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Mainecare Application Form - DOC by qxa99742


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									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.
I am a sole proprietor dentist and I own my    Yes.
practice. I have a hygienist. Am I a Type
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.
I am an Atypical Provider. Do I need an        No. An Atypical Provider Identifier (AP1) will be assigned by MIHMS.

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
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
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
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

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

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.
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
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

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.
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

Is there a fee to bill directly through your   No.
Will providers be able to be paid              Yes.
electronically once MIHMS is

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

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.
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
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

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

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.
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.

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