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Provider Enrollment, Screening & Monitoring (PRESM)Discover Your Provider (DyP): User Guide for a Facility EnrollmentVersion: 1.1Prepared for Wyoming Dept. of HealthSubmitted: center49466500Table of ContentsContents TOC \o "1-3" \h \z \u 1Introduction PAGEREF _Toc53996925 \h 62Getting Started PAGEREF _Toc53996926 \h 63Landing Page PAGEREF _Toc53996927 \h 64User Registration PAGEREF _Toc53996928 \h 75User Registration Page PAGEREF _Toc53996929 \h 86User Login PAGEREF _Toc53996930 \h 107Login Page PAGEREF _Toc53996931 \h 108Dashboard PAGEREF _Toc53996932 \h 109Enrollment Types PAGEREF _Toc53996933 \h 1110Security Sign PAGEREF _Toc53996934 \h 1111Starting the Enrollment Process for a Facility Enrollment Application PAGEREF _Toc53996935 \h 1311.1.1Identifying Information PAGEREF _Toc53996936 \h 1311.1.2Program Participation PAGEREF _Toc53996937 \h 1411.1.3Provider Identifiers PAGEREF _Toc53996938 \h 1511.1.4Address Details PAGEREF _Toc53996939 \h 1611.1.5Taxonomy/License/Affiliation Information PAGEREF _Toc53996940 \h 1811.1.6Primary Service Location Information PAGEREF _Toc53996941 \h 1911.1.7Secondary Service Location Information PAGEREF _Toc53996942 \h 2011.1.8Request Retroactive Adjustment PAGEREF _Toc53996943 \h 2211.1.9Ownership PAGEREF _Toc53996944 \h 2211.1.10Key Personnel PAGEREF _Toc53996945 \h 2411.1.11Exclusion/Sanction Information PAGEREF _Toc53996946 \h 2511.1.12Upload Documents PAGEREF _Toc53996947 \h 2611.1.13Authorized Signature PAGEREF _Toc53996948 \h 2811.1.14Affiliation PAGEREF _Toc53996949 \h 2811.1.15Provider Agreement Section PAGEREF _Toc53996950 \h 2811.1.16Payment PAGEREF _Toc53996951 \h 3111.1.17Summary PAGEREF _Toc53996952 \h 32Table of Figures TOC \h \z \c "Figure" Figure 1: Provider Enrollment Welcome Page PAGEREF _Toc53996963 \h 6Figure 2: Register to Provider Portal PAGEREF _Toc53996964 \h 7Figure 3: Register to Provider Portal continued PAGEREF _Toc53996965 \h 7Figure 4: Navigate to Login Screen PAGEREF _Toc53996966 \h 8Figure 5: Registration Successful Message PAGEREF _Toc53996967 \h 8Figure 6: Successful Registration Email Notification PAGEREF _Toc53996968 \h 9Figure 7: Confirmation screen PAGEREF _Toc53996969 \h 9Figure 8: Login Page PAGEREF _Toc53996970 \h 10Figure 9: Welcome page PAGEREF _Toc53996971 \h 11Figure 10: Security Sign PAGEREF _Toc53996972 \h 12Figure 11: Security Pop-Up PAGEREF _Toc53996973 \h 12Figure 12: Approved Provider Dashboard PAGEREF _Toc53996974 \h 13Figure 13: Facility Identifying Information section PAGEREF _Toc53996975 \h 14Figure 14: Program Participation section PAGEREF _Toc53996976 \h 14Figure 15: Provider Identifiers section PAGEREF _Toc53996977 \h 15Figure 16: Provider Identifiers section, part 2 PAGEREF _Toc53996978 \h 16Figure 17: Address Details section PAGEREF _Toc53996979 \h 17Figure 18: Address details section, part 2 PAGEREF _Toc53996980 \h 17Figure 19: Taxonomy/License/Affiliation Information section PAGEREF _Toc53996981 \h 18Figure 20: License and Certification Information tables PAGEREF _Toc53996982 \h 19Figure 21: Primary Service Location Information section PAGEREF _Toc53996983 \h 19Figure 22: Primary Service Location Information section, part 2 PAGEREF _Toc53996984 \h 20Figure 23: Secondary Service Location Information section PAGEREF _Toc53996985 \h 21Figure 24: Additional Service Location button PAGEREF _Toc53996986 \h 21Figure 25: Request Retroactive Adjustment section PAGEREF _Toc53996987 \h 22Figure 26: Ownership section PAGEREF _Toc53996988 \h 23Figure 27: Ownership Table example PAGEREF _Toc53996989 \h 24Figure 28: Key Personnel section PAGEREF _Toc53996990 \h 25Figure 29: Key Personnel table PAGEREF _Toc53996991 \h 25Figure 30: Exclusion/Sanction Information section PAGEREF _Toc53996992 \h 26Figure 31: Upload Documents section PAGEREF _Toc53996993 \h 27Figure 32: Successfully Uploaded Document Check mark PAGEREF _Toc53996994 \h 27Figure 33: Authorized Signature section PAGEREF _Toc53996995 \h 28Figure 34: Affiliation section PAGEREF _Toc53996996 \h 28Figure 35: Provider Agreement tab PAGEREF _Toc53996997 \h 29Figure 36: Provider Agreement Signature Loading page PAGEREF _Toc53996998 \h 29Figure 37: Provider Agreement, Signature page PAGEREF _Toc53996999 \h 30Figure 38: Provider Agreement, Signature page continued PAGEREF _Toc53997000 \h 30Figure 39: Provider Agreement: Final Signature page PAGEREF _Toc53997001 \h 30Figure 40: Provider Agreement: 'I agree' page PAGEREF _Toc53997002 \h 31Figure 41: Provider Agreement, Signed Document PAGEREF _Toc53997003 \h 31Figure 42: Payment Information details PAGEREF _Toc53997004 \h 32Figure 45: Summary section PAGEREF _Toc53997005 \h 33Figure 46: Dashboard page to navigate to Signature page PAGEREF _Toc53997006 \h 33Figure 47: Loading window for signature page PAGEREF _Toc53997007 \h 33Figure 48: Signature Page PAGEREF _Toc53997008 \h 34Figure 49: Signature Page after signing PAGEREF _Toc53997009 \h 34Figure 50: Agreement window for Signature page PAGEREF _Toc53997010 \h 35Figure 51: Successful Submission Pop-Up window PAGEREF _Toc53997011 \h 35Figure 52: Dashboard page that appears after submitting application PAGEREF _Toc53997012 \h 35Revision HistoryDateVersion #Assigned ByVersion01/27/20201.0TrainerCreation/Initial draft07/20/20201.0TrainerUpdated Initial draft08/27/2020 1.0TrainerSubmission10/19/20201.1TrainerResubmission IntroductionDiscover your Provider (DyP) is a solution built to provide wide-ranging functionality through the Provider Portal to include Provider Enrollment, Provider Self Service, and support for additional functionality. The purpose of the current guide is to provide useful enrollment information to facility providers. Also, this guide is intended to make the enrollment processes easier to navigate and understand. Facility providers must enroll using the Provider Enrollment portal to have the ability to submit claims and receive payment for covered services. After an enrollment application is submitted, a confirmation email is sent to the specified email address.Getting StartedBefore you begin the enrollment process, gather all the information you will need to enter during each step. Please review the following checklist:FEINNational Provider IdentifierLicense (if required based on Taxonomy) Landing PageThe Discover your Provider landing page is not only a ground for the provider registration and/or login, but also an instrument for patients to search for an acting provider in their area. The landing page also provides information on the system features as well as specific information for providers. Figure SEQ Figure \* ARABIC 1: Provider Enrollment Welcome PageUser RegistrationFor a new user to register in the system, take the following steps:On the landing page, click Sign In/Register.On the Login pop-up window, click Register.On the Register to Provider Portal pop-up window that opens, specify the following data and click Register: Email – email address, requiredPassword – password that must match the following criteria: 8 or more characters; upper- and lower-case letters; number and symbol; requiredValidate Password – confirm the passwordOrganization Name – the official name of organization, optionalOrganization Description – short description of an organization, optionalPrefix – name prefix, optionalFirst Name – first name, requiredMiddle Name – middle name, optionalLast Name – last name, requiredSuffix – name suffix, optionalPhone – phone number, requiredExtension – name extension, optional Figure SEQ Figure \* ARABIC 2: Register to Provider Portal Figure SEQ Figure \* ARABIC 3: Register to Provider Portal continuedUser Registration PageIf you moved to the registration page by mistake and you already have an account, click the Already have an account? Log in link (found below) to move to the Login page.Figure SEQ Figure \* ARABIC 4: Navigate to Login ScreenOnce you have entered the correct data and clicked Register, the Registration successful message is displayed. Follow the link from your designated email to confirm registration. Figure SEQ Figure \* ARABIC 5: Registration Successful Message Figure SEQ Figure \* ARABIC 6: Successful Registration Email NotificationOnce you click on the link you will be sent to this screen shown below. Click on the Back to Log In button and it will bring you back to the sign in page. Figure SEQ Figure \* ARABIC 7: Confirmation screenUser LoginTo log in to the system, on the landing page, click Sign In/Register. The Log into Provider Portal pop-up window opens. Specify the following data and click Log In:Username – email address specified during the registrationPassword – password specified during the registrationFigure SEQ Figure \* ARABIC 8: Login PageLogin PageIf you do not remember your password, click the Forgot password? Link and follow the steps to restore your password.If you are not registered in the system, click Register.Password ResetTo reset your password in case you forgot it, take the following steps:Click Forgot Password? On the user login page.On the Restore password page that opens, enter your email address and click Reset Password. Otherwise, click Back to Log In.Check your email and follow the link provided in it to restore the password.On the Change password page, enter your new password, confirm it, and click Change Password. The password change email confirmation is sent to you email address. DashboardAfter logging in to the Provider Enrollment Portal for the first time, the Welcome page is displayed.Figure SEQ Figure \* ARABIC 9: Welcome pageEnrollment TypesThe Provider Management system provides the following types of enrollment depending on the type of provider:Individual enrollmentGroup enrollmentFacility enrollmentPharmacy enrollmentOrdering/referring/prescribing provider enrollmentProvider Enrollment Manager enrollment Security SignIf you are logging in as an already enrolled provider, the Dashboard page has a different view with all functionality enabled. First however, you will see the following security sign: Figure SEQ Figure \* ARABIC 10: Security SignYou must click ‘Agree’ before you are able to proceed. This will occur every time you log into DyP. Once you click ‘Agree you will receive the following pop-up:Figure SEQ Figure \* ARABIC 11: Security Pop-UpNow that you have agreed and entered the secured website you are able to see the following on the DyP dashboard (if already enrolled). Figure SEQ Figure \* ARABIC 12: Approved Provider DashboardStarting the Enrollment Process for a Facility Enrollment ApplicationTo start filling in the facility enrollment application, follow the steps: On the Dashboard page, select the payer and the Facility Enrollment type. On the Facility enrollment application page that opens, fill in all the required sections, and click Submit on the final Summary page. Identifying InformationThe Identifying Information section asks about general information such as provider’s name, their FEIN number, their tax entity type, email, and whether they’ve ever used a different DBA name. The fields with an asterisk are mandatory fields that must be completed in order to submit the application. Figure SEQ Figure \* ARABIC13: Facility Identifying Information sectionProgram ParticipationThe Program Participation section is prefilled with Medicaid fee-for-service. The provider can click next knowing that this is the program they want to participate in. Figure SEQ Figure \* ARABIC 14: Program Participation sectionProvider IdentifiersThe current section is used to indicate the provider NPI, as well as indicate if a provider is already enrolled in another state and/or wants to participate in Medicare program. The National provider identification field has a verification mechanism for NPI numbers. While entering, the system provides the list of available NPIs that match the entered value. If the NPI number is not valid, it will be impossible to proceed with enrollment. There is also a table for Alternative identifiers. Figure SEQ Figure \* ARABIC 15: Provider Identifiers sectionFollowing the Alternative identifiers there are additional questions found in the Provider Identifiers section under the section title Additional Information.Figure SEQ Figure \* ARABIC 16: Provider Identifiers section, part 2Address DetailsThis current section includes information for provider mailing and billing information. On the first line denoted as the ‘Mailing address line 1’ type in your street address and then pause for a couple of seconds. If your address is found by the DyP system it will show the full address in a box on your screen. Click on your address. From there you will tab through the remaining fields and the application will populate the rest of the address for you. Figure SEQ Figure \* ARABIC 17: Address Details sectionFigure SEQ Figure \* ARABIC 18: Address details section, part 2Taxonomy/License/Affiliation InformationThis section you will select your taxonomy and additional taxonomy if applicable. Then you will add your license and certification information in the table if prompted to do so based on your taxonomy. Figure SEQ Figure \* ARABIC 19: Taxonomy/License/Affiliation Information sectionFigure SEQ Figure \* ARABIC 20: License and Certification Information tablesPrimary Service Location InformationIn the current section you will add your primary location address information and the contact person’s I information for that primary location. You can also specify the gender of patients to be served, their age range, spoken languages, specify if the service is available in all counties or not, and open office hours.Figure SEQ Figure \* ARABIC 21: Primary Service Location Information sectionFigure SEQ Figure \* ARABIC 22: Primary Service Location Information section, part 2Secondary Service Location InformationIn the current section you will add your secondary location address information and the contact person’s information for that location. You can also specify the gender of patients to be served, their age range, spoken languages, specify if the service is available in all counties or not, and open office hours. You can add a maximum of 9 additional locations this way.Figure SEQ Figure \* ARABIC 23: Secondary Service Location Information sectionFigure SEQ Figure \* ARABIC 24: Additional Service Location buttonRequest Retroactive AdjustmentThis section gives you the option to state if you would like your enrollment to be retroactive. By selecting yes, two lines will populate allowing you to fill in the reason and the date for which you’d like your enrollment to begin on. The second question is regarding if you are an out-of-state provider and whether you are enrolled with another Medicaid or CHIP program. By selecting yes, four fields will populate so that you may enter the following elements: Other Medicaid State, State Program, Enrollment Begin and End dates. Figure SEQ Figure \* ARABIC 25: Request Retroactive Adjustment sectionOwnershipThe current section is used to indicate whether provider has ownership of an organization billing Medicare and/or if any of the provider family are related to the provider practice.Figure SEQ Figure \* ARABIC 26: Ownership sectionIf you select “Yes” to any of the questions a table will populate specific to the question so that you may enter in the pertinent information. See below screenshot for an example. Figure SEQ Figure \* ARABIC 27: Ownership Table exampleKey Personnel This section is for if you have a Managing Employee such as a Director, Supervisor, Manager, Officer, and/or Agent that you want documented on the enrollment. When you click on the + ADD LINE button it opens a table for you to fill out with all their important information. Figure SEQ Figure \* ARABIC 28: Key Personnel sectionFigure SEQ Figure \* ARABIC 29: Key Personnel tableExclusion/Sanction InformationThe current section is used to indicate whether a provider or provider family member were convicted of a felony or excluded from a federal program and if there were any criminal fines, administrative sanctions, program exclusions, suspension of payments, etc. Note that these questions are mandatory. You must select Yes or No for each in order to submit your application. Figure SEQ Figure \* ARABIC 30: Exclusion/Sanction Information sectionUpload DocumentsThe current section is used to upload different files and documents to accompany the enrollment application. These files include current effective and non-expired license, board certification, NCQA Accreditation, etc. These documents must be attached to the corresponding sections. Figure SEQ Figure \* ARABIC 31: Upload Documents sectionOnce you have uploaded a document you will see the title with a white checkmark in a green circle under the section where you uploaded the document. See screenshot below. Figure SEQ Figure \* ARABIC 32: Successfully Uploaded Document Check markAuthorized SignatureThe current section provides information on a person who is submitting the enrollment including the electronic signature, title of a person submitting enrollment, and submission date.Figure SEQ Figure \* ARABIC 33: Authorized Signature sectionAffiliationThe current section allows adding existing enrolled providers through affiliation. A group provider enters NPI or FEIN number of a provider to be added, the system checks if this provider exists in the system and if their enrollment is approved. Figure SEQ Figure \* ARABIC 34: Affiliation sectionIf a provider exists (enrolled and approved), group provider clicks ‘Add’ and in the pop-up that opens, specifies the following data: Affiliation type - can have one of the following values: Group to individual Group to group Affiliation effective start and end dates - affiliation start and end dates Provider Agreement Section This section is where the user will read through, understand the agreement, and then sign the document. To electronically sign the agreement, click on the ‘Agree and Sign’ button found at the bottom of the tab. Upon submitting your signature, you will return to the tab. Then scroll back to the bottom of the page and click the ‘Next’ button. The next several screen shots depict the signing process. Figure SEQ Figure \* ARABIC 35: Provider Agreement tabFigure SEQ Figure \* ARABIC 36: Provider Agreement Signature Loading pageFigure SEQ Figure \* ARABIC 37: Provider Agreement, Signature pageFigure SEQ Figure \* ARABIC 38: Provider Agreement, Signature page continuedFigure SEQ Figure \* ARABIC 39: Provider Agreement: Final Signature pageFigure 40: Provider Agreement: 'I agree' pageFigure SEQ Figure \* ARABIC 41: Provider Agreement, Signed DocumentPayment If you must pay a payment this screen will be active. Click on ‘DOWNLOAD INVOICE’ to complete your payment to enroll in the program. Figure 42: Payment Information detailsOnce you have downloaded the invoice open it up and follow the instructions inside. When sending a check make the check payable to ‘Wyoming Medicaid’ or ‘Division of Healthcare Financing’. Send your payment by check to 2515 Warren Ave, Suite 503, Cheyenne, WY 82001. After you have successfully downloaded the invoice the user will be sent back to their application and they will be brought back to the Payment tab. From there click on ‘Next’. SummaryOn the Summary section, provider certifies that the entered information is true, accurate, and complete by selecting the corresponding Sign and agree to Terms and Conditions option. Clicking ‘Proceed to Sign’ navigates provider to the Dashboard page from where they can sign an application.Figure SEQ Figure \* ARABIC 45: Summary sectionYou will then be brought to the following set of screens so that you may electronically sign your application. Figure SEQ Figure \* ARABIC 46: Dashboard page to navigate to Signature pageThe screen below appears while the signature site is loading. Figure SEQ Figure \* ARABIC 47: Loading window for signature pageThen this screen appears. It will have all your information. Click on “Get Started”. Figure SEQ Figure \* ARABIC 48: Signature PageOnce you have electronically signed the document twice you will get the green banner asking you to ‘Please click Continue’. Figure SEQ Figure \* ARABIC 49: Signature Page after signingAfter you click ‘Continue’ you must agree to the Terms of Service by clicking ‘I agree’. Figure SEQ Figure \* ARABIC 50: Agreement window for Signature pageThen you will be brought back to the DyP portal where the following message will be displayed. Figure SEQ Figure \* ARABIC 51: Successful Submission Pop-Up windowOn the finish page, click Navigate to dashboard to view the status of your submitted application (can be already under review by an internal user). Figure SEQ Figure \* ARABIC 52: Dashboard page that appears after submitting applicationFrom this page (Figure 52), you can view or download the application package by clicking the corresponding buttons. The attachments zip application package archive includes the following documents:enrollmentApplication.pdfPayment_receipt <number>.pdfPlus, documents uploaded on the Upload documents tab during the application fill-in (if any) ................
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