"Mainecare Application Form - DOC"
MaineCare Provider Re-enrollment for Maine Integrated Health Management Solution (MIHMS) Frequently Asked Questions from Re-enrollment Training June 25, 2009 Question Answer Do providers have to re-enroll to be able to Providers must re-enroll in order to submit claims to MaineCare when submit claims in 2010 when MIHMS (the MIHMS becomes operational. “new system”) is in place or can we just use our current NPI/billing criteria? When will re-enrollment begin? The MIHMS provider portal is now expected to be available in July. Re- enrollment will be “open” only to specific types of providers during specific times, based on the three re-enrollment cycles. Providers will receive written notification of their time for re-enrollment and should not attempt to re-enroll prior to their assigned cycle. What is a portal? A web portal is a web site that creates a single point of access to information collected from different sources. A portal offers a structured approach to navigating information, i.e. re-enrolling as a MaineCare Provider or researching claims payments. Is there a filter that provides information If a provider re-enrolls electronically, they will only see the information about other providers and types I don’t that pertains to them. The portal interprets answers and displays specific need, that I can use so I don’t get questions that pertain to the provider type and specialty for that re- information that does not pertain to me? enrollment. Will MIHMS be able to handle all the re- Yes. enrollments at the same time? Do we need special software to go to on- No. The re-enrollment and continuing maintenance will be accessed on- line maintenance or to re-enroll? line. Providers only need a web browser such as Microsoft internet Explorer, Mozilla, Firefox or Netscape Navigator. I have a dial-up internet connection. Will Dial-up may not be too slow for using the MIHMS portal. Providers can this be too slow to do an on-line also save the application and come back to it later. This is done by application? choosing the resume option and having the enrollment case number (ECN) ready to get back in to the application. If my computer crashes when filling out the No. The information up through the last screen completed will be saved online application, does that mean I have to automatically by clicking the “next” button. A provider would need to withdraw? select the appropriate button to withdraw the application. I am an individual, but I also work in a Individual providers only need an individual Type 1 NPI. The clinic should clinic. Do I need a separate NPI for the enroll this provider as a rendering provider, using their Type 1 NPI. clinic? I am a sole proprietor dentist and I own my Yes. practice. I have a hygienist. Am I a Type 1? I am an Audiologist, my practice is This provider needs a Type 1 Individual NPI for themselves and a Type 2 incorporated and I provide waiver services. Organizational NPI for the practice. Waiver services do not require a Do I need two NPIs? separate NPI nor do they require a separate re-enrollment. I am a waiver provider. Am I an FAO Residential Facilities are FAO. Individuals operating as a Group or FAO (facility/agency/organization) or an should choose a Type 1 NPI. Individual? I am an Atypical Provider. Do I need an No. An Atypical Provider Identifier (AP1) will be assigned by MIHMS. NPI? I have two (2) NPIs. Do I need to do two Yes, if the provider intends to use both NPIs with MaineCare, they will separate re-enrollments? need to re-enroll the two as separate enrollments. Some providers have obtained NPIs for a “private” source of income not related to MaineCare. Those NPIs do not have to be enrolled with MaineCare. Do ambulance services require an NPI? Ambulance services are considered to be healthcare services and therefore must obtain an NPI. I am a Pharmacy/DME provider with two A separate NPI is not needed for the DME. However, if a provider such as MaineCare IDs. Do I need a separate NPI this wants a separate NPI for DME and has enumerated that way with for the DME services? Medicare, they should re-enroll the same way with MaineCare. I have an NPI but have three people who The answer depends on the type of services provided. If rendering work for me, providing services. Do they providers are needed on the claim form (formerly known as servicing need an NPI? providers), a Type 1 Individual NPI will be needed and the three working for the primary provider will need to be re-enrolled with their individual NPIs. I have a nurse practitioner without an NPI, The Nurse Practitioner MUST obtain an NPI to submit claims to MaineCare but she has a MaineCare ID. She cannot once MIHMS is implemented. There is no requirement in the NPI get her NPI because she has not provided application that prevents this Nurse Practitioner from obtaining an NPI. services for two years. She is supervised The nurse practitioner should contact NPPES at 1-800-465-3203. TTY is by a physician. How will I bill for her 1-800-692-2326. Email is email@example.com services? Our organization has two (2) sites. Can we Yes. However, if more than one MIHMS provider type is located at either re-enroll both sites under one (1) pay-to of the two locations, a second NPI to fully re-enroll each site may be NPI? needed. How do I find out if I need another NPI if I For Education Related Service providers who also provide Case am an Education Related Service Provider Management Services, the allowed services will include case management and I also provide Case Management? codes. These providers do not need to enroll as a Case Management Provider Type, nor obtain a second NPI. Individuals are only allowed to obtain one NPI. Can I have two addresses under one NPI? I Providers can have many addresses under one NPI. If there are two have one service with two direct sites and different MIHMS Provider Types at the same physical address, however, a one office with two different programs. second NPI is needed to re-enroll the second MIHMS Provider Type. Free standing habilitation and day habilitation are both considered atypical Also, can I get one check for adults and services, not health care services and can be re-enrolled for MIHMS children, free standing day habilitation and without an NPI. MIHMS will assign Atypical Provider Identifiers (API) for day habilitation? these services. If such providers have obtained a separate NPI for these, however, they will be allowed to use it to re-enroll Atypical Services. Checks will be issued to each Pay-To NPI. The number of Pay-To NPIs a provider has will determine the number and composition of the checks received. Can you use a PO Box for a Pay-To Yes, if the PO Box is used on your W-9. However, PO Boxes may not be address? used for the “Physical Address” of service locations. I have direct deposit. Do I still have to Yes. Providers will need to enter whatever address is listed on the W-9. enter a Pay-To address? An individual provider who is incorporated Yes, a Type 2 Organizational NPI is obtained for the corporation. Such has a Type 2 NPI? providers will also need to obtain a Type 1 Individual NPI. If a provider organization was not Yes, such a provider would terminate the earlier application and then re- incorporated and then became a enroll using the corporation NPI. corporation, does it need a new NPI and does the provider need to re-enroll? Will information be transferred from No information will be transferred from MeCMS to MIHMS. Information MeCMS or the National Provider Identifier contained in the NPI database will be uploaded and those fields that are (NPI) database? need for the MIHMS re-enrollment will be displayed to the provider. I have two (2) organizations, one is out-of- The out-of-state location will need to be identified as the pay-to address for state and one is in Maine. We only provide this re-enrollment. services in Maine and the out-of-state is the pay-to location. Do I need to re-enroll the out-of-state? I am a mental health (Psychotherapy) The behavioral health clinician provider type includes Licensed Clinical provider. Will I be re-enrolled as a Professional Counselors (LCPC), Licensed Clinical Social Workers behavioral health type? (LCSW), Licensed Marriage and Family Therapists (LMFT) and Psychologists. Psychiatrists should re-enroll as physician provider types. Advanced Practice Psychiatric Nurses will re-enroll as advanced practice registered nurse provider types. I am a physician and I’m allowed to In order to provide Mental Health Services as an independent practitioner, a prescribe medications, but I’m not allowed provider must be one of these provider types: Psychiatrist, License to provide counseling. How do I group Psychologist, Psychological Examiner, Licensed Clinical Professional physician and mental health? counselor (LCPC), Licensed Clinical Social Worker (LCSW) or Licensed Marriage and Family Therapist (LMFT) who practices independently. Will MIHMS process Maine Breast and MIHMS will process MBCHP claims. Providers must re-enroll for Cervical Health Program (MBCHP) claims MIHMS and re-enroll in the MBCHP program to continue providing and does a provider have to re-enroll with MBCHP services. MBCHP? Or will MBCHP re-enroll the provider? Is the re-enrollment requirement for all No, MaineCare provider IDs are required to assist MIHMS in matching current MaineCare provider ID numbers NPIs to MaineCare numbers for historical purposes. because we may have outstanding claims? Should we put old provider numbers pre- No. Pre-MeCMS IDs should not be entered for MIHMS re-enrollment. MeCMS into MIHMS? A husband and wife both have separate ID Older claims not yet processed in MeCMS will not transfer to MIHMS, but numbers. The wife provides services the continue to be worked and paid through MeCMS. Re-enrollment is for the husband does not. The husband has claims purpose of submitting new claims and continuing to receive payment, once in MeCMS that have not yet paid. Does he MIHMS is operational. need to re-enroll to keep his provider ID open so old claims can still process and be paid? Can the MaineCare Benefits Manual be The MaineCare Benefits Manual is available on the internet. The web downloaded prior to re-enrollment? address for this is http://www.maine.gov/sos/cec/rules/10/ch101.htm Our organization changed form a sole This provider should use the date the organization changed to a LLC. proprietorship to a Limited Liability Corporation (LLC). What start date should we use? How long will it take for a re-enrollment to The time for approval of re-enrollments will depend on the complexity of be approved or denied? the enrollment application. What are the reasons for a denied re- Possible reasons a provider re-enrollment application could be denied enrollment application? include: - Provider license is expired and not renewed - Provider has been sanctioned by Medicare or Medicaid - MaineCare does not cover services offered by the provider - Provider does not meet MaineCare requirements as outlined in the MaineCare Benefits Manual Do pharmacists require rendering No. providers? I am an ambulance service. Are all my No. technicians rendering providers? I am an individual practitioner with Physician’s Assistants should be re-enrolled as rendering providers. Physician’s Assistants. Are the Physician’s Assistants rendering providers? Will providers be able to submit claims and Yes, providers are encouraged to submit claims electronically to MIHMS. bill electronically? In addition to the standard HIPAA electronic claims (837), providers will be able to submit claims through Direct Data Entry (DDE) to the provider portal. Training for billing will be scheduled prior to MIHMS implementation. Is there a fee to bill directly through your No. system? Will providers be able to be paid Yes. electronically once MIHMS is implemented? I currently send claims through a Paper checks will continue to be available once MIHMS is operational. clearinghouse and I receive paper checks. However, providers who wish to sign up for electronic funds transfer (EFT) Will this process automatically update to should contact the MaineCare Provider Enrollment Unit at (207)287-4082 electronic funds transfer (EFT) with or 1-800-321-5557, MIHMS and will EFT be mandatory? Option 6. This unit will send a form to be completed and added to the Provider Agreement. Will we still need a billing agent or This really depends on how the provider intends to submit claims to clearinghouse once MIHMS goes live? MIHMS. MIHMS will be fully compliant with HIPAA. If the provider uses a billing agent or clearinghouse solely because of MeCMS issues, they may no longer need to use either. Will providers still be able to verify Yes. eligibility by phone call? Will providers still be able to get the Self Yes, providers should contact their resource coordinator at the Office of Assessment Survey (SAS) information? Adults with Cognitive and Physical Disabilities for this. What if the service location is the patient’s Patient or member homes should not be used as a service location. The home – does the provider add the member’s office from which the service is provided is what should be used. If the home as a service location? provider is an individual operating out of their home, their home address is the service location. Otherwise, the office address should be used. I am a provider that provides services The patient’s school, daycare or home should not be used as a service wherever the child is – school, daycare, or location. The office from where the service is being provided is what home. Do I need to enroll all sites where should be used for re-enrollment. If the provider is an individual operating the clients are or can I use my home office out of their home, their home address is the service location. Otherwise, the location? office address should be used. Does every provider have to register at Yes. least one site for a service site? If you add a second site, will you need to Yes, providers must respond to the questions for each service location. The answer all the same questions again? exception to this is that providers can default the Physical and Mailing Address to the W-9 address information. What do we put for a site name? Providers should use whatever familiar name they would like to call the site. Is the address listed on the re-enrollment The address used for documentation to be mailed to the provider is listed on where the application with wet signature is the Documentation Screen of the provider portal. sent? Does the MIHMS re-enrollment ask if a Not at this time, but the possibility of this is being checked. provider offers American Sign Language? I am an ambulance provider. I do not Providers need a Trading Partner Agreement (TPA) if they intend to use understand the Trading Partner. I have a any of the electronic tools that will be available for MIHMS. These include billing agent and my NPI. Why do I need a the submission of claims through Direct Data Entry (DDE) and the ability Trading Partner Agreement? to research eligibility or claim status or electronic remittance advices (ERA). The TPA specifies rules for sharing electronic data between the provider and MIHMS. If providers never intend to use the MIHMS portal for any purpose, they do not need to sign a TPA. Providers may also choose to enter into a TPA at a later date if they decide to access data through the MIHMS portal. Can a billing provider and their Yes. In fact, both must have their own TPA if they both intend to access or clearinghouse both have Trading Partner transfer health information with MIHMS. Agreements (TPA)? What is the process for the Trading Partner Clearinghouses will register with MIHMS first as soon as the Portal goes Agreements? live. They will sign a Trading Partner Agreement (TPA) and receive a USER ID and password. Once a Provider re-enrolls and their re-enrollment is approved, they will then sign a TPA and receive a User ID and password. Billing Services will register after providers have re-enrolled and will associate with providers using their enrollment PIN number Can I be my own contact person? Yes. A question about Board Members. Is the Yes, the requirement is to list all board members (voting and non-voting) re-enrollment requirement for voting or and to update this information as it changes. This is a CMS (Centers for non-voting members? Do providers update Medicare and Medicaid) requirement. these as they change? Do all board members or owners need to The “yes” and “no” questions on the CMS Form 1513 are asked in the answer all the CMS “yes” and “no” plurality. For instance “Are there any members of the Board …?” If any questions? question is answered “yes,” an explanatory comment is required identifying the details of each board member to whom the “yes” applies. The forms’ questions need to be answered only once. We are non-profit. Do we need to enter all Yes. board members? We have board members re-appointed. Do No. The only time board members need to be terminated is when they are I have to term them and re-open them? not re-appointed. For owners or board members, would I Please enter the board member’s home address. enter their home address or business address? What if I am waiting for my new license? Yes, a license date must be entered for re-enrollment because the provider Do I enter my expired license expiration portal will not allow the re-enrollment to continue if a date is not entered. date? The license will be verified by the State during the review of application workflow. If my license expires, will I receive Yes. A notice that a provider license is about to expire within 60 days is notification that my license has expired? sent directly to those providers enrolled as independent practitioners. The notice is sent to the group or organization if a provider is enrolled as rendering provider by them. Does the system accept the national license MIHMS will require whatever license is required under MaineCare policy. or only Maine licenses? At this time, only Maine licenses are accepted. Providers should refer to their section of MaineCare Policy for more detail. What is “PCCM”? PCCM stands for Primary Care Case Management. Details on PCCM is available on the MaineCare web site at http://www.maine.gov/dhhs/oms/providerfiles/provider_managed_care.html Will the PCCM question appear for any No. The PCCM screen will only display to provider types that are eligible and all provider types? to provide this service. What should providers use for their Providers should use the date they began as a Medicare provider. Medicare start date? Does my name need to match my W-9 The provider name should match exactly as it is listed on the W-9 as this is form? Can I use an initial instead of a a federal form. middle name? Can we have more than one person under Yes. contracts? Who is Unisys and what is its association? Unisys Corporation is a provider of information technology services and programs. Unisys was selected to act as the Fiscal Agent for Maine’s Department of Health and Human Services. A fiscal agent is a vendor that develops a Medical Management Information System (MMIS, otherwise known as the claims processing system) and operates certain services on behalf of the State. Fiscal agents are in use in 37 states.