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 as a PCA/HHA Aide in DC Medicaid using the DC Provider Screening and Enrollment Web Portal Version 1.4 September 19, P a g e

2 Revisions Version Date Description Author /14/2017 Review and Update Web Portal User Guide or PCA Aide users. Establish Version 1.0 for PCA Aides /29/2017 Revised and updated with requested changes /30/2018 Revised and updated to add clarification on the Alien ID Number, zip code +4 extension, and advising to enter 100 on ownership line /9/2018 Revised and updated to add additional steps for providers with a previous PCA provider number already in the PDMS system. Updated format 1.4 9/19/2018 Updated format, screenshots and table of contents. Catherine Bradica Natasha Hudson Venita Stratford Eugene Eaton Eugene Eaton 2 P a g e

3 Table of Contents Overview... 4 Creating a User Account... 4 Creating a User Account Cont Creating a User Account Cont Provider Management Home...7 New Registration Box... 8 Provider Information... 9 Primary Contact Information Specialties Taxonomies...11 Professional Licenses Categories of Service...13 Primary Service Address...14 Billing Address...15 Correspondence Address...16 Remittance Address...17 Other Address...18 Group and Facility Affiliation Screen...19 Upload required documents...20 Agreements Submission Confirmation Screen P a g e

4 Overview The PDMS Web Portal user guide provides step by step instructions on how to submit an electronic application to be a Medicaid provider in the District of Columbia. 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. 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 Enter your Social Security Number (Individual) Select the SSN Tax ID Type 4 P a g e

5 Creating a User Account Cont. NOTE: For providers with a previous PCA provider number already in the PDMS system, the PCA should do the following: Contact the call center at and a Customer Service Representative will assist you with moving forward in the process. Enter your NPI Click Next 5 P a g e

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. Click the Return to Home Page 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 6 P a g e

7 Provider Management Home Select the PCA Aide application. Once you have selected your application, click Begin New Enrollment 7 P a g e

8 New Registration Box For each required field select and enter the appropriate information Application Type: select PCA Aide Category: Individual/Solo, Provider Type Personal Care Assistance (PCA) Aide Taxonomy Nursing Service Related Name of Business Entity Enter the Aide s name Tax ID Type - SSN Tax ID (Prefilled) NPI (Required) Requested Effective Date (The date in the field will be auto populated with today s date.) Gender Date of Birth Zip Code (If 4-digit extension is unknown, use The system will validate the address and populate the correct 4-digit extension) After completing all fields, click Save. 8 P a g e

9 Provider Information For each required field select and enter the appropriate information Name of PCA Aide DBA N/A Citizenship Status If you have a qualified alien under the Federal Immigration and Nationality Act Select applicable Immigration Status Provide your Alien Number (If Alien number begins with A, you must enter the A ) Enter the number and issue date of the USMLE/ECFMG number First Name Middle Initial Last Name Tax ID NPI NPI Start Date Gender Date of Birth Provider Type Enrollment Status Click Save and then click Next 9 P a g e

10 Primary Contact Information Complete all required fields in the Primary Contact Information section as follows: This information is about the PCA Aide Name of the aide Title Not applicable Address City State Quadrant and Ward (if applicable) County (if applicable) Zip (If 4-digit extension is unknown, use The system will validate the address and populate the correct 4-digit extension) Phone Number Address Click Save and then click Next 10 P a g e

11 Specialties If you have a specialty, click on the symbol to add specialty Click Save and then click Next Taxonomies Click on the symbol to add Taxonomy information Click Save and then click Next 11 P a g e

12 Professional Licenses Click on the symbol to add all professional Licenses Complete all required fields in the Professional Licenses section as follows: Enter the PCA/HHA license number issued by the Department of Health Type State Effective Date Expiration Date License Board Name Upload copy of license (If the license state is NOT DC) 1. Click Browse to locate the files on your desktop 2. Name the file 3. Click Upload file Click Save, then Next 12 P a g e

13 Categories of Service 13 P a g e

14 Primary Service Address Complete all required fields as follows: Provider Name Enter the name of the Home Health Agency Primary Service Address Enter the address of the Home Health Agency City State Quadrant and Ward (if applicable) County (if applicable) Zip (If 4-digit extension is unknown, use The system will validate the address and populate the correct 4-digit extension) Address Phone Number Contact Phone Number address Click Save and then click Next 14 P a g e

15 Billing Address If you choose to complete the Billing Address section, complete all required fields as follows: Provider Name Primary Service Address City State Quadrant and Ward (if applicable) County (if applicable) Zip (If 4-digit extension is unknown, use The system will validate the address and populate the correct 4-digit extension) Address Phone Number Contact Phone Number address Click Save and then click Next 15 P a g e

16 Correspondence Address If you choose to complete the Correspondence Address section, complete all required fields as follows: Provider Name Primary Service Address City State Quadrant and Ward (if applicable) County (if applicable) Zip (If 4-digit extension is unknown, use The system will validate the address and populate the correct 4-digit extension) Address Phone Number Contact Phone Number address Click Save and then click Next 16 P a g e

17 Remittance Address If you choose to complete the Remittance Address section, complete all required fields as follows: Provider Name Primary Service Address City State Quadrant and Ward (if applicable) County (if applicable) Zip (If 4-digit extension is unknown, use The system will validate the address and populate the correct 4-digit extension) Address Phone Number Contact Phone Number address Click Save and then click Next 17 P a g e

18 Other Address If you choose to complete the Other Address section, complete all required fields as follows: Provider Name Primary Service Address City State Quadrant and Ward (if applicable) County (if applicable) Zip (If 4-digit extension is unknown, use The system will validate the address and populate the correct 4-digit extension) Address Phone Number Contact Phone Number address Click Save and then click Next 18 P a g e

19 Group and Facility Affiliation Screen PCA Aides are required to contact the Home Health Agency (HHA) to inform them once they have enrolled through the PDMS system so that the Home Health Agency can affiliate the PCA Aide to their respective Home Health Agency. It is the PCA Aide s responsibility to inform the Home Health Agency that employs them that they have completed their enrollment. 19 P a g e

20 Upload required documents Please Note: If other documents are needed for your application. You will upload them to this page. Make sure that the document name and description matches what is being uploaded. To upload document 1. Click Browse to locate the files on your desktop 2. Name the file 3. Enter a description 4. Click Upload file Click Save, then Next 20 P a g e

21 Agreements Complete all required fields as follows: Signature Please enter the characters in the image above Enter your Password Click Save 21 P a g e

22 Agreements- Cont. The following message will populate on the screen: Click OK Click Submit for Review Submission Confirmation Screen The Submission Confirmation screen lets you know that you have successfully submitted your application. Click on Return to Home Page Click on Log Out 22 P a g e