Maine Integrated Health Management Solution
Enrollment Guide for NOPR Providers

Maine Integrated Health Management Solution

Enrollment Guide for
Non-Billing, Ordering, Prescribing, and Referring (NOPR)Providers

Version 2.0

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MIHMS_EG_0011_v1.1_20180427.docPage 1
Last updated: 04/27/2018

Maine Integrated Health Management Solution
Enrollment Guide for NOPR Providers

Revision History

Version / Date / Author / Action/Summary of Changes / Status
0.1 / 02/23/2016 / Kari Keller / Creation per ACA Provider Revalidation CR41423 / Draft
0.1 / 03/10/2016 / Rebecca Labbe, Pam Foster / Updates per State and Molina work stream review. Additional updates per ACA changes. / Draft
0.1 / 09/26/2016 / Pam Foster / QA review and prep for formal submission / Draft
0.2 / 11/04/2016 / Rebecca Labbe, Pam Foster / Updates per State comment log v0.1 dated 10/21/2016 / Draft
1.0 / 12/28/2016 / Darcy Casey / Finalization per State approval email / Final
1.1 / 04/27/2018 / Rebecca Labbe,
Pam Foster / Updates to Sections 1 & 7, and Figures 6-4, 7-1 & 12-2 per CR70672 / Draft
1.1 / 05/04/2018 / Ryan Albrecht / QA review and preparation for State submission / Draft
2.0 / 05/17/2018 / Ryan Albrecht / Finalization per State acceptance email dated 05/17/2018 / Final

Usage Information

Documents published herein are furnished “As Is.” There are no expressed or implied warranties. The content of this document herein is subject to change without notice.

HIPAA Notice

The Maine HealthPAS Online Portal is for the use of authorized users only. Users of the Maine HealthPAS Online Portal may have access to protected and personally identifiable health data. As such, the Maine HealthPAS Online Portal and its data are subject to the Privacy and Security Regulations within the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 (HIPAA).

By accessing the Maine HealthPAS Online Portal, all users agree to protect the privacy and security of the data contained within as required by law. Access to information on this site is only allowed for necessary business reasons, and is restricted to those persons with a valid user name and password.

Table of Contents

1.Introduction

2.Information Needed

3.System Requirements

4.Public Navigation

4.1Home

4.1.1Health PAS Online Banner

4.1.2General Sub-Tab

4.1.3Member Sub-Tab

4.1.4Provider Sub-Tab

4.2Contact Us

5.Provider Enrollment Application (PEA) Navigation

5.1PEA Banner

5.2Help Links and Guidance

5.3Navigation Features

6.Trading Partner Login

7.Start the PEA

8.Provider Enumeration Information

9.Ordering/Referring Providers

9.1Ordering/Referring Provider

9.2Provider Type/Specialty

9.3Ordering Provider Taxonomy

10.Documents

10.1Additional Terms

10.2Supporting Documents

11.Signature

11.1Signature

11.2Summary

12.Resuming an Enrollment

13.Provider Enrollment Application Statuses

List of Figures

Figure 41: Sign In Hyperlink

Figure 42: Health PAS Online Banner

Figure 43: General Sub-Tab

Figure 44: Member Sub-Tab

Figure 45: Provider Sub-Tab

Figure 46: Contact Us Screen

Figure 51: PEA Banner

Figure 52: Help Links & Guidance Section

Figure 53: Navigation Menu

Figure 54: Command Buttons Example

Figure 55: Required Field Examples

Figure 56: Header Fields

Figure 61: Sign In Hyperlink

Figure 62: Sign In Screen

Figure 63: Provider Enrollment Hyperlink

Figure 64: PEA Screen

Figure 71: PEA Hyperlinks

Figure 81: Start Enrollment Screen

Figure 91: Ordering/Referring Provider Screen

Figure 92: Ordering Provider Conviction Section

Figure 93: Provider Type/Specialty Screen

Figure 94: Additional Fields

Figure 95: Ordering Provider - Provider Type/Specialty Dialog Box

Figure 96: SAVE & CONTINUE Button

Figure 97: Ordering Provider Taxonomy Screen

Figure 98: Lookup Search Screen

Figure 101: Additional Terms Screen

Figure 102: Supporting Documents Screen

Figure 103: Document Upload Dialogue Screen

Figure 104: File Uploaded Successfully Message

Figure 111: Signature Screen

Figure 112: Signature Affiliation Dialogue Box

Figure 113: Signature Affiliation Dialogue Box

Figure 114: Summary Screen

Figure 121: Provider Enrollment Hyperlink

Figure 122: My Enrollment Applications Table

List of Tables

Table 1: Communication Types

Table 2: Command Buttons and Descriptions

Table 3: Enrollment Statuses and Definitions

MIHMS_EG_0011_v2.0_20180517.docPage 1

Last updated: 05/17/2018

Maine Integrated Health Management Solution
Enrollment Guide for NOPR Providers

1.Introduction

This user guide describes the enrollment process for Non-Billing, Ordering, Prescribing, and Referring (NOPR) providers enrolling or re-enrolling in the MaineCare program.

Providers enroll in MaineCare based on the organization types described below:

An individual provider is a provider that owns and operates their own practice or otherwise provides healthcare services under their Social Security number (SSN) and a Type 1 Individual National Provider Identifier (NPI). An individual provider may associate to other entities as a rendering provider. An individual provider employed by an organization is re-enrolled by that organization as a rendering provider when required by MaineCare or the Centers for Medicare & Medicaid Services (CMS).

A NOPRprovider orders, prescribes, or refers services for MaineCare members. Billing providers are required to submit theNPI of the ordering, prescribing, or referring provider on certain claims to receive reimbursement for the service. This includes all prescription claims as well as claims from the following providers:

  • Clinical laboratories for ordered tests
  • Imaging centers for ordered imaging procedures
  • Supplies of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

NOPR providers must be enrolled in MaineCare with a Type 1 Individual NPI. NOPR providers may enroll independently or be enrolled as part of a provider that is enrolled in MaineCare. If the user provides services for a group or organization that is enrolled in MaineCare, please discuss the NOPR provider enrollment with them. If the user is enrolled as an individual provider, or is enrolled as a rendering provider employed by a group or organization, the user does not need to have a separate NOPR provider enrollment.

If the provider whois enrolling is not a NOPR provider, refer to the Enrollment Guide.

In the following sections, identify the information that must be readily available before starting the enrollment process, as well as, a detailed description of how to complete each of the enrollment steps.

2.Information Needed

Before initiating the enrollment process, gather all necessary informationto enter during each step.

For a complete list of the information, forms and other documents needed to enroll a provider, refer to the Enrollment Checklist.

3.System Requirements

To successfully use all Provider Enrollment Application (PEA)features of the MIHMS Health PAS Online Portal (online portal), ensure that the computer system meets the following minimum requirements:

  • Reliable online connection
  • Web browser—the latest version of Microsoft Internet Explorer is recommended. As new versions of Internet Explorer become available it is recommended that these versions are used.
  • The latest version of Adobe Acrobat Reader

4.Public Navigation

The following screens of the online portal are accessible to all visitors: Home, News, Contact Us, and Provider Directory.

4.1Home

The Home screen includes the Health PAS Online navigation bar, and the following three sub-tabs: General, Member, and Provider. Refer toFigure 41below.

Figure 41: Sign In Hyperlink

4.1.1Health PAS Online Banner

Located on the top of each screen, the banner provides a list of all the functions available to the provider from the current screen. This list may be different for each provider because it is based on user permissions. Some of the functions may include the following:

  • Enable Accessibility – When the Enable Accessibility hyperlink is clicked, it enables the website to present information in a way that is more understandable for accessibility software such asJob Access With Speech (JAWS).
  • Help – This is basic website functionality help.
  • Sign In or Register – These hyperlinks allow the provider to sign in or register. Use the Register hyperlink if you are a first-time user and use the Sign In hyperlink if you are an existing user.
  • Search field – This allows the provider to enter search criteria and complete a basic website functionality search. In Health PAS Online, all search fields perform partial search without wildcards. Refer to Figure 42 below.
  • A language drop-down list contains available languages. English is the default language.

Figure 42: Health PAS Online Banner

4.1.2General Sub-Tab

The General sub-tab provides information about the MaineCare program for members, providers, trading partners, and the public. Refer to Figure 43 below.

Figure 43: General Sub-Tab

4.1.3Member Sub-Tab

This sub-tab is specific to MaineCare members.Refer to Figure 44 below.

Figure 44: Member Sub-Tab

4.1.4Provider Sub-Tab

This sub-tab is specific to providers. The Provider sub-tab includes an event calendar, a news section, and important hyperlinks. Refer to Figure 45 below.

Figure 45: Provider Sub-Tab

4.2Contact Us

The Contact Us screen provides valuable contact information for MaineCare as well as office hours.Refer to Figure 46 below.

Figure 46: Contact Us Screen

Table 1below provides a list of the communication types found on the Contact Us screen and the communication type description.

Table 1: Communication Types

Communication Type / Description
/ Phone Support − Provides local and toll-free phone numbers available to reach a customer support representative during regular business hours. Voice mail is available after hours.
/ TDD/TTY Support – Provides number available for TDD/TTY support
/ Messaging Support − Sends a secure message or send an email inquiry to Molina Medicaid Solutions. If sending an email inquiry, it should not contain protected health information (PHI).

5.Provider Enrollment Application (PEA) Navigation

This section describes the various navigation features of the online portal(PEA.)

5.1PEA Banner

Located on the top of each screen, the banner provides a list of all the functions that are available for the current screen. This list may be different for each provider because it is based on user permissions. Some of the functions may include the following:

  • Enable Accessibility – When the Enable Accessibility hyperlink is clicked, it enables the website to present information in a way that is more understandable for accessibility software such asJob Access With Speech (JAWS).
  • Help – This is basic website functionality help.
  • A language drop-down list contains available languages. English is the default language.

Refer to Figure 51 below.

Figure 51: PEA Banner

5.2Help Links and Guidance

On the PEA screen, there is a Help Links & Guidance section, and includes hyperlinks to:

  • NPI Registry
  • Provider Enrollment FAQ
  • Provider Enrollment Glossary of Terms
  • Provider Disclosure Requirements and FAQ

These hyperlinks are used to assist the provider during the enrollment application process. Refer to Figure 52 below.

Figure 52: Help Links & Guidance Section

5.3Navigation Features

Every screen of the PEA has a set of standard navigation features, including:

  • The navigation menu – Shown at the top of each page, the navigation menu provides a list of all the enrollment steps, to guide the provider to where they are in the enrollment process. Refer to Figure 53 below.NOTE: Although all of the menu items are always accessible throughout the application process, it is recommended to complete each step in order during the initial completion of the enrollment application.

Figure 53: Navigation Menu

  • The command buttons – Located below the fields on each PEA screen, are a set of buttons that perform certain actions. The available actions depend on the purpose of the screen. Table 2and Figure 54below display the command buttons.

Table 2: Command Buttons and Descriptions

Command Button / Description
/ Save & Continue – Saves the information on the current screenand continues to the next screen.
/ Edit – Allows for the editing of existing information. Select the item requiring modification. Click Edit. Edit material. Click Save.
/ Add – Allows for the adding of information to a table.
/ Close – Saves the information on the current screen and closes the PEA to continue at a later time. A warning box appears with the following message, “The incomplete application has been saved and will be available for completion for a period of 30 days.”
/ Save – Saves sub-section content within a section of a screen; for example, license information.
/ Cancel – Cancels sub-section content within a section of a screen; for example, license information.
/ Reset – Resets all of the fields on the current screen.
/ Back– Returns to the previous screen.
/ Delete – Allows for the deletion of existing information or the deletion of the application.
/ Submit – Submits the application.

Figure 54: Command Buttons Example

  • Required fields – Each screen of the PEA has required fields. These fields are marked with a red asterisk (*). Examples of required fields are shown below inFigure 55.

Figure 55: Required Field Examples

NOTE: Tool Tips appear when hovering the cursor over an icon or menu function within the PEA. Tool Tips appear for a few seconds and give a brief description of the target icon.

Notice that there are header fields, which will appear on every PEA screen, as shown in Figure 56below.

Figure 56: Header Fields

  • Billing Provider ID– Displays the Pay-To NPI of the enrollment application
  • Enrollment Case Number – Displays the case number of the enrollment application
  • Status – Displays the status of the enrollment application

Additional information, such as service location name, can appear in the header fields, depending on the screen being viewed. The header field content is appropriate to the context of the screen.

6.Trading Partner Login

To access the PEA, providers must be a registered trading partner.

NOTE: If a trading partner account has not been created, refer to the Trading Partner User Guide for Providers Not Yet Enrolled.

To sign into the trading partner account, follow these steps:

1.Navigate to the online portal home screen;click Sign In. Refer to Figure 61 below.NOTE: When signing into the trading partner account, if the incorrect password is entered five times, the trading partner account locks indefinitely. To unlock the account, contact the EDI Help Desk at 1-866-690-5585, Option 2.

Figure 61: Sign In Hyperlink

The Sign In screen displays.

2.In the User Name field, enter the trading partner user name.

3.In the Password field, enter the password.

4.Read and accept the Attention HIPAA PHI: Special Handling Required statement by selecting the “I have read and accept HIPAA PHI privacy policy” check box.

5.Click SIGN IN. Refer to Figure 62 below.

Figure 62: Sign In Screen

The Non-Enrolled Provider screen displays.

6.Click the Account Maintenance drop-down list. Click the Provider Enrollment hyperlink. Refer to Figure 63 below.

Figure 63: Provider Enrollment Hyperlink

The PEA screen displays. Refer to Figure 64 below. Located within the screen are the enrollment links for the different types of applications and a table containing the enrollment information entered under the trading partner account.

Figure 64: PEA Screen

  • Case Number - Displays the case number of the enrollment application.
  • Provider ID - Displays the provider’s NPI.
  • Provider Name - Displays the provider’s name.
  • Email Address - Displays the email address used in the enrollment application.
  • Enumeration Type - Displays the enumeration type selected when starting the enrollment application.
  • Enrollment Status - Displays the status of the enrollment application.
  • Actions – The actions button displays different options. These options are dependent on the enrollment status of the enrollment application.

7.Start the PEA

From the PEA screen, there are a series of available Provider Enrollment hyperlinks. Refer to Figure 71 below.

Figure 71: PEA Hyperlinks

To begin an enrollment, choose the Provider Enrollmenthyperlink. Continue to the next section.

8.Provider Enumeration Information

All providers enroll based upon their enumeration in the National Plan & Provider Enumeration System (NPPES). NOPR providers must be enrolled in MaineCare with a Type 1 Individual NPI.

The first Provider Enrollment screen is the Start Enrollment screen. On this screen, specify how the provider has enumerated with NPPES.All fields marked with a red asterisk (*) are required fields.Refer to Figure 81 below.

Figure 81: Start Enrollment Screen

  1. In the Billing Provider NPI Number field, enter the NPI. This is a required field.
  2. In the Business Enumeration Type drop-down list, select NOPR. This is a required field.
  3. Once NOPR is selected for the Business Enumeration type the system defaultsthe Business Enrollment Type to NOPR. This is a required field.
  4. The Tax ID Type fieldwill default to SSN for a NOPR. This is a required field.
  5. In the Enter Tax ID field, specify the provider’s SSN. This is a required field.
  6. In the Re-Enter Tax ID field, re-enter the provider’s SSN. This is a required field.NOTE: For security purposes, the Tax ID and Re-Enter Tax ID fields only display the last four digits of the number entered.
  7. Click the “I attest that I have read and I will agree to the terms and conditions of Maine Provider Enrollment Application version 2.0” checkbox. This is a required field.
  8. Verify that the information on this screen is correct, and make any necessary modifications.

Do one of the following:

  • To submit the information entered and continue to the next enrollment step, click the SAVE & CONTINUE button. Continue with the next section.
  • To cancel all changes, click the CANCEL button.
  • To reset the fields, click the RESET button.

9.Ordering/Referring Providers