Provider Registration Job Aid. Contents

Transcription

1 Provider Registration Job Aid Contents Purpose... 2 Job Aid Organization... 3 Key Terms and Concepts... 4 Roles and Responsibilities... 7 High-Level Overview... 8 Your Tasks... 9 Create Provider Information Enter Contact Information Enter Address Information Create a Services and Supports Directory Entry Complete the Organization Information (for Agencies only) Create Provider Site(s) Appendix A: Provider Documentation for HCSIS Help Desk Clearance/Verification Appendix B: ODP Additional Key Terms and Concepts Appendix C: ODP High Level Process Flow Appendix D: Internal Revenue Service and US Postal Service Requirements for Business Names and Business Addresses Version 4.0 Page 1

2 Purpose This job aid is intended for the Office of Developmental Programs (ODP) and the Office of Mental Health and Substance Abuse Service (OMHSAS) providers to use as an on-the-job reference for entering provider information into the Provider Access website so it can be cleared into the Home and Community Services Information System (HCSIS). HCSIS is a web-enabled information system built to serve as the information system for all Department of Public Welfare (DPW) program offices that support the Home and Community-Based Service waivers. The Provider Registration Job Aid provides step-by-step instructions to enter a provider s information into HCSIS for the first time. ODP and OMHSAS providers are able to sign up in HCSIS via the Provider Access website on the HCSIS Home Page. In addition, the ODP County Provider Administration role can perform the Provider Registration process in HCSIS on behalf of an MR service provider. The screens the provider uses in the Provider Access website are very similar, and in some cases, identical to the screens the ODP County Provider Administration role can use in HCSIS. Providers offering services to the Home and Community-Based waivers and programs for the Office of Medical Assistance Programs (OMAP) and Office of Long Term Living (OLTL) do not enter or update their information in HCSIS. The central offices of OMAP and OLTL maintain provider information directly. Therefore, all references to provider activities in this job aid apply only to ODP and OMHSAS. Note for Provider Updates: This Provider Registration process differs from the process of updating existing provider information, which is covered in detail in the Provider Updates Tip Sheet. Notes for ODP Providers: For a provider s claim to be processed successfully through PROMISe, the provider s information must be set up in HCSIS correctly. The Service Location used to bill must match the HCSIS Site used to set up the provider s service that is approved and authorized on an individual s plan. This job aid describes how to set up site information for providers with no information in HCSIS. For instructions to view plans with the provider's authorized services on them and to run a report to view all of the provider's services in HCSIS, refer to the HCSIS Job Aid for Providers located on the Learning Management System (LMS) website. Financial Management Services (FMS): If a provider is also a vendor fiscal/employer agent (VF/EA) or Agency with Choice (AWC) FMS for a county, the provider has to be signed up in HCSIS, have the information cleared by the HCSIS Help Desk, and marked as an FMS (AWC or VF/EA) in HCSIS. This activity is performed by the County Provider Administration role. Version 4.0 Page 2

3 Job Aid Organization This job aid is organized with the following subsections: Key Terms and Concepts: The Key Terms and Concepts section includes terms and definitions used within the job aid. Roles and Responsibilities: The Roles and Responsibilities section includes the associated HCSIS roles and responsibilities defined in this job aid. Provider Registration Process Flow: This process flow is a high-level overview of how provider information is registered in HCSIS. Your Tasks: The Your Tasks section outlines the steps necessary to complete this job aid. In addition, this section identifies the HCSIS screens used to complete the tasks. Task: The Task sections illustrate how to complete each task within the job aid. Appendix: The Appendix includes the list of documentation to send to the HCSIS Help Desk, additional Key Terms and Concepts for ODP, and the High Level Process Flow for ODP. Version 4.0 Page 3

4 Key Terms and Concepts (OMHSAS and ODP) Note: This section is for OMHSAS and ODP providers. Additional Key Terms and Concepts for ODP can be found in Appendix B. Financial Management Services (FMS) ODP Only A Financial Management Services (FMS) organization provides billing and administrative services for a support service worker. Vendor Fiscal/Employer Agent (VF/EA) Financial Management Services (FMS) organizations provide fiscal support to individuals/representatives enrolled in participant-directed support service programs. In an effort to provide consistent access to VF/EA services throughout the Commonwealth, ODP will implement the VF/EA FMS model by contracting with a qualified entity. Services for a support service worker should not appear on an individual s plan without an FMS. There is one FMS organization contracted with the State to provide financial services to individuals funded by the Consolidated or Person/Family Directed Services (P/FDS) waiver. An FMS employer agent (EA) may contract at the county level for individuals funded by Base only. Geo-Coding System Geo-coding is used by HCSIS to validate an address by using Geographical Information System (GIS) Software. Address information will be more accurate and standard because of the use of software to standardize address information and populate 9-digit zip codes. Master Provider Index (MPI) MPI is the central repository of information for every provider that provides services for DPW. The MPI system assigns a unique number (MPI number) to every provider in the system. MPI also stores Service Locations for all providers. After being cleared by the HCSIS Help Desk, new Sites created in HCSIS are saved as new Service Location(s) in MPI. Refer to the Service Location vs. Site definition for additional information. National Provider Identifier (NPI) NPI is a federally issued 10-digit number for health care providers that can be used nationally. The NPI is assigned to you by the Center for Medicare and Medicaid Services and will replace all legacy provider numbers that are currently used including: UPIN (Unique Physician/Practitioner Number); Medicaid Provider Number; Medicare Provider Number; Blue Cross and Blue Shield Numbers. Provider Access has developed a crosswalk that connects the provider s current MPI ID number and Service Location ID (13-digit PROMISe Provider ID) to the provider s NPI number to support claims processing. For more information visit the Department of Public Welfare s website at n/index.htm. Version 4.0 Page 4

5 Key Terms and Concepts, continued: Provider Clearance Provider Clearance is the process of creating a provider's information in HCSIS and MPI. The HCSIS Help Desk is the gatekeeper for HCSIS and MPI. Provider Clearance is necessary to prevent incorrect or duplicate provider information in HCSIS and MPI. HCSIS and MPI share the provider s service location information. If a provider s information is being entered into HCSIS for the first time, the HCSIS Help Desk needs to clear the new provider information into HCSIS. After clearance, the new provider s information will have the verified status in HCSIS and the new provider s information will be created automatically in MPI overnight. The HCSIS Help Desk requires the provider to send documentation to validate the new provider's information. The provider must also submit the HCSIS User Security Agreement form (found on the HCSIS Homepage) in order to obtain a HCSIS user ID and password. Upon clearance into HCSIS, the HCSIS Help Desk will send the provider s contact person a permanent user ID and password. If the HCSIS Help Desk denies clearance to the provider, the provider's information entered during Provider Registration is deleted from HCSIS. If the provider s record is new to HCSIS but has information in MPI, the user will be prompted to call the HCSIS Help Desk so the provider s information in MPI can be linked into HCSIS. This is necessary to prevent duplicate provider information in MPI. Refer to Appendix A in this job aid for details about the provider documentation the HCSIS Help Desk requires to validate a new provider's information. Provider Type A Provider Type is the classification of a provider. A provider type represents a subset of related services. For example: the Therapist provider type can provide occupational therapy, physical therapy, and speech and language therapy. Only provider types related to Home and Community- Based Services for ODP, OMAP, OMHSAS, and OLTL appear in HCSIS. The combination of provider type and specialty selected for a Site in HCSIS determines which services appear for the provider to select for that Site. A Site in HCSIS can have one or more provider types and specialty combinations associated with it. However, a Service Location can have only one provider type associated with it. Refer to the Service Location vs. Site definition in Appendix B for additional information. Provider Verification Provider Verification is the process of updating a provider's information in HCSIS and MPI. Provider Verification is necessary to prevent incorrect or duplicate provider information in HCSIS and MPI. HCSIS and MPI share the provider s service location information. A service location is the combination of one provider address and one provider type and specialty code(s). Therefore, only new or changed provider addresses and provider types have to be verified in HCSIS. After this occurs, the information is added to MPI automatically. The following activities require verification: new or updated provider site addresses, new provider types added to a site, and changes to a provider s business address, mailing address or payment address. Version 4.0 Page 5

6 Key Terms and Concepts, continued: The HCSIS Help Desk requires the provider to send documentation to validate the information. The HCSIS Help Desk verifies the updates that impact MPI service locations. Updated provider information will change to the Verification Pending status if the change needs to be verified by the HCSIS Help Desk. After verification, the provider s updated information will have a Verified status in HCSIS. If the update is not approved, the Verification Pending status disappears and the provider s information reverts to what it was before the update. Refer to Appendix A in this job aid for details about the provider documentation the HCSIS Help Desk requires to validate the updates made to a provider's information. Service Location vs. Site A Service Location is what MPI designates as a physical location where a provider offers specific types of services. A Service Location is the combination of one provider address and one provider type. A Site is what HCSIS designates as a physical location where a provider offers specific types of services. A Site is the combination of one provider address and one or more provider types. After verification by the HCSIS Help Desk, every provider type listed on a HCSIS Site will be assigned a unique Service Location in MPI. All Service Locations associated with a Site are summarized on the Sites screen in HCSIS and the Organizational Summary screen in the Provider Access website. Refer to Appendix B for more details about Service Location and Sites. Taxonomy Code Taxonomy Codes are 10-digit federally established numbers which health care professionals use to identify their unique specialty areas. Taxonomy Codes are: Combination of Provider Type and Provider Specialty, Self-declared by health care provider during the NPI enumeration process, Developed by CMS and updated in January and July of each year, and Restricts the development of specialties and provider types by states. Version 4.0 Page 6

7 Roles and Responsibilities Provider Administration The County Provider Administration role (ODP) and the Provider Administration OMAP role (OMAP and OLTL) can enter and update a provider's information in HCSIS. For OMAP and OLTL, this role has a State scope. Provider Registration Data Entry The Provider Registration Data Entry role can enter and update a provider's information in the Provider Access website and has access to Service Authorization Notices. This role can review the information for one provider only. Provider Sign-Up Verifier (Help Desk) The Provider Sign-Up Verifier role receives supporting documentation from the provider after the Provider Registration process is complete. This role checks to make sure that the documentation proves that the provider's information meets ODP requirements. Once requirements are met, the Provider Sign-Up Verifier role accesses HCSIS and completes the final clearance process for providers that have completed the Provider Registration process. The Provider Sign-Up Verifier role can clear or reject a provider based on their validation of supporting documentation sent by the provider. For ODP, this role can also mark a provider as an FMS. If a provider is cleared into HCSIS by this role, the provider's information is automatically updated in MPI as well. If a provider is already in MPI but not in HCSIS, this role can link the provider s information from MPI to HCSIS. If a provider is already cleared into HCSIS and MPI, but changes are made to the provider's information in HCSIS, this role must verify the changes that affect the provider information in MPI (for example: service location changes, provider address changes). After verification, the provider's information will be updated in MPI and HCSIS. In addition, this role can change the provider s critical data, which is also updated automatically in MPI. Version 4.0 Page 7

8 High-Level Overview This process flow is a high-level overview of how provider information is registered in HCSIS. Provider Registration Specify Identification Data (SSN or FEIN) Enter/update Address and Contact information Specify each Site Address Specify Provider Type and Specialty for each service location Yes Is Healthcare? Enter NPI and Taxonomy Provider/ Program Office Validate addresses using DPW s GIS Software Validate addresses using DPW s GIS Software No Mail supporting documentation to HCSIS Helpdesk NPI documentation included Verify supporting Documentation HCSIS Help Desk Verify NPI documentation Indicates a new/redesigned step in the process Indicates enhancement to an existing step in the process Version 4.0 Page 8

9 Your Tasks To create a provider's information in HCSIS and MPI correctly, it is imperative that you understand the High Level Process Flow in this job aid before performing these tasks. 1. Create Provider Information in HCSIS. To determine if the provider s information already exists in HCSIS or MPI, HCSIS searches its own provider database as well as the MPI database. If a match is found, a "Duplicate Record" message appears and the user is instructed to call the HCSIS Help Desk. 2. Enter Provider Contacts. 3. Enter Business, Mailing and Payment Address Information. 4. Create a Services and Supports Directory (SSD) Entry. 5. Complete the Parent Entity and Regional/Field Office Information. These are optional locations representing a related organization that is able to influence the provider's policies and procedures or an organization that manages a specific grouping of sites. A parent entity and/or Regional/Field Office can be created for provider agencies only. 6. Create Provider Sites and Service Locations. Sites are the only location type that can have services associated with them. After completing the information, you will proceed to the next screen and enter the appropriate Provider Type, Specialty Code and NPI/Taxonomy numbers if appropriate. After completing the Provider Registration process, refer to Appendix A for a summary of the appropriate documentation that you are required to send to the HCSIS Help Desk. Version 4.0 Page 9

10 Create Provider Information Procedure Description To open the Provider Access website, open your internet browser (example: Internet Explorer) and type in the Address line. Click the link labeled Provider Access to access the provider screens. Dependency Internet access on your computer. Steps: 1. Open an internet browser, such as Internet Explorer. 2. Type the HCSIS website address ( in the address bar. Tip: Use the links on the left and right side of this screen to access additional information about the program offices and HCSIS. 3. Click Provider Access. Version 4.0 Page 10

11 Create Provider Information, continued Steps, continued: 4. Read the Welcome to HCSIS Provider Access screen. Tip: Use the links in the sidebar on the left side of the screen to access documents that might be helpful. 5. Click Register in the sidebar to the left side of the screen. Notes: Click Continue Saved Application if you have started the registration process but have not received your permanent HCSIS Username and Password. Version 4.0 Page 11

12 Create Provider Information, continued Steps, continued: This screen lists the information that the provider is required to fax to the HCSIS Help Desk for verification, as well as the Terms and Conditions associated with using HCSIS and Provider Access. The verification of the information on this screen is required for the provider to receive a permanent User ID and password. Until you receive a permanent User ID and password, you can use the temporary User ID and password you will generate at the end of this task. 6. Read the information on the Provider Identification screen, including the Terms and Conditions. 7. Select the checkbox next to the statement I have read, understood and agree to the above terms and conditions. Note: If you choose not to accept the terms and conditions, you cannot continue the Provider Registration process, and you will return to the Welcome screen. 8. Click [Begin Application]. The Identification Data screen appears. Version 4.0 Page 12

13 Create Provider Information, continued Steps, continued: Use this screen to identify whether the provider you are representing is an individual or agency. 9. Select Individual or Agency from the provider type drop-down box. Version 4.0 Page 13

14 Create Provider Information, continued Steps, continued: Individual/Sole Proprietor Information If you are an individual/sole proprietor who provides services, use this screen to enter identification data. If you selected Agency on the previous screen, skip the screen below and go to the next screen displayed in this job aid to document the identification data for the agency. 10. Complete the fields given in the table below. IMPORTANT: See Appendix D for rules and restrictions on permissible characters that can be entered in legal-entity and IRS-name fields. Field Name Description First Name Middle Initial Last Name IRS Name Indicate FEIN or SSN Record your FEIN or SSN This table continues on the next page. Required. Enter the first name of the individual or sole proprietor providing services. This field has a 21-character limit. Enter the middle initial of the individual or sole proprietor providing services. This field has a 1-character limit. Required. Enter the last name of the individual or sole proprietor providing services. This field has a 25-character limit. Required. Enter the name that the individual or sole proprietor uses to identify himself/herself to the IRS. This field has a 40- character limit. Required. Select the appropriate identification type from the drop-down box: Federal Employer Identification Number (FEIN) or Social Security Number (SSN). Required. Enter the nine-digit identification number. No dashes are needed. Version 4.0 Page 14

15 Create Provider Information, continued Steps, continued: Field Name Business Type Operating Status Description Required. Select Individual or a Sole Proprietorship from the drop-down list. Required. Select whether the individual or sole proprietor is profit or not-for-profit from the drop-down list. 11. Verify that the information on this screen is correct, because you cannot change it after your User ID is assigned on the next screen. 12. Click [Save and Continue]. You will be directed to the User ID/Password screen. Note: If you receive an error after entering the information on this screen, follow the instructions on the screen. Either the provider's information has to be linked into HCSIS from MPI or the provider information exists in HCSIS already. From this point forward, refer to the Provider Updates Tip Sheet for instructions to update the provider's information. Agency Information Use this screen if you selected Agency on the previous screen, because you represent a corporation, partnership or AE that provides services. If you represent an AE, you only complete this screen if the AE provides supports or services. If you selected Individual on the previous screen, skip the screen below and go to the User ID/Password screen of this job aid. Version 4.0 Page 15

16 Create Provider Information, continued Steps, continued: 13. Complete the fields listed in the table below. IMPORTANT: See Appendix D for rules and restrictions on permissible characters that can be entered in legal-entity and IRS-name fields. Field Name Legal Business Name IRS Name Federal Employer Identification Number (FEIN) Department of State Entity Number Business Type Operating Status Description Required. Enter the name of the agency providing services. This field has a 50-character limit. Required. Enter the name the provider uses to identify itself to the IRS. This field has a 40-character limit. Required. Enter the nine-digit identification number. No dashes are needed. Enter state identification number, if available. If you do not know or are unable to locate the provider s Department of State number, it can be obtained from the online searchable database at the Web site Required. Select whether the provider is a corporation, partnership, or a county/state from the drop-down list. Required. Select whether the provider is profit or not-for-profit from the drop-down list. 14. Verify that the information on this screen is correct, because you cannot change it after your User ID is assigned on the next screen. 15. Click [Save and Continue]. Note: If you receive an error after entering the information on this screen, follow the instructions on the screen. From this point forward, refer to the Provider Updates Tip Sheet for instructions to update the provider's information. Version 4.0 Page 16

17 Create Provider Information, continued Steps, continued: Note: The identification number you entered on the previous screen (FEIN or SSN) is your temporary User ID. Use this screen to enter a temporary password. You will use this password to access Provider Access and HCSIS until your application clears and a permanent HCSIS User ID and password is created for you. 16. Read the text on this screen. 17. Complete the following fields: Field Name Enter Password Confirm Password Description Required. Enter your password. The password must have six to eight alpha-numeric characters. Required. Enter the same password you just entered into the previous field. 18. Click [Save and Continue]. Note: Now you have a temporary User ID and password that will allow you to leave Provider Access and return at a later time. Use the temporary ID and Password until you receive your permanent User ID from the HCSIS Help Desk. Version 4.0 Page 17

18 Enter Contact Information Procedure Description Use this screen to enter a name, job title, phone number and address for the provider s main point of contact. This person will be the main contact between HCSIS and the provider. One primary contact must be entered, and any additional contacts can be entered as the contact type alternate. Only one contact can be the primary contact. Steps: Tip: Navigate through Provider Access using the tabs located at the top of the screen. 19. Complete the following fields: Field Name Description Contact Type First Name Middle Initial This table continues on the next page. Version 4.0 Page 18 Required. Select the type of contact the person is: Primary the main contact between the provider and HCSIS. One primary contact must be entered for the provider. Alternate additional contacts between the provider and HCSIS. This can be used to document contact information for people at specific provider sites. Required. Enter the first name of the contact person for the provider. This field has a 21-character limit. Enter the middle initial of the contact person for the provider. This field has a 1-character limit.

19 Enter Contact Information, continued Steps, continued: Field Name Last Name Title Phone Number Extension Description Required. Enter the last name of the contact person for the provider. This field has a 25-character limit. Enter the job title of the contact person for the provider. Required. Enter the ten-digit phone number of the contact person for the provider. Enter the phone number extension for contact person, if applicable. The extension must contain only numeric characters. For example, 514. Enter an address of the contact person for the provider. Note: After a primary contact is created, it cannot be deleted and a new primary contact cannot be added. If the primary contact changes, use [Edit] to change the primary contact information. 20. Click [Save] to save the contact information and enter another contact, or click [Save and Continue] to save the information and move on to the next screen. If you click [Save], [Add], [Edit] and [Delete] appear. These options are available throughout this job aid, however, they are described below only. Clicking [Add] creates a blank record and allows you to add a new contact s information into HCSIS. After entering the information for a new contact, you must click either [Save] to save the information and remain on the Contact screen, or click [Save and Continue] to save the information and move on to the Address screen. If you do not click [Save] after completing the fields on this screen, the information you typed will not be saved when you go to the next screen. Clicking [Edit] allows you to select an existing contact listed in the table at the top of the screen and update the contact s information. First, click the option button to the left of the information to change and click [Edit]. Change the information on the screen and click [Save] to save the information and remain on the Contact screen, or click [Save and Continue] to save the information and move on to the Address Information screen. If you do not click [Save] after editing the fields on this screen, the information you typed will not be saved when you go to the next screen. Clicking [Delete] allows you to delete an existing contact listed in the table at the top of the screen. Click the option button to the left of the information to change and click [Delete]. The deleted contact information will no longer appear in the table at the top of the screen. Note: Use the tabs at the top of the screen to navigate to the Address Information screen if you clicked [Add] and do not wish to enter another contact. Version 4.0 Page 19

20 Enter Contact Information, continued Steps, continued: Tip: The saved contact appears in the table at the top of the screen. Tip: Clicking [Add], [Edit] or [Delete] allows you to add, change or delete contact information. 21. Click [Save and Continue] or [Continue] after entering and saving all contact information on this screen. Version 4.0 Page 20

21 Enter Address Information Procedure Description HCSIS and MPI store three key addresses for the provider: the business address, the mailing address and the payment address. The business address entered is the provider's legal entity address, which is not necessarily a site address. You can indicate that this address is also the provider's mailing address, payment address or both. Steps: Tip: Select one, two or all of these checkboxes to indicate the address type. 22. Complete the fields listed in the table below. IMPORTANT: See Appendix D for rules and restrictions on permissible characters that can be entered in address and city-name fields. Field Name Description Address Type Select the checkbox to indicate if the address information you are about to enter is the provider's business address, mailing address, payment address, or any combination of the three. Select all that apply. Street Address Required. Enter the street address for the provider's address type selected. Suite / PO Box Enter a second line for the provider's suite / P.O. Box address, if necessary. Building / Dept Enter a third line for the address, if necessary. This field is also used to store Canadian postal codes. This table continues on the next page. Version 4.0 Page 21

22 Enter Address Information, continued Steps, continued: Field Name City State Zip County Phone Fax Website Description Required. Enter the city for the provider's selected address. Select the appropriate state from the drop-down list. Required. Enter the Zip code for the provider's address. The five-digit code is required. Enter only numbers and be sure you enter all five. The four-digit extension will be added to the code when the address is saved and validated. Select the appropriate county for the provider's selected address from the drop-down list. Required. Enter the ten-digit phone number for the provider's selected address. Enter the ten-digit fax number for the provider's selected address. Enter an address for the provider's selected address. Enter the Web site for the provider's selected address. Note Regarding Business Address Changes: If changes are made to the provider's business, mailing or payment address, the changes must be verified by the HCSIS Help Desk before the changes are updated in HCSIS and subsequently in MPI. The statuses include: Verification Pending: This status indicates that the change requires verification by the Help Desk and has not been verified. Verified: This status indicates that a decision has been made regarding the update. However, the change may or may not be approved. 23. If you have indicated that the provider has a separate mailing or payment address, click [Save] to save the address information, and click [Add] to enter another address. Otherwise, click [Save and Continue] to move on the SSD Options screen. Either way, you will be prompted to select the correct entry based on the results suggested by the geo-coding (postal software) application. 24. If one of the addresses listed is correct, click the option button to the left of the correct address. Click [Try Again] if the address information you entered is incorrect. Note: If you click [Try Again], the address information that you entered will be erased and you will be prompted to re-enter the address information. Note: All addresses are verified against the geo-coding software for accuracy. Version 4.0 Page 22

23 Enter Address Information, continued Steps, continued: Once an address is selected, if you click [Save], the [Add], [Edit] and [Delete] buttons appear on the Address Information screen. Please refer to Page 19 for information on the [Add], [Edit] and [Delete] option buttons. Note: Use the tabs at the top of the screen to navigate to the SSD Options screen if you clicked [Add] and do not wish to enter another address. 25. Click [Continue]. The SSD Options screen appears. Version 4.0 Page 23

24 Create a Services and Supports Directory Entry Procedure Description: Use this screen to indicate if the provider s information should appear in the Services and Supports Directory (SSD) that is available to the public. This allows individuals and families to search for providers by service type, location or provider name. If a provider wants their information to appear on the SSD, use this screen to indicate what information will appear. Note: The following message appears on the version of the SSD that is available to the public: Steps: "This directory reflects information entered by providers in your county. It does not necessarily reflect the availability of services in a given county. Please use this directory with your Supports Coordinator to find services and supports for yourself and/or your family member." Note: If you only provide services through OMHSAS, please select No. Tip: Select one address type and one or more lines to appear in the SSD. If you choose not to include any address, phone or information, select the Do not include address option on this screen. If you choose this option, make sure that none of the checkboxes have checkmarks in them. Version 4.0 Page 24

25 Create a Services and Supports Directory Entry, continued Steps, continued: 26. Decide whether or not the provider should be listed in the SSD available to the public: Select Yes from the drop-down list if you wish to be included in the SSD. Select No from the drop-down list if you wish not to be included in the SSD. Note: If you only provide services through OMHSAS, please select No. OMHSAS is not using the SSD at this time. If you provide services through both OMHSAS and ODP, you can select either Yes or No. 27. If you selected No, I do not wish to be included in the SSD at this time, you have completed this task. Click [Save and Continue] and go to the next task of this job aid. 28. If you selected Yes, indicate which address type and lines you wish to include in the SSD. Note: If you elected to list the provider in the SSD, your next step is to select how much information is displayed in the SSD. The provider s parent entity, regional offices, services and rates will be included automatically. 29. Use the following table to complete the remaining fields on the screen: Field Name Business Address option Mailing Address option Description If you wish to include the provider's business address, select the option button to the left of Business address. To include the provider's business address, phone number, fax number, and/or address in the SSD, select the checkboxes as appropriate. If you wish to include the provider's mailing address, select the option button to the left of Mailing address. To include the provider's mailing address, phone number, fax number, and/or address, select the checkboxes as appropriate. 30. Click [Save and Continue]. Version 4.0 Page 25

26 Complete the Organization Information (for Agencies only) Procedure Description: If the provider is an individual/sole proprietor, this screen does not appear. If this is the case, refer to the next task of this job aid. Use the tabs at the top of the screen to navigate to the Sites screen. This screen allows you to identify the Parent or Region of the provider agency. A parent entity is a related organization that is able to influence the provider s policies and procedures. A region is an organization that manages a specific grouping of sites. To identify a Regional or Field location, you will select the counties where it administers services. These are optional screens to be used by provider agencies only. Please note that you can either leave all the fields on these screens blank or complete all the mandatory fields. If you begin to complete any fields on these screens, you must complete all the mandatory fields or clear all the fields, by clicking [Reset], before continuing to the next screen. Mandatory fields are indicated with an asterisk (*). Steps: 31. Select Parent or Region from the drop-down list. Note: The Parent and Region screens are virtually identical. However, the Region screen will request that you select the counties of the region/field office where service provision is available. Tip: This field will appear only if you selected Region as the organization type. Version 4.0 Page 26

27 Complete the Organization Information (for Agencies only), continued Steps, continued: 32. Complete the fields given in the table below. IMPORTANT: See Appendix D for rules and restrictions on permissible characters that can be entered in address and city-name fields. Field Name Organization Type Name FEIN Department of State Number Street Address Suite / PO Box Building / Dept City State Zip County Phone Fax Address Regional Field Office Description Version 4.0 Page 27 Select Parent or Region from the drop-down list. Parent: a related organization that is able to influence the provider s policies and procedures. Region: an organization that manages a specific grouping of sites. Services cannot be assigned to a Region. Enter the name of the Parent or Region. This name appears as the title for this organization throughout the provider screens in HCSIS. Enter the FEIN (Federal Employer Identification Number) for the Parent or Region. Enter the department of state identification number of the Parent or Region, if available. There is an online directory for these numbers at Enter the street address. Enter the second line of the address, if necessary. Enter the third line of the address, if necessary. Enter the city for the provider's selected address. Select the appropriate state from the drop-down list. Enter the Zip Code for the provider's address. The five-digit code is required. The four-digit extension will be added to the code when the address is saved and validated. Select the appropriate county for the provider s selected address from the drop-down list. Enter the ten-digit phone number. Enter the ten-digit fax number. Enter an address for the. For regions only. Select the county (or counties) from the list that the current regional/field office is responsible for servicing. Select multiple counties by pressing and holding the Control [Ctrl] key on your keyboard. 33. Click [Save] to save the information and enter another Parent or Region, or click [Save and Continue] to save the information and move on to the next screen. 34. Click the appropriate option button to the left of the correct address, or click [Try Again] if the address information you entered is incorrect. 35. Click [Continue].

28 Create Provider Site(s) Procedure Description: Use the Site screen to enter a new provider site. A site is a provider location from which services are offered. For ODP, sites must be created for services to be selected, contracted and added to plans in HCSIS for provider claims processing. For OMHSAS, sites must be created for incidents and be recorded and tracked in HCSIS. After verification by the HCSIS Help Desk, Service Location(s) are created automatically in MPI for the new HCSIS Site. These are the Service Locations ODP providers must use to bill PROMISe successfully. Important Note for ODP Providers: Refer to Appendices B and C for the definitions for Provider Type and Service Location vs. Site to understand how to create Sites and to select Provider Types so the provider's information is set up correctly. Rules to Remember for Creating Provider Sites: Sites versus Service Locations: When a new site is cleared into MPI by the HCSIS Help Desk, the new site is created in MPI as a new service location. The new service location is a four-digit number that appears in parentheses after the provider type in the Provider Access screens. Since a service location can have only one provider type, if the site was created in Provider Access with multiple provider types, MPI will create a new service location for each provider type associated with the site. New sites should be created by ODP and OMHSAS providers only: If the provider offers OLTL services as well as ODP or OMHSAS services, contact the OLTL program office for updates to the provider s OLTL services. Naming Conventions for Provider Sites: When adding a site/location name, providers must follow the proper naming conventions required by PROMISe. This requires all site/location names to include the name of the agency and a unique identifier. When creating a new site, the following rules apply: The Legal Entity name of the provider or an accepted abbreviation should be shown preceding the name of the site. The name of the site should not include the address (e.g., 10 Main St.). If you would like to represent the address in the name of the site for identification purposes, use the following format: Main St. (10) Version 4.0 Page 28

29 Create Provider Site(s), continued Example Site Information: Legal Entity Name: Morrow's Services Name of Site: Hilltop Home Service Location Address: 10 Main St. Acceptable Naming Conventions: Morrow's Services Hilltop Home Main St. (10) Morrow's Services Hilltop Home Morrow's Services Main St. (10) Morrow's Services Main St. Note: If the site/location name includes the exact street address of the site/location (120 Main Street), the HCSIS Help Desk will not approve the request. Note for ODP Providers: Sites are vital for providers to successfully bill services through PROMISe. The Service Location the provider uses to bill PROMISe must match the HCSIS Site used to set up the provider s service contract added to plans in HCSIS. Refer to the Service Location vs. Site definition for details. After verification by the HCSIS Help Desk, sites in HCSIS are translated automatically into MPI Service Locations. Dependencies: Steps: Sites are for contracted ODP services only. New sites should not be created for OLTL Services. For OMHSAS, sites are created for Incident Management purposes only. Tip The site's name appears as the title for this address throughout the provider screens in HCSIS. This name appears when the AE creates contracts and when SCs select services for plans. Note: The site name must include the name of the agency and a unique identifier, e.g., Morrow s Services Main St. (10). Version 4.0 Page 29

30 Create Provider Site(s), continued Steps, continued: 36. Complete the fields listed in the table below for each of your agency s sites where services are offered: IMPORTANT: See Appendix D for rules and restrictions on permissible characters that can be entered in the site-name (service location), address and city-name fields. Field Name Site Name Contact Name Street Address Suite/PO Box Building/Dept City State Zip County Phone Fax Address Description Required. Enter name of the site. The site's name appears as the title for this address throughout the provider screens in HCSIS. This name also appears when the AE creates contracts (ODP only), Support Coordinators select services for plans (ODP only), and recording incidents (ODP and OMHSAS). Therefore, it is important that a site's name is clearly recognizable to the AE and SC staff. Required. Select the person who is the point of contact for the site. The list defaults from contact information entered in the Contact screen. Required. Enter street address of site. Enter second line of site address, if necessary. Enter a third line for the site address, if necessary. This field is also used to store Canadian postal codes. Required. Enter city for site address and select the appropriate state from drop-down list. Select the appropriate state from the drop-down list. Required. Enter the Zip Code for the provider's address. The five-digit code is required. The fourdigit extension will be added to the code when the address is saved and validated. Select the appropriate county for the site address from the drop-down list. Required. Enter the ten-digit phone number for the site. Enter the ten-digit fax number for the site. Enter an address for the site. 37. Click [Save] to save the site information and enter another site or click [Save and Continue] to save the information and move on to the next screen. 38. Verify the correct address using the geo-coding system. Click the appropriate option button to the left of the correct address, or click [Try Again] if the address information you entered is incorrect. 39. Once a site is entered, the [Add], [Edit] and [Delete] buttons appear on the Site Information screen. Use these options to enter additional site information. Version 4.0 Page 30

31 Create Provider Site(s), continued Steps, continued: 40. Click [Continue] after entering and saving the site address information. You will be prompted to enter the site s Provider Type, Specialty, and NPI and Taxonomy number, if appropriate. Tip: Select multiple Specialties by pressing and holding the Control [Ctrl] key on your keyboard. If you do not have an NPI at this time, click the box to the left of the statement, No NPI at this time. Version 4.0 Page 31

32 Create Provider Site(s), continued Steps, continued: 41. Complete the following fields for each of your agency s sites: Field Name Provider Type Specialty NPI No NPI number at this time Add Taxonomy link Description Required. Select a Provider Type from the dropdown list. Based on the Provider Type selected, specific specialties will be available for selection. A Site in HCSIS can have one or more Provider Types. After HCSIS Help Desk verification, there will be a new Service Location for each new Provider Type. A Site is one address with one or more Provider Types. A Service Location is always one address with only one Provider Type. Required. Select one or more specialties. Based on the provider types selected, specific specialties will be available to the provider for selection. Use the [Ctrl] key to highlight more than one. This field appears for health care provider type and specialty combinations only. Required. Enter the NPI assigned to you by the Center for Medicare and Medicaid Services. The NPI is the unique 10-digit number for healthcare providers that can be used nationally. Select the checkbox if you do not have NPI number at this time. Click this link to select one or multiple taxonomy codes. Taxonomy codes are a 10 digit federally established number which health care professionals use to identify their unique specialty areas. 42. Click [Save] to save the service location information and add another provider type/specialty combination to the site. Otherwise, click [Save and Continue] to save the information and return to the Site Information screen. 43. When you have finished entering all sites and completed the provider type and specialty information for each site, click [Submit Application]. 44. Send appropriate information to HCSIS Help Desk. Refer to Appendix A for a list of the appropriate documentation you are required to send to the HCSIS Help Desk. The HCSIS Help Desk will verify and clear this new information into HCSIS and MPI. After this occurs and changes to a provider's information are necessary, refer to the Provider Updates Tip Sheet. Version 4.0 Page 32

33 Create Provider Site(s), continued Steps, continued: OMHSAS Providers You have completed the provider registration process and you do not have to complete any further information. 45. ODP Providers Once the HCSIS Help Desk verifies and clears your site information into HCSIS and MPI, you can begin to add services to the sites. Refer to the Provider Updates Tip Sheet for instructions on adding services to a service location. 46. You have completed the provider registration process successfully. Click View My Application Summary in the sidebar on the left side of the screen to view the provider s information, basic provider demographic information, organization and site information. Version 4.0 Page 33

34 Create Provider Site(s), continued Steps, continued: View My Application Summary, continued. Version 4.0 Page 34

35 Appendix A: Provider Documentation for HCSIS Help Desk Clearance/Verification This appendix summarizes the provider documentation that the HCSIS Help Desk requires for the validation of any new or updated provider information in HCSIS. Please fax the following documentation to the HCSIS Help Desk at Obtain a HCSIS User ID and Password: Download and complete the HCSIS User Security Agreement form, located under the HCSIS User Security Agreement hyperlink on the HCSIS Homepage at Update to any Tax Reporting Information (e.g.: FEIN or name change, merging of agencies): Call the HCSIS Help Desk ( ) for specific instructions. Enter a Provider's Information into HCSIS for the First Time: A cover sheet with the provider's name, the name of the provider contact, and the contact's phone number. For (a) individuals who are not doing business as sole proprietorships; and (b) provider organizations enrolling as agencies, a copy of the Determination Letter they received from the Internal Revenue Service (IRS) or documentation from an independent third party (such as an auditor) is required as a proof of their Federal Employer Identification Number (FEIN). For all individuals who are doing business as a sole proprietorship, a copy of their Social Security Card is required as proof of their Social Security Number (SSN). On a company letterhead or a signed document, a list of all site/ service location addresses that will be enrolled in HCSIS. For PROMISe enrollment, complete the form attached to this link: Update or Add Sites: a. If adding a new Site or Provider Type, fax a cover letter, signed by the CEO or a Director, with the following information: o o o o o Program Office for which you are updating or adding a site Provider IRS Name MPI# Contact Information: Name Address Phone Number County in which you are physically located A list of the new and/or changed sites to be verified Version 4.0 Page 35

36 Appendix A: Provider Documentation for HCSIS Help Desk Clearance/Verification, Continued NOTE: For all other changes to a site, ( address, fax number, etc.) fax a summary of the changes to the HCSIS Help Desk. A signed memo is not required because a change to a site s name or address is for correcting mistakes only. b. To record in PROMISe, complete the form attached to this link: Update the Provider's Business, Mailing, and/or Payment Address: a. Fax a cover letter signed by the CEO or a Director, including the following information: o o o o o Program Office for which you are updating or adding a site Provider IRS Name MPI# Contact Information: Name Address Phone Number County in which you are physically located A list of the changed addresses to be verified Version 4.0 Page 36

37 Appendix B: ODP Additional Key Terms and Concepts Effective Dates The Effective Dates are known also as the start and end dates in HCSIS. Start date is the date the information starts being accurate in HCSIS, whereas the end date is the date that information is no longer valid, and therefore can no longer be edited in HCSIS. Effective dates apply to a service as listed below. The effective dates of a contract cannot exceed one year and they must cover the start and end dates of all the rates in the contract. There are three types of effective dates for services: (1) Service Definition dates identifies the timeframe in which a service definition is valid for use by the program office. (2) Provider Offering dates identifies the timeframe in which a specific provider is willing to offer the service. (3) Contract dates identifies the timeframe in which the service s rate is valid in HCSIS. Effective dates for the service s contract dates entered in HCSIS must fall within the service definition dates and the provider offering dates for the service. Service definitions and provider offerings do not require effective end dates. The date format used in HCSIS is MM/DD/YYYY. For additional details regarding service definition effective dates, refer to the Service Definition document section in the sidebar to the left of the screen. Exception for Individualized Rates: Because individualized rates are determined specifically for each individual, a rate change to a contract for an individualized service will be updated in a plan only if the rate has not been individualized. If the rate has been individualized, HCSIS will bypass the individual s plan and the rate in the plan will not be updated. HCSIS/PROMISe Interface for Claims Processing Refer to the HCSIS/PROMISe Claim Error Resolution Tip Sheet for details regarding the interface between HCSIS and PROMISe. Individual Support Plan (ISP) or Plan From a financial perspective, the plan (or ISP) in HCSIS summarizes the services and supports that an individual needs over the course of a plan year. Within each plan, the Supports Coordinator enters all the services the individual will need along with the corresponding provider, units and service dates. PROMISe will verify provider claims in HCSIS by comparing the claim to the authorized services listed on the plan. Version 4.0 Page 37

38 Appendix B: ODP Additional Key Terms and Concepts, Continued PROMISe PROMISe is the name of the claims processing and management information system implemented by the Pennsylvania Department of Public Welfare (DPW) in March PROMISe stands for Provider Reimbursement and Operations Management Information System. PROMISe replaced the Medical Assistance Management Information System (MAMIS) and incorporated claims processing and information management activities of other DPW program offices. PROMISe is the single system that processes human services claims and manages information for numerous Commonwealth human services programs. Service Location vs. Site A Service Location is what MPI and PROMISe designate as a physical location where a provider offers specific types of services. A Service Location is the combination of one provider address and one provider type. A Site is what HCSIS designates as a physical location where a provider offers specific types of services. A Site is the combination of one provider address and one or more provider types. After verification by the HCSIS Help Desk, every provider type listed on a HCSIS Site will be assigned a unique Service Location in MPI. All Service Locations associated with a Site are summarized on the Sites screen in HCSIS and the Organizational Summary screen in the Provider Access website. For providers to bill PROMISe successfully, they must use the Service Location associated with the HCSIS Site that has the contracted service on the individual s plan! (Explanation continued on the following page.) Version 4.0 Page 38

39 Appendix B: ODP Additional Key Terms and Concepts, Continued Service Location vs. Site, continued Example: The provider offers services from two locations in the diagram below: 1. Main Street: Respite services and Family Living services, which relate to Provider Types 51 and 52, are offered at the provider location on Main Street. Two Service Locations (0001 and 0002) are needed because there are two provider types at the Main Street Site. The provider needs to bill PROMISe using Service Location 0001 for the Respite service at Main Street and Service Location 0002 for the Family Living service at Main Street. 2. Green Street: Prevocational services and Respite services, both relating to Provider Type 51, are offered at the provider location on Green Street. Only one Service Location 0003 is needed because both services relate to the same provider type at the provider location on Green Street. The provider needs to bill PROMISe using Service Location 0003 for both the Respite service and the Prevocational service at Green Street. Note that the provider needs to be sure to use Service Location 0001 for Respite services provided from Main Street and use Service Location 0003 for Respite services provided from Green Street. Version 4.0 Page 39

40 Appendix C: ODP High Level Process Flow This process flow is a high-level overview of how provider information is created/updated and cleared into HCSIS, how contracts are created, and how services are added to ISPs. This job aid focuses on the tasks necessary to enter the provider s information in HCSIS for the first time, as explained in Step 1 of this process flow. This job aid provides step-by-step instructions for the Provider Registration Data Entry role to complete the Provider Registration process. Important Note about Providers: At this time, OMAP and OLTL central offices handle all provider information in HCSIS. Therefore, this process flow describes the ODP process only. 1. Provider information entered by the Provider or the County: Both the provider and the county can enter and update provider information in HCSIS. An ODP provider can enter their information in the Provider Access website, which is accessed via the HCSIS website ( Or, the County Provider Administration role can enter a provider s information into HCSIS on behalf of the provider. Important Note: Certain provider information updates need to be verified and cleared into HCSIS by the HCSIS Help Desk as explained in the next step of the process. The HCSIS Help Desk may require the provider to send documentation to validate the new or updated provider information. Version 4.0 Page 40

41 Appendix C: ODP High Level Process Flow, Continued Provider Registration: When entering provider information into HCSIS for the first time, HCSIS checks if the provider s information already exists in the Master Provider Index (MPI) via the provider s Federal Employer Identification Number (FEIN) or Social Security Number (SSN). MPI stores information for all existing DPW providers. If the provider s information is new to HCSIS but already exists in MPI, the user will be prompted to call the HCSIS Help Desk so the provider s information in MPI can be linked into HCSIS. This is necessary to prevent duplicate provider information in MPI. When a provider, or a county on behalf of the provider, signs up in HCSIS, an alert is generated to inform the HCSIS Help Desk that a new provider s information has to be cleared into HCSIS. Provider Updates: Upon clearance into HCSIS (Step 2) the provider s contact person with the Provider Registration Data Entry role will receive a permanent user ID and password. With this role, the provider can make updates to the existing information in HCSIS. The county can make updates to the existing information for services offered in their county only via the Provider Administration role. 2. HCSIS Help Desk clears or verifies provider information: The HCSIS Help Desk is the gatekeeper for HCSIS and MPI. This step is necessary to prevent incorrect or duplicate provider information in HCSIS and MPI. HCSIS and MPI share the provider s service location information. A service location is the combination of one provider address and one provider type (refer to the diagram on the next page and detailed definitions in Key Terms and Concepts). Therefore, only new or changed provider addresses and provider types have to be verified and cleared into HCSIS. After this occurs, the information is added to MPI automatically. The following activities require HCSIS Help Desk verification: new or updated provider site addresses, new provider types added to a site, changes to a provider s business address, mailing address or payment address, and all new providers. The HCSIS Help Desk may require the provider to send documentation to validate the information. Provider Registration: If a provider s information is being entered into HCSIS for the first time, the HCSIS Help Desk has to clear the new provider information into HCSIS. The new provider's information will not have a verification status until the provider's information is reviewed and cleared by the HCSIS Help Desk for the first time. After clearance, the new provider s information will have the Verified status in HCSIS and the new provider s information will be created automatically in MPI overnight. Upon clearance into HCSIS, the HCSIS Help Desk will send the provider s contact person a permanent user ID and password. If the HCSIS Help Desk denies clearance to the provider, the provider's information entered during Provider Registration is deleted from HCSIS. Provider Updates: The HCSIS Help Desk has to verify updates that impact information in MPI. Updated provider information will change to the Verification Pending status, if the change has to be verified by the HCSIS Help Desk. After verification, the provider s updated information will have a Verified status in HCSIS. If the update is not approved, the Verification Pending status disappears and the provider s information reverts to what it was before the update. Version 4.0 Page 41

42 Appendix C: ODP High Level Process Flow, Continued 3. Contracts are updated in HCSIS: After a provider s information contains the services being offered, contracts for the services are updated. Therefore, if a provider is contracted to provide the same service in two counties, the provider must select the service twice (once for each county) or each county s Provider Administration role has to add the service. After this occurs, the contracts are updated. For providers billing PROMISe, the contracted service s site in HCSIS has to be associated with the MPI service location the provider will use to bill the service. 4. Contracted services in plans are authorized for payment: After a provider s service is contracted in HCSIS, Supports Coordinators (SCs) can add the contracted services, listed by provider site, to plans. Then the plans have to be approved and services on the plans have to be authorized. Only authorized services can be viewed by PROMISe for claims processing. Then the provider will bill with the service location that corresponds to the provider's site in HCSIS. For providers to bill PROMISe successfully, they must use the MPI Service Location associated with the HCSIS Site that has the contracted service on the individual s plan. In the example below, a provider offers services from two locations. At their office on Main Street, they offer Respite and Family Living services, which relate to Provider Types 51 and 52. At their office on Green Street, they offer Prevocational and Respite services, both of which relate to Provider Type 51. Follow the diagram below to review how the provider s information is created in HCSIS and MPI so the provider can bill for these services through PROMISe. Refer to the Service Location vs. Site definition in the Key Terms and Concepts section of this job aid for additional details. Version 4.0 Page 42

43 Appendix D: Internal Revenue Service and US Postal Service Requirements for Business Names and Business Addresses With HCSIS Release 7.5, screens in the provider module begin enforcing standard formatting in accordance with the Internal Revenue Service and United States Postal Service requirements for Business Names and Business Addresses, respectively. In each of the standards given below, the numbers in parentheses indicate the field lengths in MPI. Names (IRS (40), Legal Entity (50), Service Location (50)) (First Name (21), Last Name (25)) The only allowable characters are: 1) Letters 2) Numbers 3) Spaces a. Cannot be the first or last character b. Cannot be consecutive 4) Ampersand (&) a. Cannot be the first or last character b. Must be preceded and followed by a space 5) Hyphen ( ) a. Cannot be the first or last character b. Must be preceded and followed by letters or numbers 6) Forward Slash (/) a. Cannot be the first or last character b. Must be preceded and followed by letters or numbers Periods and commas are not allowed in the name fields. Addresses (Address 1 (26), Address 2 (26)) The only allowable characters are: 1) Letters 2) Numbers 3) Spaces a. Cannot be the first or last character b. Cannot be consecutive 4) Pound (#) a. Cannot be the first or last character b. Must be preceded and followed by a space 5) Hyphen ( ) a. Cannot be the first or last character b. Must be preceded and followed by letters or numbers 6) Forward Slash (/) a. Cannot be the first or last character b. Must be preceded and followed by letters or numbers All other punctuation should be omitted. Version 4.0 Page 43

44 Appendix D: Internal Revenue Service and US Postal Service Requirements for Business Names and Business Addresses, Continued City Names (23) The only allowable characters are: 1) Letters 2) Numbers 3) Spaces a. Cannot be the first or last character b. Cannot be consecutive All other punctuation should be omitted. Version 4.0 Page 44