Post on 04-Mar-2018
>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
>www.dpw.state.pa.us >www.dhs.pa.gov
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
>www.dpw.state.pa.us >www.dhs.pa.gov
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
>www.dpw.state.pa.us >www.dhs.pa.gov
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
>www.dpw.state.pa.us >www.dhs.pa.gov
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
>www.dpw.state.pa.us >www.dhs.pa.gov
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 providers compliance with the ACA Provider Screening and Enrollment regulations.
October 2016 6
>www.dpw.state.pa.us >www.dhs.pa.gov
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
>www.dpw.state.pa.us >www.dhs.pa.gov
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
>www.dpw.state.pa.us >www.dhs.pa.gov
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
>www.dpw.state.pa.us >www.dhs.pa.gov
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 users session will be ended and the user will need to resume their application at a later time
October 2016 10
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Ownership!Conuot ln1ere$l
A!lacnrnents
Agreements
Summary
Navigation Panel
Common Page Elements
October 2016 www.dhs.pa.gov 11
http:www.dhs.pa.gov
'tit' pennsylvania ., DEPARTMENT OF HUMAN SERVICES
Menu Sar ~ Enralment 1n1ormauon Co11tact ln!onnatJon Hetp -~ pennsylvania '&'Y DEPARTMENT Of HUMAN SERVICES
::e1eorne
Request 1normauon
sel\llce LocatJon Aadre:;s
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Speclallle$ "" ProVlder Ellgi!>l!ll) Program (PEPI
PrOVIOer lelent11ica1ion
Aadt00nal 111 !ofmallon
Ownership!Conuot ln1ere$l
A!lacnrnents
Agreements
Summary
Navigation Panel
Common Page Elements
October 2016 www.dhs.pa.gov 12
http:www.dhs.pa.gov
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October 2016 www.dhs.pa.gov 17
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October 2016 www.dhs.pa.gov 18
http:www.dhs.pa.gov
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October 2016 www.dhs.pa.gov 20
http:www.dhs.pa.gov
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Ownership/Control Interest Page
October 2016 www.dhs.pa.gov 26
http:www.dhs.pa.gov
'tit' pennsylvania ., DEPARTMENT OF HUMAN SERVICES
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Rjulr9!1 Alb.Jhnnnt~ (4 Tolllll
Copy Of KPP,Ell connnneboo
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Attachments Page
October 2016 www.dhs.pa.gov 27
http:www.dhs.pa.gov
';fir pennsylvania ., DEPARTMENT OF HUMAN SERVICES
.,m..c pennsylvani a \iii1:.V OEPAATMENT OF HUMAN SERVICES
Requ.e-sl 1nonnat11e>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 paUc.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
'tit' pennsylvania ., DEPARTMENT OF HUMAN SERVICES
'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
'tit' pennsylvania ., DEPARTMENT OF HUMAN SERVICES
'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
'tit' pennsylvania ., DEPARTMENT OF HUMAN SERVICES
--~ 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
'tit' pennsylvania ., DEPARTMENT OF HUMAN SERVICES
ApplicaUon status Summary
n1s is the most current lnformaticn regar
'tit' pennsylvania ., DEPARTMENT OF HUMAN SERVICES
~ pennsylvania ~f DEPARTMENT OF HUMAN SERVICES
Enrollment Information Contact Information Help
Weleome
Nel'; Applicauon
Revahdation
ReactNatron
Resume Applacatton
App1catJon 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
October 2016 www.dhs.pa.gov 34
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 myemail@doma1n.com
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
'tit' pennsylvania ., DEPARTMENT OF HUMAN SERVICES
Application Password Reset
To res.et ~our pcmWOI ~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
'tit' pennsylvania ., DEPARTMENT OF HUMAN SERVICES
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 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 elass@hpe.com
' 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.)
October 2016 www.dhs.pa.gov 36
http:www.dhs.pa.gov
>www.dpw.state.pa.us >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
>www.dpw.state.pa.us >www.dhs.pa.gov
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
Departments 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
>www.dpw.state.pa.us >www.dhs.pa.gov
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 TopicsCourse ObjectivesOverviewOverviewTypes 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)