> 1 · August 2017 >> 9 • Objectives • Overview • Types of Provider Enrollment Applications...

>www.dpw.state.pa.us >www.dhs.pa.gov 1

>www.dpw.state.pa.us >www.dhs.state.pa.us

• Course Objectives

• Overview

• Provider Registration

• Provider Self Service

• Provider Qualification

• Add Service Offerings

Agenda

• 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

Course Objectives

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.

Overview

• 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.

Provider Registration

• The Provider Qualification Application process as it is known today, will no longer continue as part of the new PQ process.

Prior PQ Application Process

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

Provider Qualification Documentation Record

>www.dpw.state.pa.us >www.dhs.pa.gov 1August 2017

>www.dpw.state.pa.us >www.dhs.pa.govAugust 2017 9

• Objectives

• Overview

• Types of Provider Enrollment Applications

• Site Navigation Key Points

• Application Session Manager

• Provider User Interface Pages

• Documentation Requirements

• Online Application Emails

• Resources

Primary Topics

• 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

Course Objectives

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.

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.

Overview

• 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

Types of Enrollment Applications

>www.dpw.state.pa.us >www.dhs.pa.govOctober 2016 14

• The Electronic Provider Enrollment Application UI is accessed from a secure internet site: https://provider.enrollment.dpw.state.pa.us

• 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

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

Site Navigation Key Points

• 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

Application Session Manager

Common Page Elements

Welcome Page

Request Information Page

Service Location Address Page

Other Addresses Page

Specialties Page

Provider Eligibility Program Page

Provider Identification Page

Provider Disclosures Page

Ownership/Control Interest Page

Attachments Page

Agreements Page

Summary Page

Instructions to Submit Application

Application Submitted Notification

Resume Application Page

Application Status Page

Application Status Summary

Resetting a Password

Resetting a Password (cont.)

The electronic provider enrollment application will send email notification to the contact email the user enters at key points during the application submission and determination process. The emails will be generated from a ‘do not reply’ email address. The following are the types of emails generated:

• Online Application Initiated

• Online Application Submitted

• Online Application Returned to Provider for Revisions

• Online Application Initiated – Expiring

• Online Application Returned to Provider – Expiring

Email Notifications

Electronic Provider Enrollment Application• https://provider.enrollment.dpw.state.pa.us

Provider Enrollment Information• http://www.dhs.pa.gov/provider/healthcaremedicalassistance/enrollmentinformation/in

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• http://www.dhs.pa.gov/provider/providerenrollmentandscreeningrequirementsoftheaff

ordablecareact/index.htm• Includes the most current information from the Department relating to the ACA

federally mandated regulations

Medicaid Information • http://www.medicaid.gov/affordablecareact/affordable-care-act.html• Provides information about the ACA federally mandated regulations and how they

relate to the Medicaid program

Resources

Department of Human Services Website• http://www.dhs.pa.gov/

MAB 99-14-06 – Re-enrollment/Revalidation of Medical Assistance (MA) Providers• http://www.dhs.pa.gov/cs/groups/webcontent/documents/bulletin_admin/c_074003.pdf

Provider Enrollment Questions • http://www.dhs.pa.gov/learnaboutdhs/helpfultelephonenumbers/contactinformationhel

pformaproviders/index.htm#.Vp-jk01Ii70• Includes contact information and help for MA Providers

Resources (continued)

Provider Qualification Process

• 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 223456782 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.

Provider Qualification Status

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

Provider Search

Provider Search (Cont.)

If searching by Provider Name, several results may be returned.

Qualification Status DefinitionQualified The provider meets ODP’s qualification requirements.Not Requalified User would change the status from ‘Qualified’ or

‘Expiring’ to ‘Not Requalified’, if the provider no longer meets ODP’s qualification requirements.

Not Qualified 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.

Expiring HCSIS would automatically change the status from ‘Qualified’ to ‘Expiring on 05/01, if the provider has not been requalified.

Expired HCSIS would change the status from ‘Expiring’ to ‘Expired’ on 07/01, if the provider has not been requalified.

Provider Qualification Statuses

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.

Provider Qualification Status

Add Service Offerings

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

Provider Adds Service Offering

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

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.

Provider will select the services they are qualified for and then click on the [Select and Continue] button.

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.

The provider will select the County/Joinder(s) before selecting the [Create Service Offerings] button.

The provider can see the service(s) they have selected and are qualified for.

• Provider Qualification Mailbox -ra-odpproviderqualif@pa.gov

• Provider Enrollment Mailbox -RA-odpproviderenroll@pa.gov

Questions?

> 1 · August 2017 >> 9 • Objectives • Overview • Types of Provider Enrollment Applications...

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