Revision History. Document Version. Date Name Comments /26/2017 Training and Development Initial Creation

Transcription

1 Pharmaceutical Assistance Contract for the Elderly (PACE)/ Pharmaceutical Assistance Contract for the Elderly Needs Enhancement Tier (PACENET)Web Provider Enrollment/Provider Management Corporate User Guide Version 1.0 October 26, 2017

2 Revision History Document Version Date Name Comments /26/2017 Training and Development Initial Creation Page 2 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

3 Table of Contents Revision History...2 Table of Contents Introduction Corporate Users First Time Users Registered Users System Access Log In Log Out Provider Enrollment Add New Site s Application Addresses Section Licenses/IDs Tab Owners Tab Staff Tab Electronic Funds Transfer (EFT) Tab Electronic Remittance Advice (ERA) Tab Pharmacy Info Tab Submit Tab Adding a new Program Provider Information Management Global PIM (Provider Information Management) Change Practice Type Review Review/Revisions Practice Types PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 3

4 1.0 Introduction Web Provider Enrollment is a web-based application developed to provide authorized users with an online tool to apply for enrollment in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) Program. It is strongly recommended that you do not run in compatibility mode if using Internet Explorer. This setting can be turned on and off by selecting from the text menu at the top of your browser Tools, then Compatibility View. A check mark beside this setting indicates that you are running in compatibility mode. Google Chrome can be used instead of Internet Explorer if there are issues viewing the screens. Provider Management allows users to update an application after obtaining a user name/id and password. 1.1 Corporate Users A corporate user is someone typically from a large chain that is submitting enrollments as well as making provider management updates on behalf of numerous providers. The corporate user needs to have access assigned to them under their Corporate NPI * to act on behalf of other providers within the corporation. *Corporations without a Corporate NPI will not be able to use the Provider Management feature. To perform work on the Commonwealth of Pennsylvania Web Portal as a corporate user, you must first complete the registration process via the User Administration Console (UAC) application. See Section First Time Users for detailed instructions. If you are registered as a corporate user, you should not register for individual provider NPIs with the same user name/id. If you need access to other secured services (such as Web Claims Submission, WebRA, etc.) on behalf of a provider in addition to Provider Enrollment, it is recommended that you have a second user name/id for that access and register for those individual provider NPIs with that user name/id. Corporate users needing to update all or multiple providers under the Corporate NPI should reference Section 5.0 Global PIM for further instructions. A uniform across-the-board change affecting all individual contracts would be, but not limited to, a change in corporate tax ID, corporate officers, bank accounts, corporate phone number, or . Page 4 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

5 1.1.1 First Time Users First-time users need to enroll to submit claims for PACE/PACENET or any of the ancillary programs. To begin the enrollment process, please use the following steps: 1. From the Commonwealth of Pennsylvania Web Portal window, click the UAC hyperlink. The User Administration Console, Who are you? window appears. See Figure Figure User Administration Console, Who are you? Window 2. Refer to the User Administration Console User Guide for detailed instructions on the registration process. To access this user guide, click Help in the top-right corner of the window Registered Users Registered Corporate users will have several options that they can access from the Commonwealth of Pennsylvania Web Portal Home window Services and Applications box. Provider Enrollment Provider Information Management Global PIM Change Practice Type Each of these Services and Applications will be described in the subsequent sections of this user guide. PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 5

6 2.0 System Access 2.1 Log In To access Web Provider Enrollment, please use the following steps: 1. Access the Internet by opening the Web browser. 2. Type into the Address box and press ENTER. The Commonwealth of Pennsylvania Web Portal home window appears. See Figure Figure Commonwealth of Pennsylvania Web Portal Home Window 3. Click Login Now. The Login window appears. See Figure Page 6 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

7 Figure Login Window The first time you access the application, you will need to change your password before attempting to log in. Click the Practitioners/Pharmacists need to change your password? link to change the password. Once the password change has been completed successfully, return to the Login window in Figure and enter the User Name/ID and updated Password. 4. Enter the User Name/ID and Password. 5. Click Login. The Choose a provider to work on behalf of window appears. See Figure Figure Choose a provider to work on behalf of Window 6. In the Provider List, select the provider. PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 7

8 7. Click Select. The Commonwealth of Pennsylvania Web Portal window appears with the corporate user logged in. See Figure Log Out Figure Commonwealth of Pennsylvania Web Portal Window To log out of the Commonwealth of Pennsylvania Web Portal, click the Logout hyperlink. Refer to Figure Page 8 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

9 3.0 Provider Enrollment Corporate users can access the Provider Enrollment application to enroll a new Provider NPI site, add a program to an existing NPI, or check the status of a submitted enrollment. To access Provider Enrollment, please use the following steps: 1. Click Launch next to Provider Enrollment in the Services and Applications box. See Figure Figure Commonwealth of Pennsylvania Web Portal Home window 2. The Provider Enrollment Dashboard window appears. Refer to Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 9

10 Figure Provider Enrollment Dashboard Window 3. To search for a provider, enter the NPI in the NPI box. 4. Click Search. The provider appears if it is currently managed by the corporate user and an enrollment has been submitted. See Figure Page 10 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

11 Figure Provider Enrollment Dashboard, Provider NPI found 5. If the provider does not appear, an error message appears stating ERROR No records found matching that NPI. A new application can be submitted for the provider NPI. See Section 3.1 Add New Site s Application. 3.1 Add New Site s Application To add a new application for a provider NPI, please use the following steps: 1. Click Add New Application. Refer to Figure The Practice Type, Enrollment Type & Program(s) window appears. See Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 11

12 2. Enter the Provider s NPI. Figure Practice Type, Enrollment Type & Program(s) Window 3. Click Continue. The Enrollment for Pharmacies & Dispensing Prescribers window appears. See Figure Figure Enrollment for Pharmacies & Dispensing Prescribers Window 4. Enter the Provider Federal Tax Identification Number (TIN) or Employment Identification Number (EIN). 5. Enter the address. Page 12 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

13 6. Enter the State License Number. 7. Click Continue. The Practice Type, Enrollment Type & Program(s) window appears. See Figure Figure Practice Type, Enrollment Type & Programs Window 8. In the Practice Type list, select the appropriate practice type. The window refreshes. 9. In the Enrollment Type list, select the appropriate enrollment type. The window refreshes. 10. Select the Program(s) in which the provider wants to enroll. See Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 13

14 Figure Practice Type, Enrollment Type & Program(s) Window 11. Click Continue. The Confirm Practice and Enrollment Type window appears. See Figure Page 14 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

15 Figure Confirm Practice and Enrollment Type window 12. Click Continue. The Provider Enrollment, Demographics window appears. See Figure If selecting Special Pharmaceutical Benefits Program 1 (ADAP) or 2 (Mental Health), enter a Medical Assistance Number before clicking Continue. To cancel the enrollment, click Cancel & make changes hyperlink. PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 15

16 Figure Provider Enrollment, Demographics Window 13. Enter the Name of the pharmacy as it appears on the pharmacy license. 14. Click Save General Info. An is sent to the address on file once Save General Info is clicked. See Figure for an example. If edits are needed in the TIN/EIN, , or Name fields, just enter the information in those fields and click Save General Info. Clicking Cancel will revert the fields in this section back to the original values before the last Save. Page 16 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

17 Figure Example Addresses Section At a minimum, you are required to add contact information for your business/corporate, service, and software vendor address. Figure Addresses Section To view more information on Contact/Address Types, click Help on Contact/Address Types. Refer to Figure Click Close to exit the Help feature of the Contact/Address Types window. See Figure To hide the address fields, click Hide. To show the address fields, click Show. Refer to Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 17

18 Business/Corporate Figure Help on Contact/Address Types window The business/corporate address is required. The business/corporate address is the public mailing address. 1. Click Add New Contact. The Add New Contact/Address window appears. Refer to Figure Page 18 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

19 Figure Add New Contact/Address, Service 2. In the Type list, click Business/Corporate. Refer to Figure Enter Corporation Name. 4. Enter Contact First Name and Contact Last Name. 5. In the Street Address 1 box, enter the street address or P.O. box. 6. In the Street Address 2 box, enter additional address information or P.O. box, if applicable. 7. In the City box, enter the city. 8. In the State list, click the state. 9. In the Zip box, enter the zip code and the additional four digits, if known. 10. In the Phone box, enter the telephone number. If there is an extension, you can enter up to eight digits. Enter numbers only. Hyphens, spaces, or other special characters are not allowed. 11. In the Fax box, enter the fax number. Enter numbers only. Hyphens, spaces, or other special characters are not allowed. 12. In the box, enter the address. 13. Click Save Information. PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 19

20 To cancel saving the address, click the Cancel & do not save hyperlink. 14. The information entered appears on the Demographics tab, in the Addresses window. The Type column displays the type of address entered. See Figure Figure Demographics Tab, Service Type Correspondence The correspondence address should be completed in order to direct program mailings to another address, if desired. 1. Click Add New Contact. The Add New Contact/Address window appears. Refer to Figure In the Type list, click Correspondence. See Figure Page 20 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

21 If the address has been entered previously click the drop-down arrow on the Use a previously entered address? and choose the address that was previously submitted. The fields will be populated with the address. Figure Add New Contact/Address, Correspondence 3. In the Street Address 1 box, enter the street address or P.O. box. 4. In the Street Address 2 box, enter additional address information or P.O. box, if applicable. 5. In the City box, enter the city. 6. In the State list, click the state for the corporate address. 7. In the Zip box, enter the zip code and the additional four digits (if known). 8. Click Save Information. To cancel saving the address, click the Cancel & do not save hyperlink. 9. The information entered appears on the Demographics tab. The Type column displays the type of address entered. See Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 21

22 Figure Demographics Tab, Addresses section Lessor The Lessor address should be completed with the address of the person or company who leases property (landlord) where the provider renders services. If the address has been entered previously, click the Use a previously entered address? list and select the address that was previously submitted. The fields will be populated with the address. 1. Click Add New Contact. The Add New Contact/Address window appears. Refer to Figure In the Type list, click Lessor. See Figure Figure Add New Contact/Address, Lessor 3. In the Contact First Name box, enter the first name of the corporate contact. Page 22 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

23 4. In the Contact Last Name box, enter the last name of the corporate contact. 5. In the Street Address 1 box, enter the street address or P.O. box. 6. In the Street Address 2 box, enter additional address information or P.O. box, if applicable. 7. In the City box, enter the city. 8. In the State list, click the state. 9. In the Zip box, enter the zip code and the additional four digits (if known). 10. Click Save Information. To cancel saving the address, click the Cancel & do not save hyperlink. 11. The information entered appears on the Demographics tab. The Type column displays the type of address entered. See Figure Figure Demographics Tab, Addresses section Service The service address is required. The service address is the physical location of the pharmacy. If the address has been entered previously, click the Use a previously entered address? list and select the address that was previously submitted. The fields will be populated with the address. 1. Click Add New Contact. The Add New Contact/Address window appears. Refer to Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 23

24 2. In the Type list, click Service. Refer to Figure Figure Add New Contact/Address, Service 3. In the Street Address 1 box, enter the street address. 4. In the Street Address 2 box, enter additional address information, if applicable. 5. In the City box, enter the city. 6. In the State list, click the state. 7. In the Zip box, enter the zip code and the additional four digits (if known). 8. In the County box, enter the name of the county where the Pharmacy is located. 9. In the Phone box, enter the telephone number. If there is an extension, you can enter up to eight digits. Enter numbers only. Hyphens, spaces, or other special characters are not allowed. 10. In the Fax box, enter the fax number. Enter numbers only. Hyphens, spaces, or other special characters are not allowed. 11. In the box, enter the address. 12. Click Save Information. Page 24 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

25 To cancel saving the address, click the Cancel & do not save hyperlink. 13. The information entered appears on the Demographics tab. The Type column displays the type of address entered. See Figure Figure Demographics Tab, Addresses section Software Vendor The software vendor contact information is required. You must enter the software vendor contact information. If the address has been entered previously click the Use a previously entered address? list and select the address that was previously submitted. The fields will be populated with the address. 1. Click Add New Contact. The Add New Contact/Address window appears. Refer to Figure In the Type list, click Software Vendor. See Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 25

26 Figure Add New Contact/Address, Software Vendor 3. In the Software Vendor Name box, enter the software vendor name. 4. In the Street Address 1 box, enter the street address or P.O. box. 5. In the Street Address 2 box, enter additional address information or P.O. box, if applicable. 6. In the City box, enter the city. 7. In the State list, click the state. 8. In the Zip box, enter the zip code and the additional four digits (if known). 9. In the Phone box, enter the telephone number. If there is an extension, you can enter up to eight digits. Enter numbers only. Hyphens, spaces, or other special characters are not allowed. 10. In the box, enter the address. To cancel saving the address, click the Cancel & do not save hyperlink. 11. Click Save Information. Page 26 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

27 Figure Demographics Tab, Addresses section 12. The information entered appears in the Addresses section. The Type column displays the type of address entered. Refer to Figure Delete/Edit You can delete or edit the addresses you entered by clicking the Pencil or X icon. Icon Name Description Pencil The Pencil icon takes you to the Edit Contact/Address window. The Pencil icon only appears if you have the information previously saved. Edit the information and click Save Information to save the changes. X The X icon allows you to delete the address type previously saved. The X icon only appears if you have the information previously saved Licenses/IDs Tab Once you click the X icon, a warning window appears advising you that you have selected to delete the information. To confirm the action, click Delete or click the Cancel & do not delete hyperlink to keep the information as is. The Licenses/IDs tab requires you to enter any license or IDs for the pharmacy. For example, NPI, NCPDP (National Council for Prescription Drug Programs) number, etc. This is a required tab. 1. The State License Number pulls over from the initial entry screen and populates on the window. 2. In the (From) Effective Date box, enter the (from) effective date, or select the date by using the Calendar icon. See Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 27

28 Figure Calendar Icon To go back a month, click the single arrow pointing left on the calendar; to go forward a month, click the single arrow pointing right on the calendar; or click the month and year lists to select the month or year. To select the current date, click Today. 3. In the (To) Effective Date box, enter the (to) effective date, or select the date by using the Calendar icon. Refer to Figure Click the option that best describes your Medical Assistance Status. 5. The Medical Assistance Number is populated based on what was entered on the Practice Type, Enrollment Type & Programs window. Refer to Figure In the DEA Number box, enter the Drug Enforcement Agency (DEA) number. The DEA number is a combination of two alphas and seven numerals. 7. The Corporate NPI box is populated with the corporate NPI number. 8. Click Save License/ID Info. See Figure To cancel the entries, click the Cancel hyperlink. Your fields revert to the original values before the last save. Page 28 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

29 Figure Licenses/IDs Tab Owners Tab Based on the practice type selected, the Ownership Type list is customized. This tab is required Ownership Type To select the ownership type that best describes your business, please use the following steps: 1. In the Ownership Type list, select an ownership type. See Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 29

30 Figure Ownership Type List 2. Click Save Ownership Info. 3. Click Add New Owner/Officer Info. The Add New Owner/Officer Information window appears. See Figure The ownership type of Other requires you to complete a description. You are required to add contact information for at least one owner. Page 30 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

31 Figure Add New Owner/Officer Information PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 31

32 If the address has been entered previously click the Use a previously used address? list and select the address that was previously submitted. The fields will be populated with the address. 4. In the Contact First Name box, enter the contact s first name. 5. In the Contact Last Name box, enter the contact s last name. 6. In the Title box, enter the title. 7. In the Street Address 1 box, enter the street address or P.O. box. 8. In the Street Address 2 box, enter additional address information or P.O. box, if applicable. 9. In the City box, enter the city. 10. In the State list, click the state. 11. In the Zip box, enter the zip code and the additional four digits (if known). 12. In the Ownership Percentage box, enter the percentage of the business owned. Do not enter the percent sign when entering the percentage owned. If the percentage entered is more than a whole number, it is rounded up. However, it must total 100 percent. The percentage entered does not display a total until you submit the application, so if the percentages do not add up to 100 percent, you receive an error message after you submit the application. Click the Cancel & do not save hyperlink to cancel your entries. 13. In the Phone box, enter the telephone number. If there is an extension, you can enter up to eight digits. Enter numbers only. Hyphens, spaces, or other special characters are not allowed. 14. In the box, enter the address. 15. Click Save Information. The information you entered appears. 16. Click Save Ownership Info. The information is saved. See Figure Page 32 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

33 Figure Owner/Officer Information, Saved To delete or edit the owner/officer information, click the Pencil icon or X icon. To add additional owners, click Add New Owner/Officer Info and complete the required fields until all owners or officers are listed. To cancel the entries, click the Cancel & do not save hyperlink. The fields revert to the original values before the last save. PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 33

34 3.1.4 Staff Tab This tab is used to list your staff members. The options available in the Staff Type list are customized based on the practice type selected. This tab is required to be completed before you submit your enrollment application. Figure Add New Staff Information Window Add Staff Information To add staff information, please use the following steps: 1. Click Add Staff Information. The Add New Staff Information window appears. See Figure If you are a monitoring physician, you must enter your information under the Staff type. If you are a Dispensing Physician, you must enter someone else s information on the staff tab (the other physician/physicians in the practice). You are required to add information for the Pharmacy Manager. If you are a Certified Registered Nurse Practitioner (CRNP) entering this application and you select that option on the Practice type, you must add the Collaborating Physician s information on the Staff tab. Page 34 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

35 Figure Staff Information 2. In the Staff Type list, select the staff type. Refer to Figure In the First Name box, enter the first name. 4. In the Last Name box, enter the last name. 5. In the NPI box, enter the NPI number. This is a ten-digit numeric field. 6. In the License Number box, enter the license number. 7. In the Specialty box, enter the specialty (if applicable). 8. In the Degree box, enter the degree. 9. Click Save. The information is saved. See Figure Figure Add Staff Information, Saved PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 35

36 To delete or edit the staff information, click the Pencil icon or the X icon. To add additional staff, click Add Staff Information and complete the required fields until all staff are listed. Click the Cancel & do not save hyperlink to cancel your entries Electronic Funds Transfer (EFT) Tab Electronic Funds Transfer (EFT) is a required tab. Once completed, it authorizes Magellan Health Services, on behalf of the program(s) you signed up for, to initiate entries to the account indicated on the application and the depository named on the application Adding EFT Information Some of the information at the top of the Electronic Funds Transfer tab cannot be edited on this window. Messages in red font are present to advise where to navigate in the application to make any necessary adjustments to this information. Page 36 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

37 Figure Electronic Funds Transfer (EFT) tab PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 37

38 To enter information on the Electronic Funds Transfer (EFT) tab (Refer to Figure ), please use the following steps: 1. Enter the first name of the person in the office who handles the EFT issues in the Provider Contact First Name field. 2. Enter the last name of the person in the office who handles the EFT issues in the Provider Contact Last Name field. 3. Enter the Telephone Number. Enter numbers only. Hyphens, spaces, or other special characters are not allowed. 4. Enter the Financial Institution Name. 5. Enter the Financial Institution address using the Street, City, State/Province, and Zip Code/Postal Code fields. 6. Enter the Financial Institution Routing Number. 7. Select the Type of Account at Financial Institution from the available radio buttons. 8. Enter the Provider s Account Number with Financial Institution. 9. Select the Reason for Submission from the radio buttons. 10. Enter the Printed Name of Person Submitting the Enrollment. 11. Enter the Printed Title of Person Submitting the Enrollment. 12. Click Save EFT Info. The information is saved Electronic Remittance Advice (ERA) Tab Electronic Remittance Advice (ERA) is a required tab. Once completed, it authorizes Magellan Health Services, on behalf of the program(s) you signed up for, to provide you with weekly remittance information on claims processed Adding ERA Information Some of the information at the top of the Electronic Remittance Advice tab cannot be edited on this window. Messages in red font are present to advise where to navigate in the application to make any necessary adjustments to this information. Refer to Figure Page 38 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

39 Figure Electronic Remittance Advice (ERA) Tab PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 39

40 If you click Yes, the Will your Electronic Funds Transfers be sent to your affiliated TPA? option appears. Click Yes or No to respond to that question. If you click Yes, the TPA Number box appears. 1. Click Yes or No in the Does your pharmacy have a Clearinghouse number (TPA number)? option. If Yes, go to step 2. If No, go to step In the Trading Partner ID (TPA Number) box, enter the TPA (third-party administrator) number. This is a six digit number. 3. Enter the first name of the person in the office who handles the ERA issues in the Provider Contact First Name field. 4. Enter the last name of the person in the office who handles the ERA issues in the Provider Contact Last Name field. 5. Enter the Telephone Number. Enter numbers only. Hyphens, spaces, or other special characters are not allowed. 6. Select the Method of Retrieval from the radio button options. 7. Select the Reason for Submission from the radio button options. 8. Enter the Printed Name of Person Submitting Enrollment. 9. Enter the Printed Title of Person Submitting Enrollment. 10. Click Save ERA Info. The information is saved Pharmacy Info Tab This tab allows you to enter information about your pharmacy. For example, store hours, if you offer delivery service or are open 24 hours for emergency services. Certain fields on this tab are required Pharmacy Information To add your pharmacy information, please use the following steps: 1. Click Yes or No in the Open 24 hours? option. If you selected Yes in the Open 24 hours option, you do not need to complete the Open Every Day From, Open Every Day Until, Open Every Day Monday Friday From, Open Monday Friday Until, Open Saturday From, Open Saturday Until, Open Sunday From, or Page 40 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

41 Open Sunday Until fields. The Not Applicable check boxes automatically select next to each row of fields. 2. To enter times in the Open Every Day From, Open Every Day Until, Open Every Day Monday Friday From, Open Monday Friday Until, Open Saturday From, Open Saturday Until, Open Sunday From, and Open Sunday Until boxes, click inside the field. A pop-up box appears. See Figure Figure Pharmacy Information, Sliders to Select Hour and Minute PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 41

42 Slide the bar on the Hour and Minute option to select the time you open. The minutes will adjust in fifteen minute increments. You can select the times for the remaining fields by clicking inside the fields and sliding the Hour and Minute bars, or typing the time in the fields. When selecting the time using the sliders pop-up window, you can select the current time by clicking Now. When you are finished entering the time, click Done. The pop-up window closes. 3. Click Yes or No in the Offer Delivery Service? option. 4. Click Yes or No in the Offer Deliver Service to Dialysis Centers? option. 5. Click Yes or No in the Offer 24 Hour Emergency Service? option. 6. Click Yes or No in the Collect Calls Accepted? option. 7. Click Yes or No in the Price Matching Policy? option. 8. In the Do you participate in the following Medicare Part D Plan(s) section, click the applicable check box(s). 9. Click Yes or No in the Are you approved as a 340B provider? option. Medicare Part D may change yearly, so the plans listed may differ from those pictured. Click the Cancel hyperlink. The fields revert to the original values before the last save. If you selected the Practice type of Mail Order, you have three additional questions to answer. If you clicked Yes to Signature reference file, then that is the only question you see. If you clicked No, then you are required to answer Signature reference waiver. Mail order pharmacies utilizing a package tracking tool may find that none of these options apply. In those instances, checking NO for all three (3) questions will NOT cause the application to be rejected. If you clicked Yes to Signature reference waiver, then you must answer Signature reference waiver approval received. See Figure Page 42 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

43 Figure Pharmacy Info, Mail Order Questions 10. Click Save General Info. The information is saved Submit Tab This tab allows you to finish the application and submit it for review Declaration Depending on the programs you selected, you see the agreement forms for those programs. To view the forms and sign them, please use the following steps: 1. Click the View And Acknowledge hyperlink under the Action column. See Figure Figure Declaration, View And Acknowledge Hyperlink 2. Click the scroll bar on the Adobe window to scroll down to locate the acknowledgement fields. See Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 43

44 You need Adobe Reader to view any printable PDF document(s). Click the button to the left of the View/Acknowledge window to download a free copy of Adobe Reader. See Figure Figure View/Acknowledge Window, Agreement To close out of the agreement without signing it, click the Cancel Do Not Save hyperlink. If you click the X icon in the right-hand side of the window, you are taken out of the Web Provider Enrollment application without submitting and are required to log in again using your NPI number, the TIN/EIN, address, and the Application Tracking #. 3. In the Authorized Agent s First Name box, enter authorized agent s first name. 4. In the Authorized Agent s Last Name box, enter authorized agent s last name. 5. In the Authorized Agent s Title box, enter the authorized agent s title. The current date and time appears on the acknowledgement form. 6. Click Save Changes. Page 44 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

45 7. Repeat steps 3 6 on every agreement form. 8. Once you have acknowledged all agreements, the Submit Enrollment Application button appears along with fields to sign the preparer s name. See Figure Figure Submit Enrollment Application Button 9. In the Preparer s First Name box, enter the preparer s first name. 10. In the Preparer s Last Name box, enter the preparer s last name. 11. In the Preparer s Title box, enter the preparer s title. 12. Click Yes or No in the Training? option. 13. Click Submit Enrollment Application. The Confirm Submission window appears. See Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 45

46 Figure Confirm Submission Window If you do not wish to submit your application at this time, click the Cancel & do not Submit hyperlink. You are taken back to the previous window. 14. Click Submit to submit your application for review. The application successfully submitted message appears. See Figure Figure Successful Message If you have errors on the application or you did not complete a required field, you receive a message and are taken to the window/tab that the errors are on. See Figure An is sent to the address provided containing the application tracking number. You also receive an within 24 hours containing electronic copies of your enrollment application and agreement(s). See Figures and Please add the address PacePS@magellanhealth.com to your address book to ensure delivery of these messages. If you do Page 46 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

47 not add the address, please make sure you check your junk mail folders prior to calling Provider Services asking for the confirmation . After your application is reviewed and a determination is made, you receive notification via as well as US mail from Provider Services. Figure , provides an example of an error message that may be returned for incomplete information. Figure Enrollment Error message example PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 47

48 Figure confirmation with agreement attached Figure confirmation with enrollment attached 15. Click Return to Dashboard to return to the Provider Enrollment Dashboard window. Refer to Figure Click Close Window to return to the Commonwealth of Pennsylvania Web Portal Home window. Refer to Figure Page 48 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

49 3.2 Adding a new Program To add a new program to an existing pharmacy provider, please use the following steps: 1. From the Commonwealth of Pennsylvania Web Portal Home window, click the Launch hyperlink next to Provider Enrollment in the Services and Applications box. See Figure The Provider Enrollment Dashboard window appears. See Figure Figure Commonwealth of Pennsylvania Web Portal Home window PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 49

50 Figure Provider Enrollment Dashboard window 2. Click Add New Application. The Practice Type, Enrollment Type & Program(s) window appears. See Figure Enter the NPI. Figure Practice Type, Enrollment Type & Program(s) window Page 50 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

51 4. Click Continue. The Practice Type, Enrollment Type & Program(s) window appears. See Figure Figure Practice Type, Enrollment Type & Program(s) window 5. Enter the Part D Organization if selecting a Part D Program. 6. Select the Program(s) you wish to add to the pharmacy provider. 7. Enter the Medical Assistance Number if applying to be enrolled in either Special Pharmaceutical Benefits Programs: SPBP1 (ADAP) or SPBP2 (Mental Health). 8. Click Continue. The Demographics tab appears. See Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 51

52 9. Click the Submit tab. See Figure Figure Demographics tab Figure Submit tab Depending on the programs you selected, you see the agreement forms for those programs. To view the forms and sign them, please use the following steps: 10. Click the View And Acknowledge hyperlink under the Action column. See Figure Click the scroll bar on the Adobe window to scroll down to locate the acknowledgement fields. See Figure Page 52 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

53 You need Adobe Reader to view any printable PDF document(s). Click the button to the left of the View/Acknowledge window to download a free copy of Adobe Reader. See Figure Figure View/Acknowledge Window, Agreement To close out of the agreement without signing it, click the Cancel Do Not Save hyperlink. If you click the X icon in the right-hand side of the window, you are taken out of the Web Provider Enrollment application without submitting and are required to log in again using your NPI number, the TIN/EIN, address, and the Application Tracking #. 12. In the Authorized Agent s First Name box, enter authorized agent s first name. 13. In the Authorized Agent s Last Name box, enter authorized agent s last name. PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 53

54 14. In the Authorized Agent s Title box, enter the authorized agent s title. The current date and time appears on the acknowledgement form. 15. Click Save Changes. 16. Repeat steps on every agreement form. 17. Once you have acknowledged all agreements, the Submit Enrollment Application button appears along with fields to sign the preparer s name. See Figure Figure Submit Enrollment Application Button 18. In the Preparer s First Name box, enter the preparer s first name. 19. In the Preparer s Last Name box, enter the preparer s last name. 20. In the Preparer s Title box, enter the preparer s title. 21. Click Yes or No in the Training? option. 22. Click Submit Enrollment Application. The Confirm Submission window appears. See Figure Figure Confirm Submission Window Page 54 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

55 If you do not wish to submit your application at this time, click the Cancel & do not Submit hyperlink. You are taken back to the previous window. 23. Click Submit to submit your application for review. The application successfully submitted message appears. See Figure Figure Successful Message If you have errors on the application or you did not complete a required field, you receive a message and are taken to the window/tab that the errors are on. An is sent to the address provided containing the application tracking number. You also receive an within 24 hours containing electronic copies of your enrollment application and agreement(s). Please add the address PacePS@magellanhealth.com to your address book to ensure delivery of these messages. If you do not add the address, please make sure you check your junk mail folders prior to calling Provider Services asking for the confirmation . After your application is reviewed and a determination is made, you receive notification via as well as US mail from Provider Services. 24. Click Close (refer to Figure ) to return to the Provider Enrollment Dashboard window. Refer to Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 55

56 25. Click Close Window (refer to Figure 3.2.2) to return to the Commonwealth of Pennsylvania Web Portal Home window. Refer to Figure Page 56 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

57 4.0 Provider Information Management Corporate users can access Provider Information Management to view all providers registered under the corporate NPI. Corporations without a Corporate NPI will not be able to use this feature. The Corporate Provider Enrollment Management Dashboard displays the enrollment applications you have submitted. From this window, you can edit and resubmit provider information that has been returned for information from Provider Services; you can view applications that have been approved, to perform ongoing maintenance and add an enrollment. To access and utilize Provider Information Management, please use the following steps: 1. From the Commonwealth of Pennsylvania Web Portal Home window, click Launch next to Provider Information Mangement in the Services and Applications box. Refer to Figure The Corporate Provider Information Management Dashboard window appears. See Figure Figure Corporate Provider Information Management Dashboard window PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 57

58 2. All pharmacies attached to the corporate NPI will appear in the Applications section of the window. To search for a particular provider, enter the pharmacy NPI and click Search. The Dashboard will refresh and only list that provider. The pharmacy information can be viewed by clicking the Magnifying Glass icon in the Action column next to the record. Refer to Figure The Demographics tab appears. See Figure Edits can be made to any of the available tabs by clicking the Edit hyperlink and saving the new information. Any changes that need to be made to the Practice Type, Enrollment Type, Programs, or NPI require a new application to be submitted. This should be done via the Provider Enrollment application, not Provider Management. Refer to Section 3.0 Provider Enrollment for detailed instructions. Any changes made to contact information (adding new contacts, deleting existing contacts, or changing contact information) will require review and approval by Provider Services. To return to the Corporate Provider Information Management Dashboard, click the Back to Dashboard tab. To return to the Commonwealth of Pennsylvania Web Portal Home window, click the Portal Home hyperlink. Page 58 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

59 Figure Provider Information Management, Demographics Tab PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 59

60 5.0 Global PIM (Provider Information Management) Corporate users can access Global PIM to update multiple providers/sites with common information that applies to them as a whole. Corporations without a Corporate NPI will not be able to use this feature. To access and utilize the Global PIM application, please use the following steps: 1. From the Commonwealth of Pennsylvania Web Portal Home window, click Launch next to Global PIM in the Services and Applications box. Refer to Figure The Global Edit Dashboard window appears. See Figure Figure Global Edit Dashboard window Page 60 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

61 2. To make Global Edits, enter an address where correspondence about the edit can be sent. 3. Select at least two providers from the Select for Edit column or click the Select next 100 Approved Items box. If less than 100 sites, the chain s enrolled number appears. 4. Click Begin Global Edit. The Provider Enrollment, Demographics tab appears. See Figure Figure Provider Enrollment, Demographics Tab 5. You can edit the Provider Federal Tax Identification Number (TIN)/Employment Identification Number (EIN) or Add New Contact information on this tab. 6. If the TIN/EIN is updated, click Save General Info. The Confirm Save for All Selected NPIs window appears. See Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 61

62 Figure Confirm Save for All Selected NPIs window 7. Click Continue (Refer to Figure 5.0.3). The screen refreshes. See Figure Figure Demographics Tab, updated information 8. You can make additional changes on each tab, as needed. Figures capture examples of updates. Page 62 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

63 Figure Updating Business/Corporate Address example Figure Confirm Save For All Selected NPIs window PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 63

64 Figure Address update saved successfully Figure Licenses/IDs Tab Page 64 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

65 Figure Owners Tab All owners for the sites being updated will be displayed for edit and/or removal and/or addition. If changes are made to the Owners tab, they will apply to all sites. You must click Save Owners for the changes to finalize. 9. Once all desired changes are made on all applicable tabs, click the Submit tab. See Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 65

66 Figure Submit Tab 10. Enter the Preparer s First Name, Preparer s Last Name, and Preparer s Title. 11. Click Submit Enrollment Application. The Confirm Submission box appears. See Figure Figure Confirm Submission box 12. Click Submit. The Declaration window appears. See Figure Page 66 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

67 Figure Declaration Window 13. Click Close. You are returned to the Global Edit Dashboard. See Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 67

68 Figure Global Edit Dashboard window 14. Click the Portal Home hyperlink to return to the Commonwealth of Pennsylvania Web Portal Home window. Page 68 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

69 6.0 Change Practice Type Corporate users can access Change Practice Type to terminate the existing enrollment under the current practice type and re-enroll as a different practice type. Corporations without a Corporate NPI will not be able to use this feature. To access and utilize the Change Practice Type application, please use the following steps: 1. From the Commonwealth of Pennsylvania Web Portal Home window, click Launch next to Change Practice Type in the Services and Applications box. Refer to Figure The Provider Enrollment, Corporate NPI Warning window appears. See Figure Figure Provider Enrollment, Corporate NPI Warning window 2. Click Continue to change the Practice Type. The Practice Type Change Dashboard window appears. See Figure Click the Cancel hyperlink to return to the Web Portal Home window. Refer to Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 69

70 Figure Practice Type Change Dashboard window 3. Enter the NPI number of the provider who needs the Practice Type changed and click Search. The screen refreshes to only show that provider. See Figure Page 70 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

71 Figure Practice Type Change Dashboard window 4. Click the Magnifying Glass icon in the Action column to make the Practice Type change. The Practice Type, Enrollment Type & Program(s) window appears. See Figure Figure Practice Type, Enrollment Type & Program(s) window 5. In the Provider list, select a new practice type. The window refreshes. See Figure In the Enrollment Type list, select the enrollment type. The window refreshes. See Figure Select the Program(s) that are needed for the provider. See Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 71

72 8. Enter the Medical Assistance Number. This is not required in the enrollment example below. It is only required for enrollment in the SPBP1 (ADAP) and SPBP2 (Mental Health) programs. See Figure Figure Practice Type, Enrollment Type & Program(s) window 9. Click Continue. The Confirm Practice and Enrollment Type window appears. See Figure Page 72 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

73 Figure Confirm Practice and Enrollment Type window 10. Click Continue to proceed with the changes. The Provider Enrollment, Demographics Tab appears. See Figure PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 73

74 Figure Provider Enrollment, Demographics Tab 11. To make additional changes, refer to Section 3.0 Provider Enrollment for detailed instructions. Page 74 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

75 All information can be edited from this area. Once the edits are made, you will need to go to the Submit tab and View and Acknowledge each program as if it was a new enrollment. See Figure Refer to Section Submit Tab for detailed instructions. Figure Provider Enrollment, Submit Tab PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 75

76 7.0 Review 7.1 Review/Revisions If there are any changes needed after the enrollment application has been reviewed, you will receive an notification with a letter attached advising you that your application is returned for additional information. See Figure You are able to access the enrollment application to make the changes. Page 76 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide

77 Figure Sample incomplete/incorrect information letter 1. Log in to the Provider Enrollment application by following the steps in Section 2.1 Log In. 2. Refer to Section 3.0 Provider Enrollment for detailed instructions on making revisions to the enrollment application and re-submitting for approval. PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide Page 77

78 Once the changes are made, it is critical that you access the Submit tab and click Submit Enrollment Application to resubmit the application with the changes. The revised application is sent to PACE Provider Services where the application will be reviewed. See Figure Figure Submit Tab Once your application is approved, you will receive a letter of approval via and mail. See Figure Page 78 PACE/PACENET Web Provider Enrollment Provider Management Corporate User Guide