Sharing Data with Partners

Chapter 8, "Sharing Data with Partners," discusses how to share transactional data and master data with your partners.

This chapter includes examples of typical ways that you might share data such as opportunities, contacts, and literature.

Many types of data described in this chapter do not apply to your work with healthcare providers. You can only share the types of data that can be viewed in the screens of the Healthcare Provider Portal, which are listed in "Siebel Healthcare Provider Portal".

In addition to the types of transactional data described in this chapter, Siebel Healthcare Provider Portal supports the types of transactional data described in the following topics:

• "Sharing Claims with Healthcare Providers"

• "Viewing Information About Healthcare Facilities"

• "Sharing Members with Healthcare Providers"

• "Viewing Information about Healthcare Providers"

• "Sharing Referrals and Authorizations with Healthcare Providers"

  
  

  Note: Accounts and Opportunities are included in Siebel Healthcare Provider Portal, but they would not be used the same way as they are in Siebel PRM. Most carriers would not use these screens.

  
  

Sharing Claims with Healthcare Providers

If you share a Claim record with a healthcare provider, the provider can view it through the Siebel Healthcare Provider Portal but cannot modify it.

You share claims with healthcare providers by assigning them to provider employees. It is visible to that employee in the My Claims view.

You can assign claims to providers manually, or if your business model is appropriate, you can set up Siebel Business Process Designer or Siebel Assignment Manager to assign claims to partners automatically. For more information about Siebel Business Process Designer, see Siebel Business Process Framework: Workflow Guide. For more information about Siebel Assignment Manager, see Siebel Assignment Manager Administration Guide. For more information about claims, see Siebel Healthcare Guide.

To assign a claim to a healthcare provider employee manually  

1. Navigate to the Claims screen.

2. In the Claims list, select the claim you want to assign to the provider.

3. In the More Info form, in the Team field, click the select icon.

   The Sales Team Members dialog box appears.

4. In the Sales Team Members dialog box, click New.

5. In the Sales Team Members list, select the provider you want to assign the claim to, and click OK.

6. In the Sales Team Members dialog box, click OK.

   The provider you selected can view the claim in the My Claims view of the Provider Portal.

Viewing Information About Healthcare Facilities

Facilities are healthcare organizations that are paid by or file claims with your health plan or health insurance company. Examples of facilities are hospitals, clinics, and pharmacies. Facilities are also referred to as provider organizations.

In some situations, users at the insurance company enter information about facilities and about the providers and contacts, payments, and claims associated with a facility.

However, if your provider organizations use the Healthcare Provider Portal, they can enter this information themselves. They simply navigate to the Facilities screen of the Healthcare Provider Portal and use the Facilities list, More Info form, and Profile form to enter and maintain information about the facility. They can also click the view tabs to enter and maintain information about Claims, Contracts, Payments, Locations, HMO Members, and other information associated with the facility.

The insurance carrier can view this information using the Siebel Partner Manager or Siebel Healthcare. For more information about entering and maintaining information about facilities, see the topics about facilities in Siebel Healthcare Guide.

To view information about a facility  

1. Navigate to the Facilities screen.

2. In the Facilities list, select the facility that you want to view information about.

3. Click the view tabs to display information associated with that facility.

Sharing Members with Healthcare Providers

Members are individuals who are insured by a carrier. In some situations, members are also known as policyholders, subscribers, or insureds.

You can use the Members screen to enter information about members, or employer groups can use the Group Portal to enter information about members. After it has been entered, you can share this information with providers, so they can view the information in the Members screen of the Healthcare Provider Portal:

• You can share member data with an employee at a provider company, and this employee is able to view the member in the My Members view of the Members screen of the Healthcare Provider Portal.

• You can also share member data with a provider company, and this company is able to view the member in the All Members view of the Members screen of the Healthcare Provider Portal, but it is not visible in the My Members view for any employee at the provider company. Someone at the provider company who has access to the All Members view can use the Contact Team field to assign the member to specific employees at the provider company.

For more information about entering and maintaining information about members, see the chapter about members in Siebel Healthcare Guide.

To share information about a member with a provider employee  

1. Navigate to the Members screen.

2. In the Members list, select the member you want to share with a provider.

3. In the More Info form, click the Show More button.

4. In the More Info form, in the Contact Team field, click the Multiple Select button.

5. In the Coverage Team dialog box, click New.

6. In the Add Employees dialog box, select the provider employee you want to share the Member with, and click OK.

7. In the Coverage Team dialog box, click OK.

   This member is visible to this provider employee in the My Members view.

To share information about a member with a provider company  

1. Navigate to the Members screen.

2. In the Members list, select the member you want to share with a provider.

3. In the More Info form, click the Show More button.

4. In the More Info form, in the Organization field, click the Multiple Select button.

5. In the Organizations dialog box, click New.

6. In the Add Organizations dialog box, select the Organization for the provider you want to share the Member with, and click OK.

7. In the Organizations dialog box, click OK.

   This member is visible to this provider organization in the All Members view.

Viewing Information about Healthcare Providers

The Providers screen allows insurance carriers to view and manage information about healthcare providers. Providers are healthcare professionals who are paid by, or file claims with, your health plan or health insurance company. Examples of providers are physicians, nurse practitioners, dentists, and pharmacists. For more information about using the Providers screen, see the chapter about providers in Siebel Healthcare Guide.

Rather than the carrier entering this information, the provider company can enter and maintain information about provider employees using the Providers screen of the Provider Portal. Then the insurance carrier can view this information using the Siebel Partner Manager or Siebel Healthcare.

To view information about a provider  

1. Navigate to the Providers screen.

2. In the Providers list, select the provider that you want to view information about.

3. Click the view tabs to display information associated with that provider.

Sharing Referrals and Authorizations with Healthcare Providers

The Referrals/Authorizations screen allows healthcare providers to enter requests for referrals to other healthcare professionals and to authorize treatments, and it allows the insurance carrier to respond to these requests.

The provider enters the request in the Healthcare Provider Portal by navigating to the Referrals/Authorizations screen, creating a new request, and entering information about it. When a new request is created, it has the status of Open.

The insurance carrier can act on the request by using the Siebel Partner Manager or Siebel Healthcare to change the Substatus to Approved, Declined or some other substatus (such as Additional Documents Required or Supervisor Approval).

The provider can see whether the request has been approved by looking at the value of the Substatus field. For more information about the Referrals/Authorization screen, see Siebel Healthcare Guide.

To approve or decline a referral request or authorization request  

1. Navigate to the Referrals/Authorizations screen.

2. In the Referrals/Authorizations list, select the referral request or authorization request that you want to act on.

3. Click the view tabs to display more information about the referral request or authorization request, such as notes that the provider wrote or attachments that the provider associated with it.

4. In the Substatus field, choose Approved, Declined, or some other substatus if necessary.

   The provider is able to view the substatus in the Healthcare Provider Portal.