Reminder: Enrolled Providers Must Verify and Update Key Demographic Information Every Six Months. Verifying Demographic Information Through PIMS

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1 Reminder: Enrolled Providers Must Verify and Update Key Demographic Information Every Six Months Information posted December 18, 2013 Providers with certain provider types must verify or update key demographic information every six months in the Provider Information Management System (PIMS) to ensure that their information is correct in the Online Provider Lookup (OPL). Affected provider types include, but are not limited to, physicians, nurses, dentists, and durable medical equipment providers. If more than six months have elapsed since a provider has verified the required demographic information in PIMS, TMHP blocks access to many functions on the secure provider portal until the verification takes place. When an account has been blocked, non-administrative users will not be able to perform many work functions for the NPIs listed on the Review Required page. Non-administrative users will be advised to notify users with administrative rights so that the administrative users can verify demographic information and remove the block. If an account is blocked, any user for that account with administrative rights will see a list of National Provider Identifiers (NPIs) that require verification and update. After each NPI listed on the page has been verified or updated, the block will be removed, and users for the account will be able access all of the functions of the secure provider portal. Verifying Demographic Information Through PIMS Users with administrative rights must ensure that all demographic updates are completed and verified by following these steps: Step 1: The Review Required Page is the first page that users with administrative rights for all NPIs listed see when they log into My Account. Listed NPIs that require review will appear on the Review Required page in the following sections as appropriate: Bad Address Suggested address change verification Demographic information update TWHP certification The Continue button will appear on the Review Required page only if the NPIs to be reviewed require nothing more than the verification of a Texas Women s Health Program (TWHP) certification. If any other categories require verification, the Continue button will not appear. Figure 1: Representation of the "Review Required" Screen

2 Users will be able to navigate to their My Account main page by using the My Account link. On the My Account page, users will be able to manage their provider account, but they will be redirected to the Review Required page if they click on many of the Acute Care Online Portal links in My Account.

3 Figure 2: My Account page If there are NPIs that require review, the new Review Required page will be displayed when the following functions are selected from the My Accounts page: View R&S/COF Reports View Paid Claim Detail Reports View Payment Amounts Providers will be allowed to select TexMedConnect; however, they will be unable to access Acute Care functions within TexMedConnect. Selecting any of the Acute Care links will display the Review Required page. Access to Long Term Care links will not be restricted. Step 2: When a user with administrative rights clicks on one of the NPIs on the Review Required page, the Provider Information Change (PIC) page will appear. After the user ensures that all fields on the PIC page contain valid information and enters or changes information as necessary. Then the user marks the Check to confirm box next to each item before clicking Save to save the information for the NPI.

4 Figure 3: Provider Information Change (PIC) page

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6 Step 3: After the user saves the information for an NPI, the Review Required page appears again so that another NPI can be reviewed. When the user saves the information for an NPI and only one NPI remains to be reviewed, the PIC page for the last remaining NPI appears. When the user saves the information for the last NPI, the My Account page appears, and all restrictions to the functions are lifted. Users with Limited Administrative Rights If the user has administrative rights to some, but not all of the NPIs listed on the Review Required page, the user will see the following screen when logging in: Figure 4: Review Required Page When User Is an Administrator for Some but Not All NPI

7 Grace Period for Users Without Administrative Rights When the demographic information for an NPI needs to be reviewed, there is a 45-day grace period before access to functionality will be restricted. During this 45-day grace period, users who do not have administrative rights will see a screen that lists the NPI that needs to be reviewed. Users will be able to click the Continue button to proceed to the My Account page: Figure 5: Non-administrative User Required Review Page During 30-Day Grace Period When the 45-day grace period has expired, the Continue button will no longer appear on the screen, and users will be advised that they need to have an administrator reviews and updates the expired provider identifiers. Figure 6: Non-administrative User Review Required Page After End of Grace Period

8 In these cases, the non-administrative user must notify the administrator that updates must be made. To identify the administrator for an NPI, the non-administrative user can either choose the NPI on their Review Required page or the Provider Administrator Lookup from the My Account main page. The following screen appears: Figure 7: Provider Administrator Lookup Screen Changes to the Remittance and Status (R&S) Page If there are updates on the Review Required page that must be made, users will not be able to see Remittance and Status (R&S) Reports. When visiting the R&S page from either My Account or TexMedConnect Acute Care, users will instead see a message that informs them that the R&S reports are unavailable and instructs them how to address the issue.

9 Figure 8: R&S Screen with Unavailability Message For more information, call the TMHP Contact Center at