Instructions for Use

Welcome to the Professional Review Network's Automated Utilization Review entry system.

If you feel comfortable with completing web-based forms, you may go directly to Specific Instructions for PRN Forms.

For those of you who may be unfamiliar with the web and web-based forms, the first section of this page gives a short interactive tutorial for entering forms on a web browser. The second section gives specific instructions for completing PRN forms.

Web-based Forms Tutorial

Since you've gotten this far, you have already learned how to log onto the network, start your web browser, enter PRN's URL (Universal Resource Locator or web address) and click on the Instructions for Use link. Great, you already know most of what you need to use the PRN system. You will also need to know how to fill in and submit web forms.

To a large extent, filling out a web-based form is like filling out a paper form; you fill in blanks, check boxes and write comments. However there are a few differences with web-based forms. These differences are easy to understand and the instructions below will help you in filling out this type of form. So let's start with a bit of review.

A word about different types of "mice": If you have a Macintosh your mouse will have only one button to click. If you have a PC with Windows 3.1, Windows95 or 98, your mouse will have two buttons. When the left button is clicked, it selects items. When we instruct you to click the mouse button, it is the left button you should click.

A word about "cut," "copy," and "paste." If you have a PC with a Windows system and click the right button, a drop-down box will appear providing options for "cut," "copy," and "paste," as well as other options. Learning to use the "cut," "copy," and "paste" functions will make many operations quicker for you and with less chance of an inadvertent typing error. We strongly recommend that you refer to your computer's operating system manual for more information on these options.

Selecting Items

You move the computer's cursor by moving your mouse (trackball, pointer; etc.). You select an item in a web browser by placing the cursor on that item. When the cursor is correctly positioned on a valid, selectable item, it will change shape or color. Usually it will change from an arrowhead or a vertical bar to a hand with a pointing finger. For example; if you move your cursor over the highlighted and underlined text below:

Instructions for Use

you'll see that the cursor changes. This indicates that the highlighted text is a valid item to select.

Links

Any item that is highlighted and underlined is called a link. Links provide access to information pages or other web sites that are, in general, pertinent to the immediate website. Clicking on a link will take you directly to that item. If you click the left mouse button on the "Instructions for Use" link above, it will take you to the top of this page which gives the instructions for how to use this system.

Input Boxes

One type of input is the input box. It looks like this:

To enter something into an input box, position your cursor directly over the box. If you are positioned correctly, you will see a vertical text cursor (which looks like a large capital I) appear in the input box. Try this in the First Name box above.

If you don't see the vertical cursor, position the cursor more directly over the box. When you see the vertical cursor, click your mouse button and another cursor, which looks like a flashing vertical bar, will appear in the input box. At this point you can type your entry into the input box. Try it with the one above.

Selection Lists

Another type of input is the selection list. To use a selection list, click on the down arrow at the right side of the box. This opens the list of available choices. By sliding your cursor over the list you can highlight any of the selections and by clicking the left mouse button, select that choice. A selections list looks like this:

Try putting your cursor on the down arrow at the right side of the selection box and clicking, then choose another diagnosis from the drop down list.

Checkboxes

A very familiar input method is the checkbox. Web forms also use checkboxes. They are small, square boxes and will show a check or an X when you put the cursor on one and click the mouse button. Checkboxes click-on and click-off. If you want to switch a checkbox from checked to unchecked, just click on the same box again. Checkboxes are also all-any-none, in that any combination in a group may be checked or left unchecked. They look like this:

Try checking one or all of the boxes, on and off.

Radio Buttons

One thing that you've never seen on a paper form that you will see on a web form is a radio button. Radio buttons work just like the buttons on a car radio. Whenever you push a button, the radio goes to that station. Since you can only select one station at a time, the previous selection is turned off. Radio buttons also work like the selection list above in that you can only choose one item from the list. However with radio buttons you always see the whole list of choices.

To select an item, put your cursor on the round button and click the mouse. That item will be selected and any other item in the group that had been previously selected will become unselected. Here is an example of a set of radio buttons to try:

Text Boxes

A text box is used for inputting plain text, just like a word processor. To use a text box, place your cursor on the text box and click your mouse button. A vertical bar cursor will appear in the text box and you can begin typing. Arrow, insert, delete, and enter keys will function normally. Below is what a text box looks like, go ahead and try it!

Submit and Clear Buttons

Finally, when you have finished filling out the form, you have to submit it. Until you have clicked the Submit Form button, the data that you have entered will not be sent to PRN. If you decide that you want to discard the form that you are working on, or that you want to start over, click the Clear button.

Remember, if you click on Clear all the data that you have entered on the form will be DELETED and UNRECOVERABLE. These buttons look like this:

Please click to submit, or to reset

Both these buttons really work, so please feel free to play, then please click "Clear"!

Specific Instructions for PRN Forms

Input Form Selection

After logging onto the PRN system, the appropriate input form for submission to PRN will be found on the Form Selection page immediately below the Current News message. On that page you will find three form types listed; Cervical, Thoracic and Lumbar.

The form types are underlined and highlighted, which means they are links to that particular form. Below each form link is the list of diagnostic codes that uses that particular form for submission. For example; if the diagnosis is 739.40 Segmental Dys. - Sacral, click on the highlighted and underlined Lumbar above it to go to the Lumbar form. In this tutorial, clicking on the Lumbar link will not take you to the lumbar form. When you click on the Lumbar link in the Form Selection page you will go to the Lumbar form.

Do not click on the desired diagnostic code, nothing will happen. You must click on the highlighted and underlined form link above the correct diagnostic code to go to the correct input form for submission.

If the diagnostic code that you wish to use is not listed, select the form that relates to the appropriate body area (i.e.; cervical, thoracic, lumbar). For example; the diagnosis of 724.79 Coccygodynia is not offered. However if this was the primary diagnosis you would use the input form for the nearest spinal region, in this case the Lumbar form.

Clinical Primary Diagnosis

The Clinical Primary diagnosis is the CPT coded diagnosis that best describes the Primary Complaint. It is the condition for which the patient is presently seeking care and which you are attempting to resolve.

For example; the patient presenting with low back pain extending down the posterolateral thigh may be best represented under the diagnosis of 724.3 Sciatica. The Clinical Primary Diagnosis is the only diagnosis that MUST be presented in the PRN system. By providing the secondary and/tertiary diagnoses, as well as any significant co-morbid diagnosis, you may present a clearer picture of the case. This can be beneficial if the necessity for care is questioned, but at present it remains optional to report these other diagnoses.

Unlisted Clinical Primary Diagnosis Code
If the code that you wish to submit is not listed, please select the Unlisted Code, Enter Below choice from the drop-down list in the Clinical Primary Diagnosis box. Then enter the appropriate ICDA-9 code as a number comprised of 3 digits, a decimal point, then 2 digits (i.e.; 999.99) in the Unlisted Primary Diagnosis Code input box.

Complete the form as appropriate. Remember to enter the pertinent history (date of onset, mechanism of onset, etc.), as well as any supportive findings in the comments box. The need to enter objective findings not offered in the form is generally greater when you are reporting under an Unlisted Primary Diagnosis Code, so please be detailed in your reporting. Please note that the use of an unlisted diagnosis will require a review process that may delay the return of your response.

Secondary Diagnosis:
A secondary diagnosis would be any presenting condition(s) that produces a direct and substantial effect on the severity of, or treatment for, the primary diagnosis.

For example; consider a primary diagnosis of sciatica with a secondary diagnosis of lumbar disc degeneration. The clinical circumstances of the secondary diagnosis at the time of reporting should be less than or, at most, equal to that of the primary. The primary diagnosis must be the most severe condition present at the time of completing the form.

Example: A primary diagnosis of sciatica with a secondary diagnosis of lumbar disc degeneration and a tertiary diagnosis of cervicogenic headaches.

Please enter only the code number and put any text in the comments box at the bottom of the form.

A comorbidity factor is one which, if present in your patient, may affect the condition you are treating but is not your primary clinical focus at present. For example; the presence of diabetes in your patient may create difficulties in the diagnosis and care of sciatica. Pregnancy as a comorbid factor has well known mechanical influences on the spine and prevents the use of diagnostic tools such as x-ray and therapeutic tools such as EMS or US over the low back.

Comorbidities are most important to be presented where they have a significant negative influence on your ability to diagnose or treat your patient and where they impair clinical resolution of the primary diagnosis.

Patient Information Section

In this section, the patient and provider/insurance data is entered. Please note that the provider and insurance company ID's are used to determine the return address for the report, so please make sure that these are correct. The information fields for the patients name and Patient's Office File ID are optional. They are offered to simplify the filing of your office records.

Do not use the patient's Social Security Number anywhere on the PRN form. Use of the Social Security Number as an identifier is against Federal Law!

For any visits to be authorized, there must be an entry in the visits requested input box. If the report is a practice run, please check the "Return to Provider Only" checkbox. Use this box to "practice" submitting information to PRN without requesting actual authorization for care.

Examination Data

Please enter examination data as appropriate. If a particular test or entry has a "Help" information link associated with it, the item will be highlighted and underlined. Clicking on the highlighted item will take you to a page describing that item, or test procedure and results.

Please make sure that dates are entered where required and that the "X-Ray and MR/CT Performed" checkboxes are selected, if appropriate.

Submitting Your Completed Form

When you have completed entering the data, please click on the "Submit Form" button at the bottom of the form. This action will submit your form to PRN. When PRN has received your form, a web page will display "Thanks, your submission has been received by PRN." Depending on network traffic, this verification of data receipt may take a few seconds. Please wait for this verification response. If you have additional forms to send, click the link at the bottom of the verification page to return to the Form Selection page. If you have no additional forms to enter, you may leave the system.

Receiving Your Report

If your form is approved it will be returned to your browser immediately. We suggest that you print a copy of the review form for you records, by clicking the PRINT button on your Web browser.

Forms that require review are processed when the reviewer handles you case. Information to retrieve your case wilbe sent back to you via e-mail. The e-mail will contain a web address that will allow you to retrieve your report.

The web address embedded in the e-mail will look something like this:

In most mail programs, the web address (link) will be highlighted as it is here. You should be able to double-click on the link which will start your web browser and take you to your report. If your mail program does not support this function, you will need to open your browser and then transfer the web address into the browser location window.

We strongly suggest that you do not attempt to type the web address by hand into the browser location window. The address is long and one number typed incorrectly will deny access. Transfer the web address from the e-mail into the browser location window by using your mouse's "copy and paste" function. Using "copy and paste" is much faster and avoids inadvertent typing errors. Please refer to your system's operating manual for more information on these functions.

When your browser window opens, you will be asked for your UserID and password. After entering them correctly, your report will be displayed. The web page can then be printed and kept as a "hard copy" in the patient's office file.

• If the form is a standard submission and is forwarded to a reviewer, you will receive confirmation via e-mail that the submission has been forwarded. The web address for retrieval will be sent to you via e-mail after the reviewer has processed the submission.

• If the form is an appeal, it will be sent to the reviewer. You will receive confirmation via e-mail that the appeal has been sent. The web address for retrieval will be sent to you via e-mail after the reviewer has processed the appeal.

Further Questions

If you have any questions or comments please click here to send e-mail to PRN.

Thank you,
The Staff of PRN

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