Becoming a Medicaid Provider
Presentation to: Georgia Charitable Care Network and Jesse Parker Williams Foundation Presented by: David Ostrander, Dir...
Presentation to: Georgia Charitable Care Network and Jesse Parker Williams Foundation Presented by: David Ostrander, Director of Provider Enrollment Georgia Department of Community Health
Date: July 26, 02013
Mission The Georgia Department of Community Health We will provide Georgians with access to affordable, quality health care through effective planning, purchasing and oversight. We are dedicated to A Healthy Georgia.
Georgia Department of Community Health
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AGENDA Title or Chapter Slide •Obtaining a National Provider ID (NPI) •Enrollment (use Process as needed; feel free to delete) •Enrollment Self-Service Web Features •Common Enrollment Errors •Enrollment Applications •Session Review •Closing, Questions and Answers Georgia Department of Community Health
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How do I obtain an NPI? Providers must apply for an NPI in one of three ways: 1. Apply through the web-based application process. Visit the National Plan and Provider Enumeration System (NPPES) at https://nppes.cms.hhs.gov/NPPES/Welcome.do 2. Complete, sign, and mail a paper application to the NPI Enumerator. For a copy of the application (Form CMS-10114), refer to http://www.cms.gov/Medicare/CMS-Forms/CMSForms/Downloads/CMS10114.pdf on the CMS website. A hard-copy application can be requested through the NPI Enumerator by calling 1-800-465-3203 or TTY 1-800-692-2326
Georgia Department of Community Health
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Enrollment Process (continued)
Step One: • The Enrollment Application Instructions list all of the available contracts an applicant may enroll into for that particular application type. • The contract enrollment is based on how the applicant is licensed.
Georgia Department of Community Health
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Enrollment Process (continued)
Step Two: • The enrollment application may be submitted one of two ways: HPES Provider Enrollment PO Box 105201 Tucker, GA 30085-5201
Georgia Department of Community Health
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Enrollment Process Or Physical Address: HPES Provider Enrollment 100 Crescent Centre Parkway, Suite 1100 Tucker, GA 30084-7039 GAMMIS at www.mmis.georgia.gov Georgia Department of Community Health
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Enrollment Process (continued)
Step Three: • Once the enrollment application has been submitted, the application is then reviewed. • Facility applications are reviewed by DCH Provider Enrollment. • Individual practitioner applications are reviewed by HP Provider Enrollment. • The enrollment review timeframe is 15 days upon receipt of a completed application. Georgia Department of Community Health
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Enrollment Process (continued)
Step Four: • If the enrollment application and all of the supporting documentation has been completed correctly, the application is then approved for enrollment.
Georgia Department of Community Health
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Enrollment Process (continued)
Step Five: • The Medicaid ID is activated and issued. • The provider can now service Medicaid members and submit claims.
Georgia Department of Community Health
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Web Portal Enrollment • Providers can locate all provider enrollment documents and submit applications at GAMMIS (https://www.mmis.georgia.gov) by clicking on the Provider Enrollment and Provider Information tabs. Georgia Department of Community Health
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Web Portal Enrollment (continued)
Georgia Department of Community Health
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Enrollment Self-Service Web Features For additional assistance in completing enrollment documents GAMMIS offers CBT (Computer-Based Training): • Initial Enrollment Application CBT • Additional Location Application CBT • Enrollment Status
Georgia Department of Community Health
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Enrollment Self-Service Web Features (continued)
The Initial Enrollment Web Application CBT shows providers and/or their office staff how to submit an enrollment application online. This application is used for providers who have never been enrolled in the Georgia Medicaid program.
Georgia Department of Community Health
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Enrollment Self-Service Web Features (continued)
• The Additional Location Web Application CBT shows providers and/or office staff how to submit an Additional Location enrollment application online. • This application should be used for providers who are currently enrolled in the Georgia Medicaid program. • A Home Health Agency enrolling a branch location should also use this application. Georgia Department of Community Health
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Enrollment Tips • Make sure all applicable sections of the enrollment application are completed prior to submission. • Be sure to include the enrolling provider’s original signature on all enrollment applications. • Contract, provider type, and specialty must be listed on application.(If not, the entire application will be returned).
Georgia Department of Community Health
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Enrollment Tips (continued)
• Power of Attorney for Payee form must be notarized. • All applicant history questions must be answered. • Supporting documentation should be filled out completely.
Georgia Department of Community Health
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Enrollment Assistance Providers can prevent their application from being either returned or pended for missing documentation by following these steps: 1. Provide the original signature of the enrolling provider on the enrollment application and Statement of Participation. 2. Power of Attorney for Payee and Disclosure of Ownership do not require original provider’s signature. Copies are acceptable. 3. List the Federal Tax ID# on the application. Georgia Department of Community Health
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Enrollment Assistance (continued)
4. List the applicant’s date of birth (DOB) and Social Security Number (SSN) on the enrollment application. 5. Include the National Council for Prescription Drug Programs (NCPDP) number on the Pharmacy Application. 6. For individual practitioner paper applications, submit all five pages of the Statement of Participation and ensure it is signed and dated by the applicant. If the applicant is a facility, ensure the legal name of the business is listed in the correct field and the individual signing the form is the Authorized Agent to sign on the business’ behalf. Georgia Department of Community Health
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Enrollment Applications There are eight applications available for enrollment into the Georgia Medicaid program. 1. Individual In-State – new enrolling individual providers. 2. Individual Out-of-State Emergency – providers more than 50 miles from border. 3. Additional Location – currently enrolled providers only. 4. Facility In-State – new enrolling Facility providers.
Georgia Department of Community Health
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Enrollment Application (continued)
5. Facility Out-of-State Emergency – Facilities more than 50 miles from border. 6. Georgia Families® Registration Form (NonTraditional Providers /CMO Only) – providers interested in enrolling in MCO only. 7. Physician Assistant – enrolling providers must be affiliated with a sponsoring physician. 8. Pharmacy – new and existing pharmacies. Georgia Department of Community Health
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Enrollment Status • Providers can check the status of all enrollment applications on GAMMIS at www.mmis.georgia.gov by clicking on the Provider Enrollment tab and selecting Enrollment Application Status. • The Provider Enrollment department can be contacted for additional assistance by clicking on the Provider Contract Status link.
Georgia Department of Community Health
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Care Management Organization (CMO) Processing • The purpose of this process improvement is to make the enrollment process simpler for the provider to enroll in one or more of the CMOs. • This new process will give the CMOs access to Georgia Medicaid provider enrollment documentation. Providers will have the ability to indicate which CMO(s) would be granted access to download credentialing documents. Georgia Department of Community Health
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CMO Processing (continued)
The Web Portal will offer providers an opportunity to select network participation. This will allow providers to give the CMO access to all credentialing documents.
Georgia Department of Community Health
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CMO Processing (continued)
When did this change occur? • March 29, 2013 Who does this change affect? • New applicants only • Currently enrolled providers will need to contact the CMO directly and use the CMO’s existing credentialing process New changes: • Documents will be submitted to Web Portal alone with all supporting documents • Providers will have (15) days to return any requested documents for review Georgia Department of Community Health
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CMO Processing (continued)
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Providers are able to submit a single source of required documentation needed for DCH and CMO enrollment and or/ credentialing determination. CMOs will complete the final review process of all enrollment applications.
