Electronic Visit Verification (EVV) Provider Selection Form Process for External Users

Transcription

1 Electronic Visit Verification (EVV) Provider Selection Form Process for External Users Provider Vendor Selection 1) Navigate to TMHP.com 2) Click providers on first page of website to enter the provider section of the website. EVV Provider Selection Form Process Job Aid v2017_0913 1

2 3) On the provider welcome page, click Log in to My Account in the upper right corner of the provider home page 4) Log in to the portal with your user name and password. 2 EVV Provider Selection Form Process Job Aid v2017_0913

3 5) On My Account page, click the EVV Portal link. 6) The Provider Vendor Search page is the default page when logging in to the EVV portal. 7) To access the Provider Vendor Selection Add page, click the plus symbol next to the EVV option in the left navigation panel to view the Add option. EVV Provider Selection Form Process Job Aid v2017_0913 3

4 8) Three options will be shown: a) Add This selection will open the Provider Vendor Selection Add page. b) Search This will take you to the Provider Vendor Search page. 4 EVV Provider Selection Form Process Job Aid v2017_0913

5 c) Reference - This will take you to a hyperlink to access this Job Aid. 9) To open the Provider Vendor Selection Add form, click Add in the left navigation panel. 10) On the Provider Vendor Selection Add form, all required fields are marked with a red asterisk (*). These fields must be filled out when adding a provider or vendor. If required fields are not populated when the form is submitted you will receive an error message. a) Above the Provider Vendor Selection Add section will be a list of any fields that were not completed. EVV Provider Selection Form Process Job Aid v2017_0913 5

6 b) On the form, each field that was not properly filled in or was not filled in at all will be highlighted in red and will have the yellow caution triangle beside it. These fields will need to be completed before submitting again. 11) In the section below, each field is described. a) Date Submitted (* Form submission date) This field will be auto-populated by the current date. 6 EVV Provider Selection Form Process Job Aid v2017_0913

7 b) TIN (* Federal Tax ID [9 digits]) When entering information into the required fields, ensure that the correct number is being typed into the correct field. The fields are not always in the same order on the form. (See the example below.) In this example, the TIN is the first field on the Provider Vendor Selection Add page. On the Provider Vendor Search page, it is the second field. c) NPI/API (* National Provider Identifier/Atypical Provider Identifier.) The NPI/API, TIN and Legal Entity Name must be a valid combination. d) Either the TPI or the LTC provider number (formerly contract number) must be filled out on the Add form even though the fields are not marked with a red asterisk. Providers who have both a TPI and one or more LTC Provider numbers will be able to enter all information. i) TPI TX Medicaid Provider ID (TPI) The TPI is required if the provider/vendor is contracted with TMHP to provide Acute Care (medical services). The LTC provider number (formerly contract number) is required if the Provider has Long Term Care Program/Service listed on the form. Note: Providers can view all service groups/service codes required for EVV at the following location: e) Provider Legal Name *-The provider organization legal name. This is the name that is registered with the Internal Revenue Service. f) Provider DBA *-The Doing Business As name. This is a fictitious, assumed or trade name that is different from the provider/vendor s personal name or the names of the partners or the legal name. EVV Provider Selection Form Process Job Aid v2017_0913 7

8 g) Entity type * Click the radio button beside the entity type of the Vendor/Provider being added. i) FMSA Entity is a financial management services agency. ii) Provider Agency Entity is a provider agency. h) Address * Street address or PO Box i) Address 2 Street address second line (if needed) j) City * k) State * l) Zip code * m) Phone number * n) Fax number o) address p) EVV Program/Services Provided * Select the EVV Program/Services the provider is eligible to provide. (Check all that apply.) i) CAS Community Attendant Services ii) FC Family Care iii) PHC Primary Home Care iv) STARKids In home respite services, flexible family support services v) CLASS Community Living Assistance and Support Services vi) FFS Fee-For-Service vii) STARHealth viii) CCP Comprehensive Care Program ix) MDCP Medically Dependent Children Program x) STARPlus In home respite care 8 EVV Provider Selection Form Process Job Aid v2017_0913

9 EVV Vendor System Selection 1) Selection type * Choose only one EVV vendor system to be used by the provider agency or FMSA listed above. a) Initial Selection If this is a new or existing vendor/provider relationship b) Vendor Change If you are requesting a vendor change 2) Initiated By * Choose whether the Provider listed above is initiating this selection, or the selection is required or defaulted by the State. a) Provider b) State 3) EVV Vendor * Click on the arrow and choose the EVV Vendor. 4) No. of SADs * Total number of Small Alternative Devices documented in use or anticipated for the provider listed on this form 5) Date of Signature * Date of the Representative s Signature 6) Vendor Effective Date * Complete only if changing vendors Effective date must be no less than 120 calendar days from the submission date of this form. 7) Vendor End Date * Always Select 12/31/3999 as the Vendor End Date. EVV Provider Selection Form Process Job Aid v2017_0913 9

10 8) Payors * Select one or more payors. Please indicate all payors with which provider agency is contracted for reimbursement. a) Aetna Aetna Better Health of Texas, Inc. b) Cigna HealthSpring c) Driscoll Driscoll Children s Health Plan d) Superior Superior Health Plan e) United United Healthcare f) Amerigroup Amerigroup Corporation g) Community First Community First Health Plans, Inc. h) BCBSTX Health Care Service Corporation DBA Blue Cross and Blue Shield of Texas i) Texas Children s Texas Children s Health Plan, Inc. j) Children s Medical Children s Medical Center k) Cook Children s Cook Children s Health Plan l) Molina Molina Healthcare m) TMHP/DADS Texas Medicaid and Healthcare Partnership/ Texas Department of Aging and Disability Services Primary Representative for EVV 1) Contact Name * Enter the full name of the electronic visit verification primary representative. 2) Title * Enter the position title of the electronic visit verification primary representative. 3) Same as Provider If the primary representative is the same as the provider, check the Same as Provider radio button to copy the electronic visit verification Primary Representative information to the electronic visit verification point of contact (POC) fields below. 4) Address * Street address or PO Box 5) Address 2 Street address 2nd line (if needed) 6) City * 7) State * 10 EVV Provider Selection Form Process Job Aid v2017_0913

11 8) Zip * 9) Phone Number * 10) Fax Number 11) Address Point of Contact for EVV There are no required fields for the Point of Contact section of the form. Below are the fields that are available if point of contact information is provided. 1) POC Name Full name of the electronic visit verification point of the contact for the provider organization listed on the form 2) POC Title Position title of the electronic visit verification point of contact for the provider organization listed on this form 3) Same as Primary Representative Check to copy the electronic visit verification Primary Representative information to the electronic visit verification point of contact (POC) fields below 4) Address Street address or PO Box 5) City 6) State 7) Zip 8) Phone number 9) Fax number 10) address EVV Provider Selection Form Process Job Aid v2017_

12 Comment Field This field is used to describe a change or additional information noted on the form. Buttons 1) Back Can go back to previous screen 2) Cancel & Discard Cancel the information entered into the form and discard the form 3) Submit Submit form Provider Vendor Search The Provider Vendor Search page includes one required field. The administrator must enter a NPI/API to conduct a search. 1) Enter the NPI/API on the Provider Vendor Search page. 12 EVV Provider Selection Form Process Job Aid v2017_0913

13 2) A search can be conducted with only an NPI or API, but the the search results narrow as more information is added to the search field. 3) Other fields that can be used in the search are: a) Provider TIN Provider Tax ID # (9 digits) b) The EVV vendor can be added. The choices are: i) DataLogic ii) MEDsys c) Provider ID (TPI or LTC Provider #) depending on if the provider/vendor is an Acute Care provider or Long Term Care provider d) The payor for the NPI or API being searched for can also be added to the search criteria to narrow the results. e) The EVV program type can also be added to the Provider Vendor Search. EVV Provider Selection Form Process Job Aid v2017_

14 f) A Submitted Date or a Vendor Effective Start Date is another way to narrow the search results. 4) The search results will appear under the Search fields. There can be up to 500 search results. The number of searches showing can be changed up to 100 visible results per page. 5) If no results are found there will be a system generated message. 14 EVV Provider Selection Form Process Job Aid v2017_0913

15 Edit or Update Provider/Vendor 1) Once the search results are displayed, locate the entry that needs to be edited or updated and then click on the Details link. 2) The Provider Vendor Details page will be displayed. Providers can enter and save comments only on this page. 3) To edit vendor/provider information, click the edit button. EVV Provider Selection Form Process Job Aid v2017_

16 4) This will bring up the Provider Vendor Selection Update page. The information from the Provider/Vendor Details page will auto-populate the Provider Vendor Selection Update page. The fields on this page are editable. 5) At the bottom of the page there are several options: a) The Back button will go back to the Provider/Vendor Details page. b) Cancel and Discard will undo the changes made on the Provider Vendor Selection Update page. c) The Submit button will submit the changes made to the Provider Vendor Selection Update page. 16 EVV Provider Selection Form Process Job Aid v2017_0913

17 Copy Provider/Vendor The copy function is used to copy the data over to create a new vendor selection record. This allows the provider to create a new selection without needing to retype all the fields if the fields have similar data. Note: Comments will not copy over to the new form. 1) Select details for the current vendor. EVV Provider Selection Form Process Job Aid v2017_

18 2) Select Copy. 3) Add additional TPI, LTC provider numbers (formerly contract numbers), Programs, Services, Payors and change demographics. 18 EVV Provider Selection Form Process Job Aid v2017_0913

19 4) If TPI, or LTC provider numbers (formerly contract numbers) are added or removed this will make additional entries on the initial provider search page. EVV Provider Selection Form Process Job Aid v2017_

20 20 EVV Provider Selection Form Process Job Aid v2017_0913