Pennsylvania Department of Human Services (DHS) Electronic ... · Housekeeping . Housekeeping Rules...

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

Pennsylvania Department of Human

Services (DHS)

Electronic Provider Enrollment Application

User Interface (UI) Provider Training

October 2016 1


Housekeeping

Housekeeping Rules • Cordless phones can introduce static at times – if

possible use landlines

• Utilize the mute button/press *6 to mute and/or unmute

• The PowerPoint presentation is available in the

accessed by saving first, and then printing handouts section of the Virtual Room and can be

October 2016 2


Primary Topics

• Objectives

• Overview

• Types of Provider Enrollment Applications

• Site Navigation Key Points

• Application Session Manager

• Provider User Interface Pages

• Online Application Emails

• Resources

October 2016 3


Course Objectives

• Introduce providers to the new 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

October 2016 4


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.

October 2016 5


Overview

The DHS Electronic Provider Enrollment User Interface will:

• facilitate more effective and efficient measures for enrolling new providers as well as revalidation and reactivation

• allow providers to complete their Medical Assistance (MA) enrollment online

• perform systematic checks to determine the provider’s compliance with the ACA Provider Screening and Enrollment regulations.

October 2016 6


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

October 2016 7


Site Navigation Key Points

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

• Providers will need to create a password for each application

• Each online provider enrollment application is assigned a unique Application Tracking Number (ATN)

• Providers will be able to resume a previously started application or check status of a submitted application

October 2016 8

http:https://provider.enrollment.dpw.state.pa.us


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 will have the ability to upload supplemental documents required for enrollment based upon information collected during the application process

October 2016 9


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

October 2016 10

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A!lacnrnents

Agreements

Summary

Navigation Panel

Common Page Elements

October 2016 www.dhs.pa.gov 11

http:www.dhs.pa.gov


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•::e1eorne

Request 1n·ormauon

sel\llce LocatJon Aadre:;s

o:ncr Mdres~ Comment Bar / Status Bar

Speclallle$ "" ProVlder Ellgi!>l!ll) Program (PEPI

PrOVIOer lelent11ica1ion

Aadt00nal 111 !ofmallon

Ownership!Conuot ln1ere$l

A!lacnrnents

Agreements

Summary

Navigation Panel

Common Page Elements


http:www.dhs.pa.gov


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New Apphcallon

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Provider Eligibility Program Page


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Welcome

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Provkler 1oentrnc:auon

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Fee Determinauon

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Ownership/Control Interest Page


http:www.dhs.pa.gov


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Attachments Page


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.,m..c pennsylvani a \iii1:.V OEPAATMENT OF HUMAN SERVICES

Requ.e-sl 1n•onnat11e>n

Prov1'Cler Ea.g..,..i:y,,._ogr-am (PEP)

A.gne-cmenl s

~t-..lr.ac .. onoN ... t... .. CATHt 100000043-4 Tyio- ~E ........ rnerit SC.r1:0.1.9. 0&07'201S C OC111.-1_,Hy ~15

COMMONWEAL TH OF PENNSYLVANIA DEPARTIVIENT OF HUMAN SERVICES

O F FICE OF MEDICAL ASSI S T ANCE PROGRAMS

Provi der Agreement f or Outpa t i ent: Providers

Tnls Agreen'M!:nt.. ma.oe Dy ana t>etv.oeen tn.e °""'panrr-.nt or Human Servtces (nere1nan~r tne ""C>ol!!opartrnenr) ana

J o h n Smlt:h (heneina!'l:er lhe -PY-ovk1e..-) set.s forth the te..-ms and concJltlons gove.-nlng pa•·Uc.lpauon 1n the •-•ed4ca.I Asststance Program Tne panM:!'s to tn.es AQireemenL. tntenc:ung to Deparunent l'L ..... ~u a1sc110s.e rne tcSenUly or any person v.lho has an o-nerstup or control intere--st 1n the Pw-ovioder or 1s an agent°' managWlg ernplO)'ee of tne PrOVldet" tn.at nas been conv1Ctea or a C:f"1m1111a1 orren.s-e re~te

'ill' pennsylvania ., DEPARTMENT OF HUMAN SERVICES

~ pennsylvania \iliV DEPARTMENT OF HUMAN SERVICES

COntact 1nrormaoon Enrolllment nformauon

Wetcome Appllelbon Tf8Ckq Nwnbtr (ATN): 1000000208 Type: New Ent'OllmM:l Start Ontll: ~!101S Cc.pleuan By: 07.GCJ2015

Request inronnatJOO

Sefllice Loea:.on Address

Otller Alldresses

PrOVICler Eil!lol>dity Program (PEP)

PrOVider ldentrfK.ation

Addoonal

ln'onnatoon

Promer OisclOsures

OV.nershop , control

lnteresl

Anacnmems

Agreements

Application Comments ProllldeExtension

Emoil lois@lhedailypalneledufr

... Service Location

Street 123 Reailly Drive Room/Suite

City t.1ornlng Heights St:ate

Zlp+4 12346-5798 county

Em.;ul nomer@slmpson l>tZ

Phone Number (123) 465-7980 Extension

lndMdual With SSN

Cial1


'It pennsylvania '&'/ DEPARTMENT OF HUMAN SERVICES

Enronment 1nrormat10n Contacl lnlormation Help

Welcome

New AppllcatlOll

Reva Ilda hon

Reactrvatoo

Resume Applicatk>n

Application Status

Resume ApplJCaUon

Enter ~our applJCatlOn tracking number (A TN) Federal Tax ldentiricatJOn Number (FEIN or SSN) an


'lfit pennsylvania \llY DEPARTMENT OF HUMAN SERVICES Enror1ment lntormatJon Contact 1n101mation Help

WeJcome

New Application

Revalldatlon

Reacwatln

Resume Appllcaoon

Application Stalus

Appl\Cation Status

Enter your application tracking number (ATN) Federal Tax ldentl'"icaUon Number (FEIN or SSN) and password In order to review your appllcatlon status

If you have any questlons about completing an electron le enrollment application. please ca~ the appropriate phone number shown on the Important Phone Numbers and Ad


--~· pen nsylvani a \&'\I' DEPARTMENT OF HUMAN SERVICES E.nro11.nent lnformat.an Contact lnformauon Help New App&;cauon

Re~hc:latlOfl

React rvatlOn

Resume Applocahon

Appticabon status

Appl1Cabon status

Enter your application tracking number (ATN). FederaJ Tax ICfent.rtieaUOn Numt>ec (FEIN or- SSN) and paSS'w\.'Ord In

oroer to review your applteaitlon status

Ir you l\.ave any quest.ons abOut compJeting an ele


ApplicaUon status Summary

n1s is the most current lnformaticn regar


~ pennsylvania ~f DEPARTMENT OF HUMAN SERVICES

Enrollment Information Contact Information Help

Weleome

Nel'; Applicauon

Revahdation

ReactNatron

Resume Applacatton

App•1catJon Status

DESKTOP-T249039

Resume Apphcallon

Enter your applicatton 1rack1ng number (ATN) Federal Tax ldentncation Number (FEIN or SSN) and password in order 10 resume }our existing provider enrollment application

If you have any questions about completing an electronic enroftment applicat10n please can the appropriate phone number shown on the Important Phone Numoers and Addresses page or this site.

If lorgotten the password cannot be reset and your appllcaUon lntormatton ls no longer avallable. You wtU need to begin a ~ ~ appl1catton

Indicates a required field

· Application Tracking Number (ATN) II ii 1111# 'I

• SSN o r FEIN

P:issword fnror •rPl1ca~on password

Forgot Password?

'**''

Resetting a Password


http:www.dhs.pa.gov

Application Password Reset

To reset your password, you must provide the Application Tracking Number (ATN) that

identifies your application. In addition, you must also provide the Email Address, SSN

or FEIN and Provider Type provided when the application was first submitted.

Furthermore, you will need to provide and confirm a new password for your

application. Upon submission of the correct information. you will receive an email to

the email address on f ile for this application with a password reset code. After

receiving this code, you will need to enter it below. When submitting your reset code,

you must also provide the ATN, Email, SSN or FEIN, and Provider Type submitted on

the original application.

• Application Tracking Number (A TN) liii1ill1ililiiili#

Contact Email [email protected]

• SSN or FEIN A 1111"11 ii J#:T

• Provider Type Select a Provider Type v

Do you have a password reset code? 0 Yes 0 No



To res.et ~our pcmWO«I ~CIU mu:;,t pro~ lhe Appl11Cn Tr.lt:klng Number (ATN> lttal ioeni.ries )'OW appecallOn In acJcJlliOn. you mt1S1 aiso prO\llOe me Ema11 AOdress. SSN Of FEIN and PI0\10ef T~pe prowoeci wne111.11e applleallOn was ~t SUDtMled Fu~mort! you v.111 nttd to ~t! and OOl'l!llrn a rrt'N pa~'M)rd kW you1 appllCa!JOn Upon SUbmlSSion Of l/11! Com!d lll'ormabCfl. ~OU Wiii R!C"ewe an emad 10 ane emau aooress on Ille IOI OllS appllea:Jon v.1111 a passwora reset cooe Al\ef 1~1119 lnts toOe, you IMO neeO to enter II belDW When $Ubmlt11ng yOUJ resel c:oae. )'OV mu~ a!$0 PfO\'~ttieATN, effi

• Applleatlon Tr3ek1ng, Numb..-(A TN) 1000000129

ConL>ct Em;in l'~COOI

• SSN or FEIN 22~8T7

• Provldu Ty~ is· Omei1o180QI ~ v

oo you nave 11 password rntl coclt? Cl y" !!: No

I · New P:inw0



To reset your password, you must provide the Application Tracking Number (ATN} that identifies your application_ In addition, you must also provide the Email Address, SSN or FEIN and Provider Type provided when the application was first submitted. Furthermore, you will need to provide and confirm a new password for your application_ Upon submission of the correct information. you will receive an email to the email address on file for this application with a password reset code. After receiving this code, you will need to enter it below. When submitting your reset code, you must also provide the ATN, Email, SSN or FEIN, and Provider Type submitted on the orlginal application_

· Application Tracking Number (A TN) 1000001316

Contact Email [email protected]

' SSN or FEIN 884512231

• Provider Type 25 - Dme/Medteal Supplies v

Your password reset request was successfully submitted_ Please check your e-mail for your password reset code and enter it below.

Do you have a password reset code? B Yes 0 No

I Password Reset Code Complete Password Reset

Resetting a Password (cont.)


http:www.dhs.pa.gov


Email Notifications

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

October 2016 37


Resources

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 October 2016 38

https://provider.enrollmentmo.dpw.state.pa.us/http://www.dhs.pa.gov/provider/healthcaremedicalassistance/enrollmentinformation/index.htmhttp://www.dhs.pa.gov/provider/providerenrollmentandscreeningrequirementsoftheaffordablecareact/index.htmhttp://www.medicaid.gov/affordablecareact/affordable-care-act.html


Resources (continued)

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

October 2016 39

http://www.dhs.pa.gov/http://www.dhs.pa.gov/cs/groups/webcontent/documents/bulletin_admin/c_074003.pdfhttp://www.dhs.pa.gov/learnaboutdhs/helpfultelephonenumbers/contactinformationhelpformaproviders/index.htm#.Vp-jk01Ii70

Slide Number 1HousekeepingPrimary Topics�Course ObjectivesOverviewOverview�Types of Enrollment ApplicationsSite Navigation Key PointsSite Navigation Key PointsApplication Session ManagerCommon Page ElementsCommon Page ElementsWelcome PageRequest Information PageService Location Address PageOther Addresses PageSpecialties PageProvider Eligibility Program PageProvider Identification PageProvider Identification PageAdditional Information PageFee Determination PageFee Determination – Copy ApplicationProvider Disclosures PageProvider Disclosures PageOwnership/Control Interest PageAttachments PageAgreements PageSummary PageResume Application PageApplication Status PageApplication Status SummaryApplication Status SummaryResetting a Password Resetting a Password (cont.)Resetting a Password (cont.)Email NotificationsResourcesResources (continued)

Pennsylvania Department of Human Services (DHS) Electronic ... · Housekeeping . Housekeeping Rules...

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