Frequently Asked Questions
Click on a question below to reveal the answer.
How do I upload a medical record or provide other clinical documentation?
Providers should upload all clinical documentation through Telligen’s provider portal. Detailed instructions will be presented during training sessions scheduled for March and April. Detailed instructions can be found in the User Manual located on the Document Library page of this website.
How can I check on the status of a review?
Providers can access Telligen’s 24/7 provider portal to check the status of case(s) submitted for review.
What constitutes a “technical denial?”
Technical denials are issued when the provider does not submit clinical information or other documentation necessary to complete the review. A technical denial will also be issued when requested information is not submitted within the state-defined time frame.
How do I submit an urgent request for a person being discharged from an institution?
Please upload a title page with the reason for urgent request as well as the appropriate discharge plan. Then call Telligen’s office to explain the situation and expedite the process. Our contact number is 1-888-276-7075, please choose the option for DME. Telligen’s goal will be to complete these requests with 48 hours (not including weekends). Please note that any request for an item for a person currently with a Long-Term Care span will display “No Review Required.” Telligen and the Department will override the system in these instances – for these instances – please contact Telligen at 1-888-276-7075. Telligen will be exploring ways to improve this process from a technological standpoint.
What if I submit a request with the wrong procedure code?
Telligen will reject the submission and request a new submission under the appropriate procedure code. Please be sure to double check that the procedure code is accurate.
What dates do I enter when requesting an item?
Please be sure to enter the correct date of service and time span, not the date of request, when requesting an item. The date of service is used to ensure payment.
How do I submit a claim for services over and above program limitations?
If you have a claim for a service that exceeds the program limitations, the provider should direct bill up to the program limit. The provider should then submit the remaining items to Telligen. The request should explain why the total number is medically necessary.
When can I submit a claim after I receive approval from Telligen?
Please do not submit a claim until you receive a letter from the Department stating your approval. Currently, there is a 1-2day lag between the approval and the letter. In the future, this process will be automated and there will be a limited waiting period.
What HCPCS do I need to enter into Qualitrac?
Providers should only enter the codes(HCPCS) that require preauthorization. HCPCS that do not require preauthorization (Direct bill items) should NOT be entered and could delay your review.
How should I submit procedure codes for w/c accessories?
When submitting requests for wheelchairs, please include all components requiring pre-authorization including miscellaneous components(K0108) and components not on the list. Wheelchairs and accessories that require pre-auth should not be separated.
How do I let Telligen know that my request is a re-certification?
Please note that the request is a re-certification in the comments section.