The Clinical Care Report was
introduced in 2011 to promote better coordination of health care for our
members and physicians. Unless a member has opted out, this tool is accessible
through the NaviNet® web portal and offers
participating physicians a snapshot view of care that their patients have
received based on IBC-paid medical and prescription drug claims.
The Clinical Care Report is
intended for viewing by the following participating health care providers:
- a member's personal or
primary care physician;
- a new physician with whom a
member has an upcoming scheduled appointment;
- a physician who is
addressing a current emergency medical need.
Information available in the
Clinical Care Report
The information populated in
the Clinical Care Report is derived from member claims data and includes the
following information:
- disease conditions reported
in the past two years;
- visits to the emergency room
in the past year;
- hospital admissions in the
past four years;
- outpatient procedures in the
past two years;
- specialists seen in the past
two years;
- prescriptions filled in the
past six months;
- alerts by condition (i.e.,
gaps in care), if any;
- lab tests with results (when
available);
- diagnostic imaging in the
past two years;
- immunizations in the
past four years.
Note: The Clinical Care Report is not a complete medical record of all
services, tests, or products that a member may have received. It does not
include data for sensitive health conditions such as mental/behavioral health,
substance abuse, HIV/AIDS, sexually transmitted diseases, genetic testing, or
for services for which IBC did not pay a claim.
How to grant or remove access to
the Clinical Care Report
Initially, only the designated Security
Officer(s) in each provider office has access to the Clinical Care Report, and
he or she can control user access through the User Management transaction on
NaviNet.
Therefore, in order for providers to
access the Clinical Care Report, a designated Security Officer first must
enable individual users or all users.
Granting access to all users within an
office
To update the settings to allow all users within
an office access to the Clinical Care Report, the designated Security Officer
must first select NaviNet Administration from
the NaviNet Central menu.
Select Office Management from the drop-down menu on the
left, and then select Office Transaction
Management.
Scroll down the Transaction Management for Office
screen until you find the transaction called Eligibility & Benefits – Clinical Care
Report in the Name column. Click Enable to turn on access to all individuals in your
office.
To turn off access for all users in your office,
follow the same steps and click Disable
instead.
Granting access to only select individuals
within an office
The designated Security Officer can also limit
access to the Clinical Care Report to certain individuals within a provider
office. To do so, first select NaviNet
Administration from the NaviNet Central menu.
Select User
Management from the drop-down menu on the left, and then select User Transaction Management.
The designated Security Officer must search for
the appropriate user by entering a last and first name and then clicking Search. Select the appropriate user from the list
that populates, and then select Edit Access
to view the list of transactions.
Scroll down the Transaction Management for User
screen until you find the transaction called Eligibility & Benefits – Clinical Care
Report in the Name column. Click Enable to turn on access to the individual.
To turn off access for certain individuals in your
office, follow the same steps and click Disable instead.
How enabled users can view a member's Clinical
Care Report
Once enabled, physicians can view the Clinical
Care Report by selecting the Eligibility and
Benefits Inquiry option from the Plan Transactions menu.
To determine if a member has a Clinical Care
Report, the user should enter the member's information (either the member ID
number or last name, first name, and date of birth) and select the Search button.
If the member has not opted out of the tool, there
will be a flag in the column labeled "CCR". The blue flag in that column
indicates that the member's Clinical Care Report is available for you to view
once you have agreed to abide by the terms and conditions. Click the blue flag
to view the report.
We hope you'll find this tool valuable as you care
for your patients, our members. If you have questions regarding this tool,
please call the eBusiness Provider Hotline at 215-640-7410.
If you are not yet NaviNet-enabled at your office
location, register by going to the NaviNet website and selecting Sign up from the top right.
NaviNet® is
a registered trademark of NaviNet, Inc., an independent company.