District of Columbia Department of Health Care Finance. Provider Data Management System and Service (PDMS) Project

Transcription

1 District of Columbia Department of Health Care Finance Provider Data Management System and Service (PDMS) Project How to Enroll in DC Medicaid Using the DC Provider Screening and Enrollment Web Portal Version 1.8 May 8, 2018 Page 1

2 Revisions Version Date Description Author /19/2016 Create document from template. Margalit De Gosztonyi /02/2016 New Template Benni DeMarco /06/2016 Updated template for general use Margalit De Gosztonyi /12/2016 Updated Information to reflect DC PDMS project Margalit De Gosztonyi /06/2016 Editing and formatting Margalit De Gosztonyi /12/2016 Review and Edit Awilda Ortiz /13/2016 Final Formatting Margalit De Gosztonyi 0.8 6/02/2016 Review and Final Edit Awilda Ortiz 0.9 9/04/2016 Updated with screen shots Kelly Micka 1.0 6/08/2017 Updated with New System Changes Natasha Hudson 1.1 6/08/2017 Review and Edit Awilda Ortiz 1.2 6/09/2017 Updated with new screen shots for Provider update functionality changes Natasha Hudson 1.3 6/09/2017 Review and Edit Awilda Ortiz 1.3 6/10/2017 Review and Edit Patricia Squires 1.4 6/12/2017 Edit and Update Natasha Hudson 1.4 6/15/2017 Review Dawn Gelle 1.4 6/15/2017 Review Awilda Ortiz 1.5 6/20/2017 Edit and Update Natasha Hudson 1.5 6/23/2017 Review and Update Awilda Ortiz 1.6 1/26/2018 Edit and Update Natasha Hudson 1.6 1/26/2018 Review and Update Venita Stratford 1.7 3/22/2018 Updated with new screen shots for Waiver Services and the Application Fee page to reflect the current amount 1.8 5/8/2018 Updated the Professional License section to include directions & screen shots for Medical Residents documents uploads. Eugene Eaton Eugene Eaton Page 2

3 Table of Contents Overview...4 Creating a User Account in the DC PDMS Provider Web Portal 4-64 Provider Management Home Page New Application..7 Application and Provider Types Identification- Provider Information Screen Identification - Primary Contact Information 13 Licenses and Classifications Screen Primary Service Address Practice Locations / Office Hours Individual Providers Associated with Your Group Affiliation Screen Disclosure of Ownership Control Interest statement Disclosure of Ownership and Control Interest Questions W9 Form..26 Agreements- Malpractice Claims History...27 Upload Required Documents Agreements Questions..28 Agreements..29 Signature section.30 Submission Confirmation Screen..31 Waiver Services...32 Application Fee. 33 Page 3

4 Overview The PDMS Web Portal user guide provides step by step instructions on how to submit an electronic application. The PDMS dashboard displays data for each stage of the enrollment process and allows providers to start a new application or take action on previously submitted applications and re-enrollments. From their dashboard, Provider Enrollment Specialists can view the current status of new provider applications as well as initial/ongoing re-enrollments. Their dashboard tracks the aging of each provider application based on the workflow step/status of the application. Creating a User Account The first step to submitting an online application is to create User Account in the DC Provider Data Management System (PDMS) Web Portal. Click on Create Account Enter your Tax ID Either your Social Security Number (Individual) or EIN (Organization) Select the correct Tax ID Type Enter your NPI Click Next Page 4

5 Creating a User Account Cont. Enter all required information see example below Click Register Page 5

6 Creating a User Account Cont. After successfully creating the account, a notification will appear and a confirmation will be sent to the address provided. The contains a link to the Web Portal to log in to your account using the User Name and Password you created. Enter the User ID and Password you created Click Log In Page 6

7 Provider Management Home Page To ensure you are selecting the correct application please review the summary next to each application, this summary will include any special instructions for that application. Once you have selected your application, click Begin New Enrollment Page 7

8 Application and Provider Types Enter information in all required fields. For each required field select and enter the appropriate information Category: Individual/Solo, Group, Facility/Institution, Pharmacy Provider Type Specialty Taxonomy Name of Business Entity (Or First and Last Name if Individual/Solo) Tax ID Type (EIN or SSN) Tax ID NPI (If applicable) Requested Effective Date [The date in the field will be auto populated with today s date. If you are requesting a retro effective date enter the date manually. Zip Code Zip Code Extension [To look up your 4 digit Zip Code Extension click here USPS ZIP CODE LOOK UP Page 8

9 Application and Provider Types (cont.) Facility Group/Institution Page 9

10 Pharmacy Page 10

11 After completing all fields, click Save. Page 11

12 Identification- Provider Information Screen If your provider type is required to submit additional documentation, such as an Out of State Rate Letter, you will need to upload the documents on the appropriate pages following the steps below. 1. Click Browse to locate the files on your desktop 2. Name the file 3. Click Upload file Complete the Citizenship Status. If you are a qualified alien under the Federal immigration and Nationality Act Select applicable Immigration Status Provide your Alien Number Page 12

13 Provider Information Screen- Continued Enter the number and issue date of the USMLE/ECFMG number Note: After clicking save you must upload a copy of your USCIS (Immigration) form using the Upload feature at the bottom of this page Identification - Primary Contact Information Complete all required fields in the Primary Contact Information section Click Save Licenses & Classifications - Professional Licenses Click on the symbol then the browse button to add license After you click the green symbol the below screen will populate. Fill out each section of the page via the available fields & drop down menus. In the Upload Documents section click browse, select your file, upload, save and next. Page 13

14 *Note if you are a Medical Resident uploading your license, second screen capture below is what you should be uploading in the Upload Document section. In the Type and License Board Name fields, select other as shown below. Licenses and Classifications- Specialties Page 14

15 Click on the symbol to add specialty Click Save and then click Next Licenses and Classifications- Taxonomies Click on the symbol to add any additional Taxonomy Click Save and then click Next Licenses and Classifications- Professional Liability Insurance Complete all required fields in the Professional Liability section Upload proof of liability Insurance 1. Click Browse to locate the files on your desktop 2. Name the file 3. Click Upload file Page 15

16 Click Save, then Next Licenses and Classifications- Professional Licenses Click on the symbol to add all professional Licenses Click Save and then click Next Licenses and Classifications- CPR Certifications Click on the symbol to add CPR Certifications Click Save and then click Next Page 16

17 Licenses and Classifications- State CDS Number Complete each field Click Save and then click Next Licenses and Classifications- Categories of Service Page 17

18 Licenses and Classifications- Medicare Number Click on the symbol to add other state Medicare enrollments. Click Save and then click Next Page 18

19 Practice Locations- Primary Service Address Primary Services Address is required, Billing/Payment Contact Information, Correspondence Information and Remittance Address are not a required section. An optional Other Address is also available. Enter information in the required fields If the information is the same as the Practice Location (physical address), put a check mark in the box and the information will populate. To locate the 4 digit Ext. Zip Code click USPS ZIP CODE LOOK UP Select the page name under the provider file to add other addresses to the application. Page 19

20 Practice Locations- Office Hours Page 20

21 Group and Facility Affiliation Screen 1. Click the to add your group member information 2. Group Affiliation Add Group Name Add Medicaid ID of the group Include NPI number if applicable Enter Tax ID of the group Page 21

22 3. Health Care Affiliation Indicate whether this is your primary facility Enter the facility name Enter the Staff Category Enter the Status of Privileges Enter the start date and end date if available Indicate whether there is or has been a restriction of privileges and, if so, specify in the text box. Click Save Then Click Next Page 22

23 Disclosure of Ownership and Control Interest statement Click the white + symbol next to Instructions to expand the section Click the white + symbol next to Definitions to expand the section Click the white + symbol next to Owner Information to expand the section Click the to add the Owner information Page 23

24 The steps below will guide you through completing each section. Disclosure of Ownership and Control Interest -Add Owner Information 1. Click Save Page 24

25 Disclosure of Ownership and Control Interest - Questions Click on the + to expand the section and answer the Yes/No Questions If you answer yes to any of these questions, another box will appear requesting additional information. Page 25

26 W9 Form Upload a completed w-9 form Click Next Page 26

27 Agreements- Malpractice Claims History Click No or Yes Upload Required Documents If other documents are needed for your application. You will upload them to this page. Page 27

28 Agreement Questions Questions section Click No or Yes for each question Page 28

29 Agreement Click on each web link. [A separate tab will show on your web browser containing the applicable agreement.] View agreement Place a checkmark in the I agree or I attest box. [Note: The check box is only accessible after clicking on the web link.] Page 29

30 Signature section: Enter characters in image Enter the password you used to log into the web portal Click Save Application complete pop up will appear Click OK Scroll back to the top of the page Click Submit for Review Page 30

31 Submission Confirmation Screen The Submission Confirmation screen lets you know that you have successfully submitted your application to DC Medicaid. Click on Return to Home Page or Log Out **Remember** - A provider is not enrolled in DC Medicaid until they receive a Welcome to DC Medicaid letter. How to Track the STATUS of Your Enrollment 1. Log into your account by going to 2. On your Provider Management Home page you can view the Status of your application in the My Providers Section. 3. If you have any question or concerns, please contact MAXIMUS Provider Customer Service at (Monday-Friday 8:00am-5:00pm EST) Page 31

32 Waiver Services For waiver providers, the provider will indicate what services they are applying for by checking the box under the Provider Request column. Page 32

33 Application Fee Certain institutional providers are required to pay an Application fee made out to DC Treasury Select method of payment, or request a waiver of the fee due to Hardship, or having already paid the fee to Medicare or another state. Page 33