District of Columbia Department of Health Care Finance Provider …

District of Columbia Department of Health Care Finance Provider Data Management System and Service (PDMS) Project

How to Enroll in DC Medicaid Using the DC Provider Screening and Enrollment Web Portal

Version 2.0 April 29, 2019

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Date 01/19/2016 02/02/2016 02/06/2016 04/12/2016

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4/29/2019

Description Create document from template.

New Template

Updated template for general use

Updated Information to reflect DC PDMS project Editing and formatting

Review and Edit

Final Formatting

Review and Final Edit

Updated with screen shots

Updated with New System Changes

Review and Edit

Updated with new screen shots for Provider update functionality changes Review and Edit

Review and Edit

Edit and Update

Review

Review

Edit and Update

Review and Update

Edit and Update

Review and Update

Updated with new screen shots for Waiver Services and the Application Fee page to reflect the current amount Updated the Professional License section to include directions & screen shots for Medical Residents documents uploads. Updated with New System Changes, Screenshots Updated with System Changes

Author Margalit De Gosztonyi Benni DeMarco Margalit De Gosztonyi Margalit De Gosztonyi

Margalit De Gosztonyi Awilda Ortiz Margalit De Gosztonyi Awilda Ortiz Kelly Micka Natasha Hudson Awilda Ortiz Natasha Hudson

Awilda Ortiz Patricia Squires Natasha Hudson Dawn Gelle Awilda Ortiz Natasha Hudson Awilda Ortiz Natasha Hudson Venita Stratford Eugene Eaton

Eugene Eaton

Eugene Eaton

Eugene Eaton

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Table of Contents

Overview Creating a User Account Provider Management Home (New application) Reactivating Providers Application and Provider Types Identification- Provider Information Screen Identification-Primary Contact Information Specialties Taxonomies Professional Liability Professional License DEA CDS Categories of Service Medicare Number Primary Service Address Office Hours Affiliations W9 Malpractice Claims History Required Documents Agreement Questions Agreement Waiver Services Submitting Updates to the Provider File Application Fee

4 4-6

7 8 9-12 13-14 15 16 16 17 18 19 19 20 20 21 22 23 24 25 25 26 27-28 29 30-32 32

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Overview The PDMS Web Portal user guide provides step by step instructions on how to submit an electronic application. The PDMS dashboard displays data for each stage of the enrollment process and allows providers to start a new application or take action on previously submitted applications and re-enrollments. From their dashboard, Provider Enrollment Specialists can view the current status of new provider applications as well as initial/ongoing re-enrollments. Their dashboard tracks the aging of each provider application based on the workflow step/status of the application.

Creating a User Account The first step to submitting an online application is to create User Account in the DC Provider Data Management System (PDMS) Web Portal. Click on Create Account

? Enter your Tax ID ? Either your Social Security Number (Individual) or EIN (Organization) ? Select the correct Tax ID Type ? Enter your NPI ? Click Next

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Creating a User Account ? Cont.

? Enter all required information ? see example below ? Click Register

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Creating a User Account ? Cont.

After successfully creating the account, a notification will appear and a confirmation email will be sent to the email address provided.

The email contains a link to the Web Portal to log in to your account using the User Name and Password you created.

? Enter the User ID and Password you created ? Click Log In

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Provider Management Home Page

To ensure you are selecting the correct application please review the summary next to each application description, this summary will include any specific instructions for that application type. Once you have selected your application, click Begin New Enrollment

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Reactivating Terminated Providers

If you are a terminated provider who would like to reactivate your provider file, for the purpose of completing a reenrollment or submitting an updates in the Provider Data Management System. Please follow the instructions listed below. 1. Login to your provider file using your user ID and password. Note If it has been over 60 days since your termination, there will be a gap in your enrollment with DC Medicaid from your termination date to your re-enrollment date.

2. Under the Manage Provider section you will see the hyper link Reactivate Provider click it.

3. After clicking Reactivate Provider you will be able to complete the provider reenrollment or update in the Provider Data Management System.

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