone - not web or fax.
Consultation Process
12. What is the expected time for the HealthHelp consultation process?
If done via WebConsult, most consults can be completed in less than eight minutes once you are comfortable with the web submission process. If the consult requires nurse to nurse or peer to peer review, HealthHelp strives to complete consults as quickly as possible. Most consults are completed in the same day, but some may take 48 hours.
13. What is the expected time for peer to peer telephonic consultation?
Generally, peer-to-peer conversations last less than twenty minutes once physicians are able to connect via phone.
14. What is the process when I know that the ordering physician will not be able to respond within the 48-hour time frame for case continuation?
In the comments section, the ordering office should explain that the doctor will be unavailable for a physician to physician review and specify the date and time of availability, and the number at which the physician may be reached. The radiologists will wait to call the physician until the date and time that has been provided by the office staff or nurse.
15. During the review process, who will be contacted for follow-up?
When the case is elevated to clinical review, the HealthHelp nurse will call the provider’s office and identify him/herself as being a nurse with HealthHelp and will request to speak with the contact name given to the Client Service Representative. Once the nurse is connected to the provider contact, the nurse will identify that he/she is with HealthHelp and is calling on behalf of St. John’s Health Plan regarding the imaging for “patient’s name”.