Agenda. Course Objectives Overview Provider Registration Provider Self Service Provider Qualification Add Service Offerings.
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2 Agenda Course Objectives Overview Provider Registration Provider Self Service Provider Qualification Add Service Offerings > 2
3 Course Objectives Introduce the new Provider Registration Process for new providers Introduce Licensed Providers to the new Provider Self Service link Introduce Providers to the new Provider Qualification Form and Add Service Offering Screens Gain navigation skills within the HCSIS application Understand the features and functionality of the Provider Qualification and the Add Service Offering Screens > 3
4 Overview The ACA initiative includes modifications to ODP-ID s existing provider qualification process to provide for utilization of the Electronic Provider Enrollment Application User Interface (UI) for provider screening, while still providing the Program Office with access to data in HCSIS and EDW. Provider access screens will be retired. Providers will now complete a new Provider Qualification Form that will be made available to track the outcomes of the qualification determinations in HCSIS. Providers will now add services through HCSIS screens, and not through Provider Access. > 4
5 Provider Registration ODP Licensed Providers will be required to self register, to obtain a user id that will allow them access to the Provider Self Service portal for Certification and Licensing. > 5
6 Prior PQ Application Process The Provider Qualification Application process as it is known today, will no longer continue as part of the new PQ process. > 6
7 Provider Qualification Under ODP-ID s new qualification process, detailed information on the qualification of providers will be maintained on a paper form (DP1059) outside of HCSIS. Provider Qualification Documentation Record > 7
8 August > 1
9 Primary Topics Objectives Overview Types of Provider Enrollment Applications Site Navigation Key Points Application Session Manager Provider User Interface Pages Documentation Requirements Online Application s Resources August > 9
10 Course Objectives Introduce ODP provider organizations to the DHS Electronic Provider Enrollment Application User Interface (UI) Gain navigation skills within the online provider application Understand the features and functionality of the online provider application August > 10
11 Overview The federally mandated Affordable Care Act (ACA) requires that all states comply with the provider screening and enrollment regulations found at 42 Code of Regulations (CFR) 455, Subpart E Provider Screening and Enrollment. DHS implemented the Electronic Provider Enrollment Application to help streamline enrollment processes, make updates to provider applications, conduct the required screening activities, obtain the required documentation and ensure compliance with the ACA. August > 11
12 Overview The DHS Electronic Provider Enrollment User Interface: facilitates more effective and efficient measures for enrolling new providers as well as for revalidation and reactivation of providers allows providers to complete their Medical Assistance (MA/ODP) enrollment online performs systematic checks to determine the provider s compliance with the ACA Provider Screening and Enrollment regulations. August > 12
13 Types of Enrollment Applications New application brand new provider never enrolled with PA Medicaid Revalidation application provider currently enrolled with PA Medicaid Reactivation application provider re-enrolling with PA Medicaid August > 13
14 Site Navigation Key Points The Electronic Provider Enrollment Application UI is accessed from a secure internet site: Providers must create a password for each application Each online provider enrollment application is assigned a unique Application Tracking Number (ATN) Providers are able to resume a previously started application or check status of a submitted application via the UI October > 14
15 Site Navigation Key Points The application consists of multiple pages that guide the user through completing their online enrollment The application only displays appropriate pages and questions that are collected from the user based on the provider type and provider specialty selected Providers are required to upload supplemental documents required for enrollment based upon information collected during the application process August > 15
16 Application Session Manager The user must click Finish Later or Save and Continue after completing the information on each page of the application in order for the page information to be saved If a user is inactive for more than 25 minutes, the user will receive a message requiring them to respond in order to continue the session If a user does not respond within 5 minutes, the user s session will be ended and the user will need to resume their application at a later time August > 16
17 Common Page Elements August > 17
18 Common Page Elements August > 18
19 Welcome Page August > 19
20 Request Information Page August > 20
21 Service Location Address Page August > 21
22 Other Addresses Page August > 22
23 Specialties Page August > 23
24 Provider Eligibility Program Page August > 24
25 Provider Identification Page August > 25
26 Provider Identification Page August > 26
27 Provider Disclosures Page August > 27
28 Ownership/Control Interest Page August > 28
29 Ownership/Control Interest Page August > 29
30 Ownership/Control Interest Page August > 30
31 Ownership/Control Interest Page August > 31
32 Attachments Page August > 32
33 Agreements Page August > 33
34 Summary Page August > 34
35 Instructions to Submit Application August > 35
36 Application Submitted Notification August > 36
37 Resume Application Page August > 37
38 Application Status Page August > 38
39 Application Status Summary August > 39
40 Application Status Summary August > 40
41 Resetting a Password August > 41
42 Resetting a Password (cont.) August > 42
43 Resetting a Password (cont.) August > 43
44 Notifications The electronic provider enrollment application will send notification to the contact the user enters at key points during the application submission and determination process. The s will be generated from a do not reply address. The following are the types of s generated: Online Application Initiated Online Application Submitted Online Application Returned to Provider for Revisions Online Application Initiated Expiring Online Application Returned to Provider Expiring August > 44
45 Resources Electronic Provider Enrollment Application Provider Enrollment Information dex.htm Includes information regarding requirements for each Provider Type and links to the Department s provider enrollment forms Provider Enrollment and Screening Requirements of the Affordable Care Act ordablecareact/index.htm Includes the most current information from the Department relating to the ACA federally mandated regulations Medicaid Information Provides information about the ACA federally mandated regulations and how they relate to the Medicaid program August > 45
46 Resources (continued) Department of Human Services Website MAB Re-enrollment/Revalidation of Medical Assistance (MA) Providers Provider Enrollment Questions pformaproviders/index.htm#.vp-jk01ii70 Includes contact information and help for MA Providers August > 46
47 Provider Qualification Process > 47
48 Provider Qualification Status New Providers will be requalified during the fiscal year that falls after their first date of qualification Existing Providers will be requalified on a three-year cycle based on the last digit of the provider s MPI Existing Provider Requalification Cycle For example: if an Existing provider with an MPI number of has a qualification Begin Date of 07/10/2018, the provider must be requalified by 06/30/2021. Sixty days prior to the provider s qualification End Date, a batch process will switch the Qualification Status to Expiring. If the status in not manually updated by a user by the provider s qualification End Date, a batch will update the Qualification Status to Expired. > 48
49 Provider Search This screen allows ODP-ID users to search for and select a provider to view or manage their qualification information in HCSIS. To Navigate to this screen follow this path: Provider>Qualification>Qualification Status > 49
50 Provider Search (Cont.) If searching by Provider Name, several results may be returned. > 50
51 Provider Qualification Statuses Qualification Status Qualified Not Requalified Not Qualified Expiring Expired Definition The provider meets ODP s qualification requirements. User would change the status from Qualified or Expiring to Not Requalified, if the provider no longer meets ODP s qualification requirements. HCSIS would change the status from Not Requalified to Not Qualified on 07/01 or users can change the status to Not Qualified at any time, if the provider s qualification is being terminated. HCSIS would automatically change the status from Qualified to Expiring on 05/01, if the provider has not been requalified. HCSIS would change the status from Expiring to Expired on 07/01, if the provider has not been requalified. > 51
52 Provider Qualification Status This screen allows users to view and track the outcomes of qualification determination by specialties for a provider. Users can also view the history of updates or changes for a specialty record. > 52
53 Add Service Offerings > 53
54 Provider Adds Service Offering Notification is received from the HCSIS Help Desk that the provider may add services for which they are qualified for in HCSIS. Provider logs into HCSIS to add service offering > 54
55 Provider Add Service (Cont.) Provider will navigate to the Add Service screen by selecting the following menu path: Provider>Service Management>Add Service>Provider Search > 55
56 Provider Add Service (Cont.) Providers can only add services for which they are qualified for. An error message will display if selecting services for which the provider is not qualified. > 56
57 Provider Add Service (Cont.) Provider will select the services they are qualified for and then click on the [Select and Continue] button. > 57
58 Provider Add Service (Cont.) Providers can see the services added after clicking the [Select and Continue] button on the previous page. The provider will enter a Begin Date and select the [Continue] button. > 58
59 Provider Add Service (Cont.) The provider will select the County/Joinder(s) before selecting the [Create Service Offerings] button. > 59
60 Provider Add Service (Cont.) The provider can see the service(s) they have selected and are qualified for. > 60
61 Questions? Provider Qualification Mailbox - ra-odpproviderqualif@pa.gov Provider Enrollment Mailbox - RA-odpproviderenroll@pa.gov > 61
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