Recognition Program Online Application Step-by-step Instructions Guide for Single Site Submission

Recognition Program Online Application Step-by-step Instructions Guide for Single Site Submission No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording or any information storage and retrieval system, without the written permission of NCQA. 2014 by the National Committee for Quality Assurance 1100 13th Street, NW, Suite 1000 Washington, DC 20005 www.ncqa.org All rights reserved. Printed in the U.S.A. NCQA Customer Support: 888-275-7585

Introduction Thank you for your interest in NCQA s Patient-Centered Medical Home (PCMH) or Patient-Centered Specialty Practice (PCSP) Recognition Program. This document provides instructions for submitting your application to NCQA prior to completing either your PCMH 2011, PCMH 2014 or PCSP 2013 Survey Tool. The Patient-Centered medical home (PCMH) is a model for care provided by medical practices that seeks to strengthen the clinician patient relationship by replacing episodic care based on illnesses and patient complaints with coordinated care and a long term healing relationship. The American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics and the American Osteopathic Association have jointly defined the medical home as a model of care where each patient has an ongoing relationship with a personal physician who leads a team that takes collective responsibility for patient care. The physician led care team is responsible for providing all the patient s health care needs and, when needed, arranges for appropriate care with other qualified clinicians. A medical home also emphasizes enhanced care through open scheduling, expanded hours and communication between patients, clinicians and staff. The PCMH and PCSP are health care settings that facilitate partnerships between individual patients and their personal clinicians, and when appropriate, the patient s family. Care is facilitated by registries, information technology, health information exchange(s) and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. The online electronic application process is intended to make the submission of PCMH and PCSP Recognition Programs applications submission more efficient. The resources provided within the application module contain information about how to: Contact NCQA Take advantage of NCQA s free informational programs Get your questions answered Resolve any difficulties you may have with the program materials NCQA looks forward to working with you to create a productive and successful experience.

Table of Contents Table of Contents About the Instructions... 1 Setup/Access NCQA Store Account... 2 Purchase Online Application from NCQA Store... 4 Getting Started... 6 Log In... 6 License Agreement... 7 My Accounts... 8 Home Page... 9 Resources... 10 Account Manager and User Information... 11 Edit Account Information... 11 Add/Edit/Delete Users and Administrator... 12 Legal Documents with NCQA... 14 Administrative Steps and Document Submission... 15 Information Entry Sessions... 15 Completing Practice Site Information... 16 Edit a Practice Site... 19 Adding Applications to Practice Sites... 20 Adding Clinicians to Practice Sites... 24 Adding Clinicians to an Application... 26 Completing the Legal Agreements, Adding Applications, and Entering Clinician Information... 28 Completing the Legal Agreements... 29 Submitting Information... 31 Feedback... 32

1 About the Instructions The Online Application is a Web-based module that PCMH and PCSP applicants use to submit orders for survey tools and to submit applications necessary to seek NCQA Recognition and to set up multi-site submissions. The Recognition Program Online Application Instructions guide applicants through the process of entering the following information directly into the Online Application. Account/User information enter once per account there may be multiple users per account. Practice site information enter once per practice site there may be multiple practice sites per account. Clinician information enter once per Clinician there may be multiple clinicians per practice site. Application information enter once per Application there may be multiple applications per practice site. NCQA only accepts submissions that have been entered into the Online Application. Online Application The Online Application collects information in tables. For each table, the introductory section focuses on how to navigate the Online Application. Instruction Conventions NCQA uses the following conventions in these instructions. References to documents (e.g., PCMH Requirements) are in italics. References to tabs or items on the Main Menu of the Web-based Application (e.g., Practice Sites ) are in bold italics. References to links or buttons (e.g., Add Practice Site) are in bold underline. References to drop-down menu choices (e.g., Yes and No ) are in quotations. Important notes are in bold and are in shaded boxes.

2 Setup/Access NCQA Store Account Access the NCQA Store to purchase an Online Application by following these steps: A. Enter store.ncqa.org into the address window of your Internet browser or search engine. NCQA recommends using Internet Explorer to complete the Online Application. B. Select Log In beside the search engine at the top of the page.

3 NOTE: If you have access to another NCQA site (e.g., Policy/Product Clarification Support (PCS)), you may use the same log-in information to log into the NCQA Store. C. Log-in to the NCQA Store account under Registered Customers with your e-mail address and password. D. If you do not have already have an account, select Create an Account and complete the form.

4 E. After completing the registration form, select My Account to confirm your account information in correct. NOTE: The NCQA Store account name will be added as the Online Application account name; however, you may change the name if it is not correct under the Account Manager tab in the tool. Purchase Online Application from NCQA Store A. Under the Recognition tab, select the applicable program from the dropdown menu (e.g., Patient- Centered Medical Home (PCMH)).

5 B. Use the Search engine to locate the appropriate product (e.g., 2014 PCMH Online Application). Click Add to Cart. C. Once the selected product has been moved to the Shopping Cart: i. Confirm the correct product has been selected. ii. Confirm the quantity under the Qty column. iii. Enter any applicable discount codes. Click Apply Voucher. iv. Get a shipping and tax estimate quote by selecting Get a Quote. v. Click Proceed to Checkout.

6 Getting Started This section provides instructions that pertain only to the Online Application. Log In Follow these steps after you have received an e-mail from NCQA with your User ID and Password. Step 1 Step 2 Step 3 Navigate your Web browser to https://recognitionportal.ncqa.org/rponlineapp/login.aspx. Enter your Username and Password from the e-mail you should have received from publications@ncqa.org when you ordered the PCMH or PCSP Online Application. Click Login.

7 License Agreement The software license agreement is a legal agreement between your organization and NCQA. It permits you to access and use the Online Application. You will be required to accept the license agreement each time you log in to the Online Application. Step 1 Step 2 Use the scroll bar to read the entire license agreement. Click I Agree to confirm acceptance of this agreement. Click Submit. Note: If you click I Disagree, you will not have access to the online application.

8 My Accounts Step 3 You will be directed to the My Accounts page. All accounts associated with your e-mail address will be displayed. Click on the account you would like to work with.

9 Step 4 When first logging into the selected account, verify your account information. The information that is displayed is what NCQA currently has on file for the selected account. Review and change any information so that NCQA can update its records. Step 5 Click Save/Update to save and continue.

10 Home Page The Home Page of the Online Application outlines the areas of the application that must be completed in order for it to be submitted to NCQA. This page also includes links to NCQA s other Recognition Programs and links to resources and documents that will help you complete the application. You will be brought to the Home Page after logging in and selecting your account. Step 6 Use the tabs on the blue ribbon to navigate through the pages of the Online Application.

11 Resources Step 7 Under the Resources tab, NCQA has provided some helpful documents to help you get started and to answer questions you might have. *If you purchased PCMH 2011, PCMH 2014 and/or PCSP 2013, select the appropriate button to view the corresponding resources.

12 Account Manager and User Information Edit Account Information Step 1 Step 2 Click Account Manager on tool bar. Click Edit in Account Information box. Step 3 Enter information into the fields following the format and instructions below. Field Name Information Format Instructions Account Name Text Field Enter name associated with account. Address 1, 2, 3 Text Field Enter the number and street mailing address of the practice. City Text Field Enter the city name. State Drop-Down Select the state from the list in the drop-down menu. Zip Number Enter the zip code. Tax ID Text Field Enter the Practice s Tax Identification number. Account Telephone Number Number (XXX) XXX-XXXX Enter the telephone number of the primary person tied to the account.

13 FAX Field Name Information Format Instructions Contact Information Number (XXX) XXX-XXXX Enter the fax number of the account. A Contact Person Text Field (First, Last) Enter first and last name for the person whom NCQA can contact regarding the Application. E-mail Text Field; must include @ Enter the e-mail of the contact person. Contact Title Text Field Enter the title of the contact person. Contact Phone Number Number (XXX) XXX-XXXX Enter the telephone number of the contact person. Step 4 Click Save/Update to save account information. Add/Edit/Delete Users and Administrator Multiple users are able enter information into the Online Application. You are able to set-up multiple users with their own unique username and password to access the account. Step 1 On the Account Manager page, Click Add Users Field Name Information Format Instructions Username Text Field Enter e-mail address of user. Password Text Field Enter a password that meets the following requirements: 8-20 characters in length Contain at least one digit, at least one upper-case letter, at least one lower-case letter, and at least one symbol such as $ Password (confirm) Text Field Re-enter password. E-mail Text Field; must include @ Enter e-mail address of user.

14 Step 2 Step 3 Click Save/Update. Check proper roles are assigned to user: sysuser - a user able to view/edit the Online Application sysdmin - administrator of account If you need to change the role of user select the role and Click >,< buttons to change the role status. Step 4 To save and close a user Click the X button at the top right hand of box. Step 5 To edit a user Click Edit User on the username line under Modify on the Account Manager page.

15 Legal Documents with NCQA Before you can submit a PCMH 2011, PCMH 2014 or PCSP 2013 Application to NCQA, you must sign the Business Associate Agreement (BAA), and the PCMH 2011, PCMH 2014 or the PCSP 2013 Agreement electronically or manually based on which application you are submitting. If you are just submitting for PCMH 2011 you just need to sign the PCMH 2011 Agreement. If you are only submitting for PCMH 2014 you need to sign the PCMH 2014 Agreement. If you are just submitting for PCSP 2013 you need to sign the PCSP 2013 Agreement. For either application the BAA must be signed. See page # 18 for instructions.

16 Administrative Steps and Document Submission Information Entry Sessions Separate information entry sessions: You may work on the Online Application in as many time periods as you like; the module saves your information from one work session to the next. Multiple users for information entry: You may set up multiple users to access and to enter information into the Online Application. Logout: When you are finished with a session, click Logout to close the Online Application.

17 Completing Practice Site Information You must complete the Practice Site Information first for each Online Application. You only need to enter information for each practice site once. Step 1 Step 2 Step 3 From the Home Page, Click on the Click Here link to go to the Practice Sites page or Click on Practice Sites on the tool bar. You will be sent to the Practice Sites page. Answer the question Do you have more than one site? (If NO continue to the next step. If you answer YES, Click the link Click Here to see if you are eligible for multi-site submission). See multi-site step by step instructions guide to submit your application as multi-site. Field Name Information Format Instructions Your Practice Site Name * Text Field Enter the legal name of the practice. If the applicant is a solo practice or an individual Clinician applicant, enter the Clinician s name. Sponsor Name Text Field Enter the legal name of the sponsor, if you are a participant in a sponsored PCMH or PPC project. Practice NPI Text Field Enter the Practice NPI for the practice. *This is a required field for all NY practices. Certificate Name Text Field Enter the name of the practice as it will appear on the certificate. Address 1, 2, 3 * Text Field Enter the number and street mailing address of the practice. City * Text Field Enter the city name. State * Drop-Down Select the state from the list in the drop-down menu. Zip * Number Enter the zip code. You may enter the zip code + 4 here. **If you are in NY State you need to enter your zip code + 4 in order to participate in the NYS Medicaid Medical Home reimbursement program for PCMH. Practice Telephone Number FAX Number (XXX) XXX-XXXX Number (XXX) XXX-XXXX Enter the telephone number of the practice. Enter the fax number of the practice. Mailing Address Check Box Select box if the mailing address is the same as the practice site address.

18 Address 1, 2, 3 Text Field Enter the number and street mailing address of the practice. City Text Field Enter the city name. State Drop-Down Select the state from the list in the drop-down menu. Zip Number Enter the zip code. Primary Contact Information Contact Person * Text Field (First, Last) Enter first and last name for the person whom NCQA can contact regarding the Application. E-mail * Text Field; must include @ Enter the e-mail of the contact person. Title Text Field Enter the title of the contact person. Phone Number * Number (XXX) XXX-XXXX Enter the telephone number of the contact person. Step 4 Click Add Practice Site. Step 5 Step 6 Step 7 Enter information into the fields following the format and instructions below. (Required fields are denoted by *.) Click Save/Update to save information. Enter more practice sites if needed by clicking on Add Practice Site.

19 Adding Practice Site in Single Site application:

20 Edit a Practice Site Step 1 Step 2 Step 3 Step 4 Click on the [Site Name] under the Name column on Practice Sites page. Click Edit in Practice Site Information box. Edit information. Click Save/Update to save information.

21 Adding Applications to Practice Sites Step 1 Step 2 Click Practices Sites on toolbar. To add an application to a practice site, click the [Site Name] under the Name column. Single Site: Step 3 Click Add Application.

22 Step 4 Enter the ISS License provided by NCQA after ordering your survey tool and click Validate If the address doesn t match with the address on the survey tool order request, this window will appear which will prompt you to validate this license with the correct ISS userid.

23 Step 5 Enter information into the fields that are released after entering the Valid ISS License Number. Follow the format and instructions below. (Required fields are denoted by *). Use the table that is associated with the program you are submitting for PCMH 2011, PCMH 2014 or PCSP 2013.

24 Fields for PCMH 2011 and PCMH 2014 Application: Field Name Information Format Instructions ISS License Number * Text Field Enter the License number received from NCQA after ordering survey tool(s). Practice Site Specialties Drop-down Select primary care specialties represented at practice site. Practice Site Sub-Specialties Check Box Select Sub- Specialties represented at practice site. Practice Site Description Drop-down Select from the drop-down menu. Certified HIT Products List Text Fields Enter the name of the HIT Products List associated with this practice site. EHR Security Risk Analysis Radio Buttons Select Yes or No for the question. Fields PCSP 2013 Application Field Name Information Format Instructions ISS License Number * Text Field Enter the License number received from NCQA after ordering survey tool(s). Practice Site Specialties Check Box or Dropdown Select primary care specialties represented at practice site. Practice Site Sub-Specialties Check Box Select Sub - Specialties represented at practice site. Practice Site Description Drop-down Select from the drop-down menu.

25 Adding Clinicians to Practice Sites Step 7 Step 8 Step 9 Step 10 Add the clinicians that are associated with the practice site. Click Clinicians at this Practice Site- Add/Edit/Remove. You will be directed to the Clinicians Page. Click Add Clinician. Step 11 Enter information into the fields following the format and instructions below. (Required fields are denoted by *). Field Name Information Format Instructions NPI Number * Text Field Enter the Clinician s NPI number Clinician Name * E-mail Text Field (First, Middle, Last) Text Field; must include @ Enter the Clinician s first, middle and last names in the fields. Enter the e-mail of the Clinician. Credentials Drop-down Select from the drop-down menu. Tax ID # * Text Field Enter the Clinician s Tax Identification Number DEA # Text Field Enter the Clinician s DEA number Gender Drop-down Select Male or Female DOB Date Enter the Clinician s Date of Birth in format MM/DD/YYYY License Number * Number Enter the Clinician s license number for the state given in the Practice Site Info section (state of mailing address). License State * Drop-down Select the state from the list in the drop-down menu. Primary Board Specialty Drop-down Select the Clinician s specialty (e.g., internal medicine, orthopedic surgery, chiropractic ). Primary Board Number Text Field Enter the Clinician s primary board number Secondary Board Specialty Drop-down Select the Clinician s specialty (e.g., internal medicine, orthopedic surgery, chiropractic ). Secondary Board Number Text Field Enter the Clinician s secondary board number

26 Step 12 Click Save/Update to save information. Step 13 Step 14 Step 15 Step 16 Click Edit to edit Clinician Information. Click Save/Update after changes are made. Click Add Clinician to enter more clinicians. If you would like to delete a clinician, click Delete under the [Action] column and then confirm your choice by clicking Yes or No Add all clinicians to Application you are submitting for.

27 Adding Clinicians to an Application Step 17 Step 18 To add clinician(s) to an Application, Click the link under [Clinicians] column. **The link will say Empty if no clinician(s) are tied to the Application or will show the number of clinician(s) that are entered for the Application (e.g. 2 Clinicians). You can add/delete clinicians to the unsubmitted Application at anytime Click Add Clinician to Application in the List of Clinicians for this Application pop up box. Step 19 Step 20 Step 21 Select clinician s name you want to add and Click Select Applicant. Continue to add all of the clinician(s) tied to the application. Once all clinicians have been added to List of Clinicians for this Application, Click Accept.

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29 Completing the Legal Agreements, Adding Applications, and Entering Clinician Information Completing the Leal Agreements If you have not completed the Business Associate Agreement (BAA), PCMH 2011, PCMH 2014, or PCSP 2013 Agreement for your organization you will need to do so before submitting your Application. You may access all of the legal agreements for electronic or manual signature from the Account Manager screen. If you choose not to sign one or all of the legal documents electronically, you will need to download the appropriate document(s) and send in a signed hard copy of the document(s) to NCQA. To obtain a hard copy of the document(s) click on the document name. Then select the Click Here link on the document(s) starting page. Print out the document(s). If you have any changes you must red line them and the changes must be visible. Mail the signed copy(s) to NCQA at the following address. You will be notified by e-mail when the document(s) have been accepted and uploaded to your account. NCQA Patient Centered Medical Home Recognition Program 1100 13 th Street NW, Suite 1000 Washington, DC 20005 Follow these steps to complete your legal document(s) electronically. Below are the screen shots and steps for the BAA. The screens and steps are similar for the other legal document(s). ** If you are just submitting for PCMH 2011 you just need to sign the PCMH 2011 Agreement. If you are just submitting for PCMH 2014 you need to sign the PCMH 2014 Agreement. If you are just submitting for PCSP 2013 you need to sign the PCSP 2013 Agreement. For either application the BAA must be signed. Step 1 Click BAA in the Legal Document box on the Account Manager page.

30 Step 2 Read through Business Associate Agreement starting screen. Step 3 Click Begin Electronic BAA. Step 4 Enter information into the fields following the format and instructions below. (Required fields are denoted by *.) Field Name Information Format Instructions Authorized Representative Name * Text Field Enter the representative s first and last names in the fields. Title of Representative * Text Field Enter the title of the representative. Organization Covered Entity* Text Field Enter the name of the person responsible for signing the agreement. Covered Entity Attention To * Text Field Enter the name of the signed party. Covered Entity Street * Text Field Enter the number and street mailing address of the practice. Covered Entity City/State/Zip * Text Field Enter the city name, state, and zip of the signing party. Covered Entity E-mail * Text Field; must include @ Enter the e-mail of the signed party. Step 5 Click Generate Agreement PDF.

31 Step 6 Step 7 Step 8 Step 9 Read through the BAA. Select Click to E-Sign the Document. You can Print or Save the document by selecting the print or save icons at the top of the agreement. You can access your BAA at anytime by clicking Account Manager on the toolbar.

32 Submitting Information To submit your complete Online Application to NCQA, follow the instructions below. The six requirements for NCQA to review your information are: Signed Legal Documents Purchased survey tools for each practice site Completed application information Completed clinician information Matching license numbers in ISS and on practice site application Fixed any error messages How to submit your Application: Step 1 Step 2 Step 3 Step 4 Click Submit Application on tool bar. Review the instructions for submitting the Application. If you need to edit your Application click Edit under the [Action(s)] column. If you need to delete your Application click Delete under the [Action(s)] column. Step 5 Step 6 Step 7 Step 8 Click Submit under the [Action(s)] column to submit your Application. If your submission was successful you will receive an e-mail thanking you for your submission. If you do not receive a successful message from NCQA, please contact Customer Support. If you need to request an Add-On click Request Add-On under the [Action(s)] column. You will only be able to do this if you already submitted an application and survey before. NCQA will review your Online Application and notify you when you may upload your survey tool by e-mail within 5 days. Once an Application is acknowledged for submission, that Application is no longer available to un-submit.

33 Feedback NCQA welcomes any suggestions or comments you may have about the Online Application. To submit comments, log into the Product/Policy Clarification Support (PCS) system, http://ncqa.force.com/pcs/login or Contact Us at www.ncqa.org, and select Recognition Programs as the first dropdown option before entering your comment.