Provider Network Verification (PNV) Portal Florida. User Guide V

Transcription

1 Provider Network Verification (PNV) Portal Florida User Guide V

2 Table of Contents Provider Network Verification (PNV) Portal... 4 Initial Log In... 4 Log Out... 7 PNV Announcements... 7 PNV Automated s... 7 Navigation... 8 Menu... 8 PACE Inbox... 9 Search Tools Provider Network Search Medicaid Research Tracking # Research Tracking # Submission History Downloads PNV File Specifications PNV User Guide Panel Roster Report Layout Reports LTC Network Adequacy Detailed Plan Roster Invalid Provider Type/Specialty LTC Facility Analysis Rule Status PNV User Guide 6/2014 2

3 Adds & Terms Submission Status Provider Master Roster Provider Network Validation SMMC Panel Roster Help Help Desk Document Change History PNV User Guide 6/2014 3

4 Provider Network Verification (PNV) Portal Florida Provider Network Verification (PNV) Portal is a system created and administered by Automated Health Systems. The portal can be found at Initial Log In 1. To establish a password to the Portal upon initial login click Forgot your password? 2. Enter your address and click Submit. PNV User Guide 6/2014 4

5 3. If successful, a message will appear stating that an has been sent. 4. Click the link on the to set the password. PNV User Guide 6/2014 5

6 5. Enter and verify the password, then click Submit. Password Complexity: The password must be at least 8 characters long, contain at least one uppercase letter, and at least one number. 6. Click Return to login once the password was changed successfully. 7. A confirmation is sent upon each password reset. 8. Login to the Portal using your and the new password. PNV User Guide 6/2014 6

7 Log Out To logout of the system, click Logout. PNV Announcements All recent announcements will be listed on the home page. 1. Click View All to see a history of all announcements posted. PNV Automated s The portal sends automated s when files are submitted 1. Error Processing File Only sent when a file submitted by a plan was not in a format that could be accepted by the system 2. File Summary Report Sent the morning after a file is submitted Contains a summary of records submitted, errors, warnings, etc. that occurred during processing PNV User Guide 6/2014 7

8 Navigation Menu To navigate throughout the portal simply click the selection on the menu in the top right corner of the screen 1. Click Home to return to home page from anywhere within the application 2. Click Pace Inbox to access PACE enrollment requests 3. Hover over Search Tools for a drop-down menu of system searches Provider Network Search: Used to search the plan s network and providers Medicaid Research: Used to research the Provider Master File (PMF) for specific provider information such as Medicaid ID, NPI, DBA, etc Tracking Number Research: Use the plan s Tracking ID to research a specific record submission and determine if a record is active in the system or not Tracking Number Submission History: Use the plan s Tracking ID to research a specific record submission history and to download the associated files 4. Click Downloads for a list of the most current version of documents available for download, such as the Provider Network Verification Specification, User Guide, and Panel Roster Report Layout. PNV User Guide 6/2014 8

9 5. Hover over Reports to obtain detailed information on a specific plan LTC Network Adequacy: This report provides a summary of each plan s network compliance with adequacy standards LTC Network Adequacy Detail: This report provides details on each plan s network compliance with adequacy standards and displays the providers used to meet the standard Plan Roster: This report is an unedited representation of the plan s network submission Invalid Provider Type/Specialty: This report reflects when the submitted provider for a service does not align with the provider type and specialty type allowed LTC Facility Analysis: This report is an analysis of the facility type and the plans they participate in Rule Status: This report reflects rule status and information for the current date Add & Terms: This report will show what providers the plan has added or terminated with each submission 6. Click Help for access to various topics to help understand how to use tools on the portal or file submission questions PACE Inbox The PACE inbox allows access to all PACE enrollment requests Please see the PACE User Guide for further information PNV User Guide 6/2014 9

10 Search Tools Provider Network Search The Provider Network Search allows a search for providers using criteria other than the record tracking number. 2. Place cursor on the Search Tools menu option and select Provider Network Search 3. Enter the desired search criteria and click Search 4. The search results screen provides a list of providers meeting the criteria selected to include their Name, Address and Phone Number. PNV User Guide 6/

11 5. To get more details on a provider in the results, click on the Provider s name. 6. The provider detail screen provides specific information about the provider including: Tracking # Provider Location Region Participation Plan Benefits rendered Counties served PNV User Guide 6/

12 Medicaid Research The Medicaid Research tool is used to research the Provider Master File (PMF) 1. Place cursor on the Search Tools menu option and select Medicaid Research 2. Enter the search criteria you wish to use, including Provider Medicaid ID, Tax ID Number, License Number or NPI, and click Search 3. Results include specific information on the provider including: Name of Provider Source Medicaid #, License #, NPI # Medicaid Status Type of provider Specialty of the provider PNV User Guide 6/

13 Tracking # Research Here the current detailed data about a specific provider can be obtained by using the record tracking number 1. Place cursor on the Search Tools menu option and select Tracking # Research 2. After selecting, Tracking # Research from the Search Tools menu, enter the Tracking # and click Search 3. The results return the detailed provider data shown under screen provides specific information about the provider including: Provider Location Region Participation Plan Benefits rendered Counties served PNV User Guide 6/

14 Tracking # Submission History This search tool provides historical information on all files submitted for a specific tracking number. 1. Place cursor on the Search Tools menu option and select Tracking # Submission History 2. Enter the Tracking # then click Search PNV User Guide 6/

15 3. The results on this screen indicate information submitted by the plan Filename Response Row Processed Date Field Was accepted 4. To view additional information: Click the Filename to open a text document of the file submitted Click the file name in the Response field for the system's response to the file submission If multiple submissions click First, Previous, Next, Last to navigate through the files PNV User Guide 6/

16 Downloads Documents available for download can be found under the Downloads menu. 1. Place cursor on the Downloads menu option and make selection. PNV File Specifications File specifications for submitting the plan s provider file are available for download. 1. Place cursor on the Downloads menu option and select PNV File Specification 2. A PDF of the most recent version of the document will open. PNV User Guide 3. A PDF of the PNV User guide can be found under downloads Panel Roster Report Layout 4. File specifications for submitting the plan s Panel Roster are available for download. PNV User Guide 6/

17 Reports To access a specific report place cursor on the Reports menu option and select report type LTC Network Adequacy The LTC Network Adequacy report provides an at-a-glace view of the plan s current status in reference to the Minimum Network Adequacy Requirements. 1. Select a health plan from the drop down box 2. Select an area from the Region Drop down box or select ALL 3. Click View Report PNV User Guide 6/

18 4. Search results: The report will generate information to include: Region, County Name, Benefits of the plan, Plan count, Required Count for the plan PNV User Guide 6/

19 LTC Network Adequacy Detailed The LTC Network Adequacy Detailed Report provides details on each plan s network compliance with adequacy standards and displays the providers used to meet the standard 1. To view report, place cursor on the Reports menu option and select report type LTC Network Adequacy Detailed 2. Select a health plan from the drop down box 3. Select an area from the Region Drop down box or select ALL 4. Click View Report PNV User Guide 6/

20 5. The report will generate information to include: Region name, County Name, Plan benefit, Name of provider, Medicaid Status of provider, Plan Provider Type PNV User Guide 6/

21 Plan Roster This Provider Roster report is an unedited representation of the plan s network submission 1. To view report, place cursor on the Reports menu option and select report type Plan Roster 2. Select a health plan from the select a Value drop down box 3. Select an area from the Region Drop down box or select ALL 4. Click View Report PNV User Guide 6/

22 5. The report will generate information to include: Region, Name of the provider, Medicaid #, NPI #, Address of the provider, Plan benefits PNV User Guide 6/

23 Invalid Provider Type/Specialty This report reflects when the submitted provider for a service does not align with the provider type and specialty type allowed 1. To generate report, place cursor on the Reports menu option and select report type Invalid Provider Type/Specialty 2. Select a health plan from the drop down box 3. Select an area from the Region Drop down box or select ALL 4. Click View Report PNV User Guide 6/

24 5. The Invalid Provider Type/Specialty report will generate information to include: Region Name, County Name, Plan benefit, Display Name, Medicaid #, Provider Type and Specialty PNV User Guide 6/

25 LTC Facility Analysis This report is an analysis of the facility type and the plans they participate with 1. Place cursor on the Reports menu option and select report type LTC Facility Analysis 2. Select a value from the select a region drop down 3. Select a value from the select a client code drop down box PNV User Guide 6/

26 4. Click View Report 5. The LTC Facility Analysis report will generate information on the specific types of facilities and the plans they participate with. The Facility Name will be listed along with the Plan Names, and a Total count. PNV User Guide 6/

27 Rule Status This report reflects rule status and information for the current date 1. To generate report place cursor on the Reports menu option and select report type Rule Status The Rule Status report will generate information to include: Code of Rule, Message about the rule, Is active, Is Warning 2. In the active only drop down Yes or No can be selected 3. Click View Report PNV User Guide 6/

28 Adds & Terms This report reflects Additions and Terminations for the most recent submission 1. To generate report place cursor on the Reports menu option and select report type Add & Terms 2. Select a Health Plan from the drop down and select a Date 3. Click View Report PNV User Guide 6/

29 4. The Add & Terms report for the Health Plan selected will generate and information to include: Status, Region, Plan Name and Name of provider, Medicaid #, Tracking #, and Plan Benefits. PNV User Guide 6/

30 Submission Status 1. To generate report place cursor on the Reports menu option and select report type Submission Status 2. Select a Health Plan from the drop down and select a Region or choose All 3. Click View Report PNV User Guide 6/

31 5. The Submission Status Report for the plan selected will generate and information will include: Region, County, Plan Benefit, Name of provider, Provider Status, and Errors PNV User Guide 6/

32 Provider Master Roster This report provides a list of all providers and provider types that participate with Medicaid 1. To generate report place cursor on the Reports menu option and select report type Provider Master Roster 2. Select the Provider Type from the list of provider types in the drop down 3. On the Active only field choose Yes or No Active means they are on the most recent PMF PNV User Guide 6/

33 4. On the Managed Care field indicate Yes or No if the provider is active in at least one health plans network. 5. The Provider Master Roster for the plan selected will generate and information will include: Name of the providers, DBA, Medicaid ID, NPI, Provider Type, Provider Specialty, County, Region, Status, In Managed Care, and Activity PNV User Guide 6/

34 Provider Network Validation This report provides a look into all the health plans and can be used to verify the provider type associated with a particular health plan. 1. To generate report place cursor on the Reports menu option and select report type Provider Network Validation 2. Select a Health Plan from the drop down, also select a Provider Type and select a specific Region or All PNV User Guide 6/

35 3. The report will list all information for the provider to include the Name of the Health Plan, Provider Name, License #, Medicaid #, Provider type Region, Address, City, State, Zip, the Phone number and the Plan benefits PNV User Guide 6/

36 SMMC Panel Roster The report will contain all active and future recipients assigned to the Plan, as well as, anyone that left the plan within the last 90 days. 1. To generate report place cursor on the Reports menu option and select report type SMMC Panel Roster 2. Select a Health Plan from the drop down and the enrollment program 3. The results from the plan s enrollments can be filtered by a. Active b. Inactive c. Future d. Cancelled 4. Select True to include and False to exclude specific criteria from the report 5. If the begin and end dates of an enrollment span are equal, then it means the enrollment was cancelled. All enrollments will stay on the report until 90 days have passed since the end date of the enrollment. PNV User Guide 6/

37 6. The SMMC Panel Roster report will include all the fields below Recipient Number Case Number SSN First Name Middle Initial Last Name Region County Payee Name Mailing Address1 Mailing Address2 Mailing City Mailing State Mailing Zip Code Residence Address1 Residence Address2 Residence City Residence Residence Zip Phone Number State Code Language Pregnancy Pregnancy Due Special Need 1 Special Need 2 Indicator Date Special Need 3 Special Need ACWM Codes MC Special Notes Conditions Enrollment Program Plan Number Begin Date End Date Service Location Number Plan Enrollment Indicator LTC Level Of Care Open Enrollment Status LTC Program Recommendation Open Enrollment Begin Date LTC Level Of Care Auth Date Open Enrollment End Date Other Health Indicators Disenrollment Reason PNV User Guide 6/

38 Help Information on submitting files, linking providers and using the portal can be found under Help. 1. Place cursor on the Help menu option and click to select 2. Help topics will appear with a list of How to questions and answers Help Desk For technical support, please contact the PNV help desk at address: PNVHelpdesk@automated-health.com PNV User Guide 6/

39 Document Change History Date Version Description 6/04/ Information updated under Help (Help Desk info added) 9/27/ PACE inbox section added 9/27/ Updated screen shots throughout document to include PACE inbox on the menu 5/1/ Screenshots update to include new downloads available 5/1/ Screenshots update to include new reports 6/4/ Remove PACE inbox from guide 6/4/ Added Information on Recent Announcements and Automated s PNV User Guide 6/