Utilization Management

Claims Services
Summer 2019
Sprint 2018
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from Evolent Health.

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Copyright © 2018 Evolent Health. All Rights Reserved

 TABLE OF CONTENTS

Job Aids Page

Crosswalk of Terms 4
Log-In 6
Select the Application 8
Search Feature 9
Anatomy of a Request 10
Admit Type

Providers
Diagnosis 3
Care Note and Communications for Request

Examining Reviews 12
Review Header

Procedure Code or Bed Type

Approved Amount

Dates of Service
Procedure Details

Decision History

Care Notes, Claim Notes, and Communications for Review

ICONS & LEGEND

Tip
This icon denotes a helpful hint or additional information.

Caution
A caution symbol indicates a common documentation pitfall or user error with (potential)
consequence.

Industry Gold Standard or Best Practice

The blue ribbon is included where national industry recognized quality or safety standard
is expected or is built into the system.
 CROSSWALK OF TERMS

Standard Term Identifi Term

Case, Auth. Request

Case Number, Auth. Number Reference Number

Case Note, Clinical Note, Progress Note Care Note

Fax, Letter, or Document Communication

Member Patient
Job
Aid Member ID Patient ID
4
Requested service, CPT code, J-Code, Review or Review Line
Dental Code, or HCPC Code

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 NOTES

Job
Aid
5

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 LOG-IN
The Evolent Application Support Team sends your username to the email address
associated with your Identifi Account.
Identifi is secure on “the Web”. It requires no other portal or VPN (although secure internet
is industry standard practice). Because Identifi is on the web, you may access it from any
computer. You do not need a special company-issued computer or program loaded to
access Identifi.

STEP 1: Launch Identifi

The newest version of Identifi is supported on four browsers: Google Chrome*, Firefox,
Job Internet Explorer, and MS Edge for Windows 10. 8 GB of RAM is recommended for optimal
Aid
performance.
6
Note*: It is suggested that users use Google Chrome, as it provides the best user experience
for our web applications.

STEP 2: Enter Web Address

Type the web address into the browser address bar.
· For training and practice, use https://uat.myidentifi.com.
· For Production (“real members”), use https://myidentifi.com.

STEP 3: Enter Username

A. Enter the username and follow the instructions when logging in to either TRAIN or
PRODUCTION.
B. Click the SIGN IN button.

For assistance with access or log in, Support’s contact information is available on the
login screen.

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 LOG-IN

STEP 4: Account Verification

A. A verification code will be sent to the email associated with your identifi account
from Identifi Support Team.

B. Enter the VERIFICATION CODE. (This code is only active for 10 minutes.).
C. Select the CONTINUE button. Job
Aid
7

STEP 5: Initial Log-In

Accept “Terms and Conditions”
A. At the bottom of the Terms and Conditions page, check the box to confirm that you have
read and agree.
B. Select the CONTINUE button.

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 SELECT THE APPLICATION

After logging in, select the Utilization Management application.

CARE REVIEW

Job
Aid
8

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 SEARCH FEATURE

This feature allows you to search for a patient or a Request by its Reference Number.

Initiate search:
1. Select the magnifying glass.
2. Select the desired search type, Patient or
Request, from the top of the window.

Job
For a Patient: Aid
3. Enter search parameters. 9
4. Select SEARCH.
5. Using multiple patient identifiers, locate the
correct patient from the list of matches.
Click to open the patient’s record.

For a Request:
Complete steps 1 and 2 above.
6. Type in the Reference Number.
7. Select Go To.

When accessing a patient record, it is an industry recognized safety standard to use

three acceptable member identifiers to validate correct member.

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 ANATOMY OF A REQUEST

Refer to screenshot next page.

1. Select the Identifi UM icon to return to the home screen.
2. This icon opens a menu of the last 15 patient records you have accessed for each client.
3. The Magnifying Glass is the universal icon for a search feature. For details see page 6.
4. The Patient Record has the patient’s name in the blue box with date of birth, sex, and patient
identification number to the right. Click the patient name to show the Patient Details dropdown
(see pg. 13).
5. An Authorization or Request (as it is called in Identifi) contains the Reference number at the top.
The Request also contains the:
Job
Aid A. Admit Type (Inpatient Requests only)
10 B. Providers —Requesting, Vendor/Facility, and Attending or Rendering depending on Request
Type.
C. Diagnosis
D. A Request has a “Care Notes and Communications” section. Communications include
letters (both sent and received) as well as faxes of clinical information.
• Use the “EXPAND ALL” link to scroll and view all notes.
• Click the Communication’s header then click “View” to open the document in another
window.

6. The Request is an “umbrella” that contains Review(s).

A Review represents 1 code or 1 discreet piece of equipment or service requested. A Request for
an electric wheelchair, for example, may have 20 Reviews— One review for each piece of the
chair. Reviews are detailed in later pages.
7. A quick navigator appears along the right hand side. Think of this as a Table of Contents. Click
any of the subjects listed and the navigator will display that part of the Request on your screen.
The navigator prevents you from having to scroll so much.

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 ANATOMY OF A REQUEST

Job
Aid
11

(A patient record with a Request and its Reviews)

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 EXAMINING REVIEWS

The Reviews section appears below the Request. Each Review represents one code
be it CPT, J-Code, HCPC, or dental. Numbered Reviews show in collapsed form.

Refer to screenshot next page.

1. Each Review’s header contains details: dates of service, code and abbreviated description, as
well as approved amount. Click anywhere in the header to expand the Review and view its
details.
2. The Procedure Section contains approved amount and start and end date. An Inpatient Review
(also known as Bed Type Review) is included on page 12.
Job 3. Click the View Decision History link to see all details. It also includes approved amount. If a
Aid Review underwent appeal, the appeal decision appears as an added row in the Decision History
12 along with the approval details.
4. Each Review contains its own “Care Notes, Claim Notes, and Communications for Review”
section.
• Click “Expand All” to scroll and read each note or view uploaded Communications.
• The Decision Note is housed here.
• A Claim Note specific to the Review is contained here. Claim Notes are directed solely to the
Claims Department and share details of how to pay the claim in special circumstances.

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 EXAMINING REVIEWS

Job
Aid
13

(3 DME Reviews. Review 3 expanded to show Review details)

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