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Provider Internet ePEAP User Manual

1. 72 Provider Internet ePEAP User Manual February 1 2008 1 Introduction to the ePEAP Internet User Manual Would you like to request changes to your provider files with PA PROMISe through the Internet If you are currently an enrolled provider with a valid provider ID and service location and have Internet access you can request changes to your provider information by accessing ePEAP through PROMISe PROMISe interfaces with the electronic Provider Enrollment Automation Project ePEAP for one stop shopping To use this service you must be a registered user of PA PROMISe and have a password 11 Who Is Eligible To Use ePEAP All provider types are currently eligible to use ePEAP 1 2 How to Register for ePEAP With a valid provider ID and service location you can register to use ePEAP The ePEAP application is accessed from the Provider Main Page in PA PROMISe Please go to http promise dpw state pa us to access the PA PROMISe main page and click on the PROMISe Online link The Logon window for the PA PROMISe Internet application is displayed below p E N NS Welfare 5 Need Help Use the Internet Help Manuals here Already registered If you have already set up your account or a provider has set one up for you log on here Logon ID 13 digit Provider ID or 9 digit Alternate ID Password Forgot Password Not yetregistered Create your user account now This
2. NPI Taxonomy Microsoft Internet Explorer provided by EDS COE DER Taxonomy for DOGOOD JAMES L NPI ID 1234567893 Provider ID 300180963 Service Location 0002 ALLOPATHIC amp OSTEO PHYSCNS 208000000 GENERAL PRACTICE DEFAULT SPCLTY CD Close Provider Internet ePEAP User Manual February 1 2008 2 ePEAP Menu Window 2 1 ePEAP Menu When you have successfully logged into the Provider Internet Application and accessed the ePEAP Menu you can access each sub application as explained in this section The following documentation describes how to navigate to the various parts of the ePEAP system By clicking on the following links in the Provider Options box the windows described below are accessed Enrollment Information ePEAP Enrollment Information window e Recent Requests ePEAP Recent Requests window Terminate MA Enrollment ePEAP Terminate Medical Assistance Participation window Manage Bulletins Remittance Advice ePEAP Manage Bulletins Remittance Advice window Please Note Provider accounts who do not receive MA Bulletins will only see a Manage Remittance Advice link e Active Service Locations Active Service Locations window By clicking on the following links in the For Groups Only box the windows described below are accessed e Verify Provider Membership ePEAP Verify Provider Membership In My Group window e View Provider Group Members Pop up wind
3. Instructions Address 234 NEW HAVEN RD CAMP HILL PA 17011 0000 123 HOPE RD HARRISBURG 17011 0000 Phone Fax 717 975 1234 000 000 0000 717 444 4444 000 000 0000 All addresses assigned to your Provider ID are listed below in alphabetical order by city Please click select next to the address you wish to assign as the new Pay to Mail to and or Home Office address for your Service Location If the desired address is not listed you may Add to List Handicap Access Yes Assigned to Your Service Location Pay To 123 HOPE RD HARRISBURG 17011 0000 select 423 HOPE RD HARRISBURG PA 17011 0000 select 423 HOPE RD HARRISBURG PA 17011 0000 select 423 HOPE RD HARRISBURG PA 17011 0000 717 444 4444 000 000 0000 717 444 4444 000 000 0000 717 444 4444 000 000 0000 717 444 4444 000 000 0000 Service Location select 423 HOPE RD HARRISBURG PA 17011 0000 717 444 7777 717 444 5555 Home Office Mail To Address Menu ePEAP Menu Help Review Submit Accessibility and Use To access the Provider Address Information complete the steps in the step action table s Provider Internet ePEAP User Manual 24 February 1 2008 To Access the Manage Active Addresses Information Step Action Result 1 Sign on to the PA PROMISe Internet The Provider Main Page appears on the application using instructions prov
4. Provider Internet ePEAP User Manual February 1 2008 Field Description Data Type Length Your Provider ID Identifies the current provider for this ePEAP session Number Uses the number assigned to the provider at the time of enrollment in the MA program Provider Name Unlabelled field following Your Provider ID Name Character 50 of the current provider as used on official Commonwealth records ePEAP Access Display the level of authority the user has on the Character 16 ePEAP system View Opens a window displaying the taxonomy code s Hyperlink 0 Taxonomy associated with the NPI View Opens a window displaying the specialty code s Hyperlink 0 Specialties associated with the provider service location 1 7 1 View Specialties To View Specialties for the Logged on Provider ID and Service Location Step Action Result Click on the View Specialties link in the The following pop up window opens Specialty Microsoft Internet Explorer provided by EDS DER Specialties for DOGOOD JAMES L Provider ID 300180963 Service Location 0002 Provider Type 31 318 GENERAL PRACTITIONER Provider Internet ePEAP User Manual February 1 2008 1 7 2 View Taxonomy To View Taxonomy Codes Associated With the NPI Number Step Action Result Click on the View Taxonomy link in the l l ePEAP Header The following pop up window opens
5. To Access the ePEAP Verify Provider Membership in My Group Window Step Action Result 1 Select the Verify Provider Membership The Verify Provider Membership in My link in the ePEAP Menu Group window opens Provider Internet ePEAP User Manual February 1 2008 68 Verify Provider Membership in My Group Step Action Result 1 Enter the Provider ID and Service Location in the corresponding fields 2 Click the Check button The verification is displayed Other Options Step Action Result 1 Click the ePEAP Menu button Opens the ePEAP Menu window 2 Click the Help button Describes the fields on the Recent Requests window 3 Click the Exit button Opens the PA PROMISe Provider Main Page Field Descriptions Field Description ding Length Check Verify a provider is in a specific group Button 0 Exit Exit ePEAP Button 0 Help Describes the fields on the ePEAP window Button 0 Provider ID Provider ID of the individual provider whose group Number 9 membership is being verified Service Service location of the individual provider whose group Character 4 Location membership is being verified ePEAP Menu Opens the ePEAP menu window Button 0 Provider Internet ePEAP User Manual February 1 2008 69 9 View Provider Group Members The Provider Group Members window is used to view a provider s group enrollment This is a view only window and the information
6. 2008 Field Help Issued By License License End Date License Start Date MA Enroll End Date Description Description of the fields on the ePEAP window Authority state agency that issued the provider s medical license Practitioners in Pennsylvania must be licensed and currently registered by the appropriate state agency Date license expires Date this license was first issued or a renewal date Date provider officially terminates enrollment concludes a period in which the provider is authorized to receive Medicaid payments for services rendered MA Enroll Start Date Date the provider officially began as a Medical Degree Medicare Indicator Information Medicare Number Medicare Type NPI New Medicare Provider Name Provider Type Provider Type Description Medical Assistance provider and became authorized to receive Medicaid payments Provider s medical degree Assign move or remove Medicare Indicator when current service location has a validated NPI number Medicare billing number assigned to the provider service location Read only as of 2 1 2008 Type of Medicare billing number Possible Drop Down List Box values are DME Medicare A Medicare B and Railroad Read only as of 2 1 2008 NPI of the group Data Type Button Character Character Date MM DD CCY Y Date MM DD CCY Y Date MM DD CCY Y Date MM DD CCY Y Drop Down List Box Check Box Al
7. Microsoft Internet Explorer REMITTANCE ADVICE Press to terminate the mailing of paper RAs Press Cancel to return i Cancel Accessibility and Use To access the ePEAP Manage Bulletins Remittance Advice window and manage the delivery of Medical Assistance Bulletins and Remittance Advices complete the steps in the following step action tables To Access the ePEAP Manage Bulletins Remittance Advice Window Step Action Result Sign on to the PA PROMISe Internet The Provider Main Page appears on the 1 application using instructions provided in desktop Section 1 5 of this manual Click on the ePEAP Provider Enrollment 2 Automation Project link in the Other The ePEAP Menu window opens Links section of the window 3 Select the Manage Bulletins Remittance The ePEAP Manage Bulletins Remittance Advice option Advice window opens To Discontinue Delivery of Paper Medical Assistance Bulletins Step Action Result Under the How do you want to receive newly issued bulletins heading click the By Email radio button to discontinue delivery of paper MA Bulletins 2 Type your email address in the My Email address is field 3 Retype your email address in the Retype Email address field 4 Click Continue to process the request HM oa window appears 5 Press OK to terminate the mailing of paper The Review Your Changes window is MA Bulletins or
8. This information is required to validate your NPI assignment If documentation is not received claims may be rejected 7 Click the Continue button The ePEAP Main Menu window opens Note Until the NPI number is validated by DPW a red Pending label will display next to the NPI field on all window headers Provider Internet ePEAP User Manual 47 February 1 2008 To Add or Change Taxonomy Codes Step Action Result Click the Manage NPI Taxonomy link The ePEAP Manage NPI and Taxonomy Codes window opens 2 Select new taxonomy code s to be added by clicking the check box es next to the code Remove existing taxonomy codes by clicking the check box es next to the code to remove the check mark This window will only display the taxonomies valid for the registered Provider Type and Specialty combination Click the Continue button The Review Your Changes window opens 4 Review the entered information If ready to process click Submit Changes The Contact Information window opens 5 Complete the requested contact information fields Name Phone and E Mail are required fields Click Submit The following Changes are Complete window is displayed Changes Are Complete Your provider information has been updated as you requested If you wish to view your request again please select Recent Requests from the ePEAP Menu The Tracking Number for thi
9. This service location already is associated with a different NPI Only one NPI is allowed per service location during the same time period The taxonomy is not associated with the provider types and specialties for this service location The NPI Taxonomy Zip combination is already being used End date must be greater than effective date Individuals can only have one NPI number Tax ID cannot be changed to SSN You must select a county when adding a Pennsylvania address Effective date must be numeric Effective date must be 8 numbers in length Effective date is not a valid date Valid date range is 1966073 1 22991231 Enter a Complete Date Enter a date in the future End date must be numeric End date must be 8 numbers in length End date is not a valid date Valid date range is 1966073 1 22991231 Fax number must be numeric Fax number must 10 digits Fax number must be numeric To Correct N A N A N A N A N A Select a county for the drop down list Enter numeric date Enter 8 numbers Enter a date within the valid date range Enter in a valid end date Enter a future end date Enter numeric values Enter 8 numbers Enter a date within the valid date range Enter in a 10 digit fax number Enter in a 10 digit fax number Enter a 10 digit fax number Provider Internet ePEAP User Manual 73 February 1 2008 Error Field Medicare Number Pay to Phone Phone Ph
10. 1 If more than 1000 records are on file for a provider group only the first 1000 are initially displayed To view additional results select the desired block of records from the Displaying results drop down list 2 Click View Results The selected block of records is displayed in the Provider Group Members window Other Options Step Action Result 1 Click the Close button Opens the ePEAP Menu window Field Descriptions Field Description Data Type Length Close Closes the current window Button 0 Displaying Results List of results in increments of Drop down List Box 15 1000 Only displayed when more than 1000 results are returned Effective Date Individual membership effective Date MM DD CCYY 8 date End Date End date of individual s group Date MM DD CCYY 8 membership Group Name Group name Character 50 Group Provider ID Group provider number Character Location Group provider location Character 4 Member Name Group member s name Character 50 Member Number Group member s provider number Character 9 Provider Type Group member s provider type Character 2 Service Location Group member s service location Character 4 View Results Displays a group of results Button 0 Provider Internet ePEAP User Manual February 1 2008 71 Error Field Code Address 1 2 City 3 Comment do not use this 1 box to request changes Continue 1 5657 5658 5662 5663 5664 10 Field Edits for this Document All of the
11. Information window opens To Enter Enrollment Changes Step Action Result 1 To change the Birth Date select new values for the month day and year from the corresponding drop down lists The provider s birth date is changed 2 To change the Gender select a new value The gender information is changed from the corresponding drop down list 3 To change the Medical Degree The medical degree information is information select a new value from the changed corresponding drop down list 4 Click the Continue button to review any The Review Your Changes window opens changes Click the Continue To Make Changes button to return to the Enrollment Information window Note Medicare numbers can no longer be updated via ePEAP Beginning May 23 2008 NPI numbers will be used to process Medicare carrier crossover claims instead of Medicare numbers Provider Internet ePEAP User Manual 17 February 1 2008 Other Options Step Action Result 1 Click the Cancel button to cancel all The update is cancelled and the Enrollment changes and restore the original Information window opens information 2 Click the Reset button to reset the New information is cleared and the original information to its original values information is restored 3 Click the Review Submit button to review The Review Your Changes window opens and submit all changes to the in
12. My Group window opens 2 Select the View Provider Group Members The Provider Group Members pop up link window opens Provider Internet ePEAP User Manual 11 February 1 2008 To Access Help Step Action Result 1 Select the View Helpful Hints link The Helpful Hints for the ePEAP User window opens and displays a list of tips for using the page To Exit ePEAP Step Action Result 1 Click the Exit button Opens the Provider Main Page ePEAP Menu Field Descriptions Field Description Data Type Length Enrollment Opens the ePEAP enrollment window Hyperlink 0 Information Exit Exits ePEAP Button 0 Help Describes the fields on the ePEAP window Button 0 Manage Opens the Manage Bulletins Remittance Advice Hyperlink 0 Bulletins Remittance window Advice Active Service Opens the Active Service Locations window Hyperlink 0 Locations Recent Request Opens the Recent Request window Hyperlink 0 Terminate MA Opens the Terminate MA Enrollment window Hyperlink 0 Enrollment Verify Provider Opens the Provider Membership window Hyperlink 0 Membership View Helpful Hints Displays helpful hints for the ePEAP user Hyperlink 0 View Provider Group Displays pop up window with list of Provider s Hyperlink 0 Members group members Provider Internet ePEAP User Manual February 1 2008 12 3 Using the ePEAP Enrollment Information Options The ePEAP Enrollment Information lin
13. Reset Description Data Type Length New street address Character 60 Returns to the Address Menu window Button 0 Update is cancelled and the content is cleared Button 0 New city Character 18 Opens the Review Your Changes window Button 0 Pennsylvania county where address is located Drop down 0 List Box Exits ePEAP Button 0 Telephone extension for new address Number 4 Fax number for the specific address code Character 10 Indicates by Yes or No whether address is Radio Button 0 handicap accessible Describes the fields on the ePEAP window Button Assigns this new address as the home office Check 0 address for current service location Assign this new address as mail to address for Check Box 0 current service location Assigns this new address as the pay to address Check Box 0 for current service location Phone number for the specific address code Character 10 Clears all fields Button 0 Provider Internet ePEAP User Manual February 1 2008 29 Field Description Data Type Length Review Submit Opens the Review Your Changes window Button 0 State New state IDiop dosh 0 List Box ZIP Code New 5 digit ZIP code plus 4 digit suffix Character 9 ePEAP Menu Returns to the ePEAP menu window Button 0 3 2 3 ePEAP Edit Addr w epeap edit addr The ePEAP Edit Address Related Information window is used to modify address related phone and fax numbers and handicap access status
14. ePEAP window Button 0 Reset Resets the form Button 0 Review Submit Opens the Review Your Changes window Button 0 Your e mail address Provider s legal entity e mail address Character 70 for messages from the Medical Assistance Program ePEAP Menu Returns the ePEAP user to the ePEAP menu Button 0 window 3 3 Fee Assignment Information epeap fee assign info The ePEAP Fee Assignment Information window contains a menu of maintenance options for providers to use to manage fee assignment From this window the following options can be selected Adda Group for Fee Assignment Manage Fee Assignments This window is accessed from the PA PROMISe Internet Provider Main Page through the ePEAP Provider Enrollment Automation Project link which opens the ePEAP Menu Click the Enrollment Information link to open the Enrollment Information window and then click the Fee Assignment Information link to open the Fee Assignment Information window Provider Internet ePEAP User Manual February 1 2008 35 Layout PENNSYI Nu or Welfare Your Provider ID 300180963 DOGOOD JAMES L NPI 1234567893 View Taxonomy Service Location 0001 Active Full Access Status ePEAP Access 123 HOPE RD HARRISBURG PA 17011 Provider Type 31 PHYSICIAN View Specialties Fee Assignment Information You may add a Group to assign fees to an account other than your own You may also review
15. site requires Internet Explorer version 6 with 128 bit encryption Please visit the DPY Website Toolbox if you need to download Internet Explorer or upgrade to a higher version of Internet Eplorer 13 Former MAMIS ePEAP Users If you had an account already established on the former MAMIS ePEAP system enter your four digit PIN from that account in the Logon ID field when you first access the PROMISe Internet site and click the Log On button PROMISe prompts you to change your password Subsequent logons must be made with your new password To access the Provider Main page you must log on with your new PROMISe provider ID which consists of your nine digit provider number plus a four digit service location Provider Internet ePEAP User Manual February 1 2008 1 4 Establishing a New Provider User Account If an account has not yet been established for you click on the link Create your user account setup now The User Registration window below displays User Registration Type of Access Required Provider Provider ID 13 digits required E mail Address _ Example doctor hospital com Retype E mail Address Contact Person Phone Number 10 digits Enter a password Retype password Providers and Billing Agents must enter the SSN or IRS EIN that is registered with your Provider Number This required to validate your identity SSH IRSEM Select a security questi
16. the Pay To Mail To and Home Office addresses and to change the provider s email address Note This window cannot be used to add a new service location Base Information Each enrolled MA provider has basic information that Hyperlink 0 should be kept current This link accesses the ePEAP Basic Enrollment Information window used to display and update this information including medical degrees licensing ID numbers billing and Medicare participation ePEAP Menu Opens the ePEAP Menu window Button 0 Exit Exits ePEAP and returns to the PA PROMISe Button 0 Provider Main Page Fee Assignment Accesses these options Add a Group for Fee Hyperlink 0 Information Assignment Manage Fee Assignments Help Opens the Help menu for the current ePEAP window Button 0 Manage Opens the Manage NPI and Taxonomy Codes Hyperlink 0 NPI Taxonomy window Review Submit Opens the Review Your Changes window Button 0 3 1 ePEAP Basic Enrollment Information epeap base info The ePEAP Basic Enrollment Information window is used by the provider community to display and update basic provider information Existing provider information is automatically displayed To update information enter new values in the New section of the window and click the Review Submit button This window is accessed from the PA PROMISe Internet Provider Main Page by clicking on the ePEAP Provider Enrollment Automation Project link in the Other Links section of t
17. your provider information Documentation for each window in this manual includes Window Narrative Brief description of the window its purpose and use Sample image of the window that shows all data fields and controls y buttons drop down boxes etc Field Description Detailed description of each data field and object within the window Table including field lengths and data types Accessibility and Use Description of how the window is accessed followed by step by step Narrative Step Action instructions to navigate within and between windows and perform Tables basic functions and operations within the window Provider Internet ePEAP User Manual February 1 2008 Error Messages Error Codes and Corrective Actions to fix incorrect invalid entries or actions Note Field Edits have been combined and are located in Section 9 of this document Field Edits 1 7 Common Window Display Common to the PROMISe ePEAP Internet windows is the label found on the top header portion of each ePEAP window This label displays identifying information for the provider ID used to log into ePEAP Provider Identification Number NPI National Provider Identifier If an NPI number has been entered but has not yet been validated by DPW a red Pending label will display next to the NPI field on all window headers If an NPI number has been entered a link to view Taxonomy Codes associ
18. 1 20 2006 3 43 37 PM Complete View 947 64240 11 21 2006 1 16 51 PM Complete View 949 64241 11 21 2006 1 19 36 PM Complete View 954 64243 11 21 2006 2 30 20 PM Complete View 956 64244 11 21 2008 2 48 45 Complete View 1027 64288 12 8 2006 11 08 34 AM Complete View 1073 64307 1 19 2007 9 20 09 AM Complete View Cancel Contact 1074 64308 1 19 2007 9 25 31 AM Received View 1089 64323 1 23 2007 11 21 45 AM Complete View 1090 64324 1 24 2007 8 27 18 AM Complete View 1091 64325 1 24 2007 8 40 50 AM Complete About this Request Date Closed 01 24 2007 at 8 40 AM Tracking Number 1091 64325 Contact Information Name Mortimer Snerd Phone 717 222 0001 E mail mort dogood com Fax Changes Requested For Provider ID 300180963 DOGOOD JAMES L Service Location 0001 234 NEW HAVEN RD Change Address CAMP HILL PA 17011 Current Requested Phone 717 975 9876 717 975 1234 Phone Ext 567 PEAP Menu Accessibility and Use To access the ePEAP Recent Requests window and view cancel or submit a message to DPW complete the steps in the following step action tables To Access the ePEAP Recent Request window Step Action Result 1 Select Recent Requests from the ePEAP The Recent Requests window opens Menu View Recent Requests Step Action Result Click the View link next to the request to The request you selected will be displayed view below the request list Provider Internet ePEA
19. 180963 DOGOOD JAMES L Status Active NPI 1234567893 View Taxonomy ePEAP Access Full Access Service Location 0001 123 HOPE RD HARRISBURG 17011 Provider Type 31 PHYSICIAN View Specialties Manage NPI and Taxonomy Codes 1 Select one or more applicable taxonomy codes 2 Click Continue 3 Review Request and Submit NPI 123456 193200000X GROUP MULTI SPCLTY DEFAULT SPCLTY CD 193400000 GROUP SINGLE SPCLTY DEFAULT SPCLTY cD 202KD0000X ALLOPATHIC 8 OSTEO PHYSICIANS PHLEBOLOGY DEFAULT SPCLTY CD 208000000 ALLOPATHIC amp OSTEO PHYSCNS GENERAL PRACTICE DEFAULT SPCLTY CD RI m Note Once you have associated an NPI with your Provider ID and Service Location it cannot be updated or removed via ePEAP Instead it will be necessary to mail a written request to DPW with supporting documentation for review Enrollment Information ePEAP Menu Error Messages The number entered is not a valid NPI number Please verify and re enter The above error message is displayed if the NPI number you entered is invalid this would occur if the number was keyed in error entered NPI cannot be associated with the service location to which you are logged in Please refer to your ePEAP Manual for handling The above error message is displayed if there is a conflict between the 13 digit Provider ID number to which you are logged in and the NPI number you are entering If you rece
20. AP Character 10 change request Help Describes the fields on the ePEAP window Button 0 Name The name of the contact person for the ePEAP change Character 35 request Phone The phone number of the contact person for the Character 10 ePEAP change request Reset Resets the form Button 0 Submit Changes Submits all entered ePEAP change requests Button 0 ePEAP Menu Navigates to the ePEAP Menu Window Button 0 Provider Internet ePEAP User Manual February 1 2008 53 4 Recent Requests The ePEAP Recent Request window is used to track a provider s open requests in the ePEAP system The details of individual requests can be viewed open requests can be cancelled and messages can be sent to DPW requesting information regarding the status of a request This window can be accessed from the PA PROMISe Internet Provider Main Page and then select ePEAP Provider Enrollment Automation Project From here select Recent Requests to display the Recent Requests window Layout PENNS AUR Gn Your Provides ID 300 180863 DOGOCO JAMES L Stans NPI 1234507009 View Taxonomy Access Full Access Sarvice Lecation 0201 123 HOPE RD HARREALRG PA 17011 Provider Type 31 FHYSICIAN View Recent Requests Tracking Submit Date Status View 6256 64006 942642005 3 08 20 In Process View 637 64097 10 2 2005 3 29 47 In Process View 639 64098 10 7 2005 8 36 02 In Process V
21. Cancel to return displayed Provider Internet ePEAP User Manual February 1 2008 62 To Restart Delivery of Paper Medical Assistance Bulletins Step Action Result Under the How do you want to receive newly issued bulletins heading click the 1 By US to your mail to address radio button to resume delivery of paper MA Bulletins to your mailing address The following confirmation window is 2 Click Continue to process the request displayed Microsoft Internet Explorer A After 7 31 2007 you will no longer receive bulletins by email notification The Review Your Changes window is 3 Click OK displayed To Discontinue Delivery of Paper Remittance Advices Step Action Result Click on the Access RAs on line through PROMISe and eliminate receipt of paper RAs radio button to discontinue delivery of paper RAs 2 Click Continue to process the request Me Su oc Advice pop up window appears 3 Press OK to terminate the mailing of paper The Review Your Changes window is RAs or Cancel to return displayed To Restart Delivery of Paper Remittance Advices Step Action Result Click on the Receive paper RAs via US mail radio button to restart delivery of paper RAs 2 Click Continue to process the request bu displayed Field Descriptions Field Description Data Type Length Access RAs on S
22. Default assignment for this service location To replace a default assign another address Concer f Reser TT Address Menu ePEAP Menu Help Review Submit EJ Provider Internet ePEAP User Manual February 1 2008 30 Accessibility and Use To access the Edit Address Related Information window and perform address maintenance tasks complete the steps in the following step action tables To Access the Edit Address Related Information Window Seam Re 1 Sign on to the PA PROMISe Internet The Provider Main Page appears on the application using instructions provided in desktop Section 1 5 of this manual 2 Click on the ePEAP Provider Enrollment The ePEAP Menu window opens Automation Project link in the Other Links section of the window 3 Select the Enrollment Information option The ePEAP Enrollment Information window opens 4 Click the Address Information link The ePEAP Provider Address Information window opens 5 Click the Change Phone Fax button The Edit Address Related Information window opens To Change Address Related Information 1 Enter the new information in the Phone Ext and Fax fields 2 If the location is handicapped accessible click Yes otherwise click No 3 Assign Current Location nnnn as Check all boxes that apply Preselected Pay to Addre
23. Documentation Unit GLOBAL HEALTHCARE PA PROMISe Provider Internet ePEAP User Manual SYSTEM DOCUMENTATION LIBRARY REFERENCE NUMBER 00000164 SECTION 4 5C PROVIDER INTERNET EPEAP USER MANUAL LIBRARY REFERENCE NUMBER 00000081 REVISION DATE 02 01 08 VERSION 3 6 Library Reference Number 00000081 This document contains confidential and proprietary information of the Pennsylvania Title MMIS account of EDS and may not be disclosed to others than those to whom it was originally distributed It must not be duplicated published or used for any other purpose than originally intended without the prior written permission of EDS Pennsylvania MMIS Information described in this document is believed to be accurate and reliable and much care has been taken in its preparation However no responsibility financial or otherwise is accepted for any consequences arising out of the use or misuse of this material Address any comments concerning the contents of this manual to EDS Attention Documentation Unit PA MMIS 225 Grandview Ave MS B100 Camp Hill PA 17011 EDS and the EDS logo are registered trademarks of Electronic Data Systems Corporation EDS is an equal opportunity employer and values the diversity of its people 2007 Electronic Data Systems Corporation All rights reserved TM PA PROMISe Provider Handbook Provider Internet ePEAP User Manual Table of Contents 1 INTRODUCTION TO TH
24. E EPEAP INTERNET USER MANUAL eee ee eren eee en neto netos etas ta sense eee 1 1 1 Wh Is Eligible To Use ePEATP ue iste DC EDT a uen nib ee 1 1 2 How to Register for ePEAP scie ie caresses saccade daia uta cun dit caca e aia ada inca ta dacat dead cata dau 1 1 3 Former MAMIS ePEAP Users cca ceace nere eee etes eo Ie aan pat aan ada ada tie 1 1 4 Establishing a New Provider User Account nenea eee nene emana enma eee ana tren enne retener ee en nenne 2 1 5 Provider Main Pages ara niea bp e ata n bt i ted tete bab 4 1 6 WAT OWS ies soo ee eoe a OR BO D D UN ERG RO EROR 5 L7 Common Window Displ y ier oe temet teet pee qe tite ote on 6 1 7 1 View Specialties ee Reni eo oe e re pde ede e p EE Ee T eret edu 7 1 7 2 View Taxonomy 9 obs be eo etuer toe i ja ai a out ada pda 8 2 EPEAP MENU WINDOW e eeeeeeeeee esee tasto tasa tosta tuse ta sons 9 21 EPE AP Meni E Mg 9 3 USING THE EPEAP ENROLLMENT INFORMATION OPTIONS ccccccsssscscscscssccsscscscsssesssccessesseeees 13 3 1 ePEAP Basic Enrollment Information epeap base info 15 3 2 ePEAP Provider Address Information epeap info 20 3 2 1 ePEAP Manage Active Addresses epeap man act addr ssssssssesseseseeeseeeeenenre nennen 23 3 2 2 ePEAP Add a New Addres
25. EAP Enrollment Information window opens 4 Click the Manage NPI Taxonomy link The ePEAP Manage NPI and Taxonomy Codes window opens Provider Internet ePEAP User Manual February 1 2008 45 To Add an NPI National Provider Identifier Code Available only if an NPI Code has not been previously associated with a provider and service location combination Once you have associated an NPI number with your Provider ID and Service Location it cannot be updated or removed via ePEAP Instead you must mail a written request to DPW with supporting documentation for review Step Action Result 1 Enter a valid NPI number in the Manage NPI and Taxonomy Codes window Note If an NPI number has already been added the NPI field will be read only and not accessible 2 Click the applicable check box es to select one or more taxonomy codes This window will only display the taxonomies valid for the registered Provider Type and Specialty combination If the taxonomy related to your provider type specialty does not appear contact Provider Enrollment via email at PROMISe state pa us with a subject line Taxonomy Discrepancy to verify the provider type and specialty codes associated with this service location 3 Click the Continue button The Review Your Changes window opens 4 Review the entered information If ready to The Contact Information window process click Submi
26. ISe Provider Main Page Provider Internet ePEAP User Manual 39 February 1 2008 Field Descriptions Field Description Data Type Length Continue Moves to the next logical page or form Button 0 Exit Exit ePEAP Button 0 Fee Assign Menu Returns the ePEAP user to the Fee Assignment Button 0 window Help Describes the fields on the ePEAP window Button 0 Provider ID of Provider identification number of the group Number 9 Group Review Submit Opens the Review Your Changes window Button 0 Service Location Service location of the group Character 4 of Group ePEAP Menu Returns the ePEAP user to the ePEAP menu window Button 0 3 3 2 ePEAP Manage Fee Assignments w epeap add grp fee The ePEAP Manage Fee Assignments window lists the fee assignments for the current provider service location and selects fee assignments to be terminated This window is accessed from the PA PROMISe Internet Provider Main Page through the ePEAP Provider Enrollment Automation Project link which opens the ePEAP Menu Click the Enrollment Information link to open the Enrollment Information window then the Fee Assignment Information link to open the Fee Assignment Information window Click the Manage Fee Assignments link to display the window Provider Internet ePEAP User Manual February 1 2008 40 Layout Initial PENNS IWAN 22 PEAP Manage Fee Assignments Instructions 1 Selectthe fee assignment you wish t
27. Opens the Specialties window for the selected service Hyperlink 0 Specialties location View Opens the Taxonomy window for the selected service Hyperlink 0 Taxonomy location Provider Internet ePEAP User Manual February 1 2008 67 8 Verify Provider Membership in My Group Group providers can use the ePEAP Verify Provider Membership in My Group window to verify that individual providers have made fee assignments to the group at the current group service location This window is accessed by clicking the Verify Provider Membership link in the ePEAP Menu Layout CVIUANI PI M NS Departnpect of Pulilic Wallure 7 era Your Provider DAGDAL MEDISAL ASSOCIATES Stm 1334952380 View Taxonomy ePEAP Access Ful Access Service Location 3331 123 E ST CAMP BILL FA 17011 6312 Provider Type 31 FI CLAN Ais Spevia Les Verify Provider Membership in My Group instructions Ta caec eter row deris nember 2 your Gwoup 1 Enter tie Proe der s ID and Service Location 2 Clek me Chee buran Provider ID 222132253 Service Location 000 Provider ID 300180963 Service Loc 0001 is a member of your Group Provider ID Sve Loc Provider Name Membership Dates 322133263 LOGZOD JAMES L 0240007 2312299 Accessibility and Use To access the ePEAP Verify Provider Membership in My Group window and verify membership complete the steps in the following step action tables
28. P User Manual February 1 2008 55 Contact DPW Step Action Result 1 To contact DPW regarding the status of an In Process request click the Contact link The Contact DPW message form opens 3 To clear any entered text click the Clear The entered text is erased Message button 4 To send the message to DPW click the The message is forwarded to DPW for Send Message button review Cancel Requests Step Action Result 1 Click the Cancel link next to the request to The request you selected will be cancelled be cancelled Other Options Step Action Result 1 Click the ePEAP Menu button Opens the ePEAP Menu 2 Click the Help button Describes the fields on the Recent Requests window 3 Click the Exit button Opens the PA PROMISe Provider Main Page Field Descriptions Field Description Data Type Length Cancel Cancels the selected request Hyperlink 0 Contact Displays a message area at bottom of window Hyperlink 0 Through message area user may submit a message to DPW regarding the selected request Exit Exit ePEAP Button 0 Help Describes the fields on the ePEAP window Button 0 Options Options available for request Character 4 Status Recent Identifies the current status of a request A request may Character 10 Rqst have the status of Received In Process Complete Rejected or Withdrawn Provider Internet ePEAP Us
29. _ Provider Address Information The address information for your Service Location is displayed below To change any of the information please click the corresponding Change button The addition of NEW SERVICE LOCATIONS and changes to the physical address of a service location MAY NOT be completed through ePEAP They must be requested on the NEW SERVICE LOCATION REQUEST FORM Accessibility and Use To access the ePEAP Provider Address Information window and perform address maintenance tasks complete the steps in the step action table s Provider Internet ePEAP User Manual February 1 2008 21 To Access the ePEAP Provider Address Information Window Step Action Result Sign on to the PA PROMISe _ Internet The Provider Main Page appears on the application using instructions provided in desktop Section 1 5 of this manual Click on the ePEAP Provider Enrollment 2 Automation Project link in the Other The ePEAP Menu window opens Links section of the window 3 Select the Enrollment Information option me SPEC OON window opens 4 Cities ddressInfonmationdinte The ePEAP Provider Address Information window opens To Update Provider Address Information Step Action Result Select any of the following options aes 1 Click the Pay to Change Address link The Manage Active Addresses window ope
30. ated with the NPI number is displayed e Service Location number and address e Provider Type ePEAP Status Active or Inactive ePEAP Access Full or XXXX Link to view all active Specialties associated with the displayed Service Location Your Provider ID 300276278 DOGOOD MEDICAL ASSOCIATES Status Active NPI 1384654368 View Taxonomy ePEAP Access Full Access Service Location 0001 123 E MAIN ST CAMP HILL 17011 5312 Provider Type 31 PHYSICIAN View Specialties This information displays on every ePEAP window Descriptions for the fields found in the label are listed below These descriptions are not included with subsequent window information in this manual and are presented below for reference If while logged into the ePEAP application you notice that this information has changed please contact DPW for help Field Descriptions Field Description Data Type Length NPI National Provider Identifier Number 10 Provider Type Provider Type for current service location Character 2 Provider Type Unlabelled field following Provider Type Describes Character 50 Description provider type Service Location Unlabelled field following Service Location Character 78 Address Abbreviated address of current provider service location Service Location Identifies current provider service location Character Status Status of provider service location Will display Character 8 Active or Inactive
31. ation Step Action Result 1 Click on the View Specialties link for the requested Service Location The following pop up window opens Specialty Microsoft Internet Explorer provided by EDS COE Dax Specialties for DOGOOD JAMES L Provider ID 300180963 Service Location 0002 Provider Type 31 318 GENERAL PRACTITIONER Provider Internet ePEAP User Manual 66 February 1 2008 To View Taxonomy Codes Associated With a Service Location Step Action Result 1 Click on the View Taxonomy link for the requested Service Location The following pop up window opens E NPI Taxonomy Microsoft Internet Explorer provided by EDS COE DER Taxonomy for DOGOOD JAMES L NPI ID 1234567893 Provider ID 300180963 Service Location 0002 ALLOPATHIC amp OSTEO PHYSCNS 208D00000X GENERAL PRACTICE DEFAULT SPCLTY CD Field Descriptions Data Field Description Type Length Exit Exit ePEAP Button 0 ePEAP Menu Opens the ePEAP menu window Button 0 Help Describes the fields on the ePEAP window Button 0 NPI National Provider Identifier Number 10 Physical Site Street address associated with a service location The address Address consists of the following items Name e Address Line 1 e Address Line 2 City State Zip 10 digit Service Number assigned to an individual service location Character 4 Location View
32. contains a proper ending a three letter domain or a two letter country code Layout PENNS T Your Provider ID 300180953 DOGOOD JAMES L Status Active NPI 1234567893 View Taxonomy ePEAP Access Full Access Service Location 0001 123 HOPE RD HARRISBURG PA 17011 Provider Type 91 PHYSICIAN View Specialties Manage E mail Address Instructions Add or update your e mail address as needed Then click Continue Your e mail address for messages from the Medical Assistance Program jdogoodfdac cam Reser Address Menu ePEAP Menu Help Review Submit Accessibility and Use To access the Manage E mail Address window and add or update your e mail address complete the steps in the following step action tables To Access the Manage E mail Address Step Action Result 1 Sign on to the PA PROMISe Internet The Provider Main Page appears on the application using instructions provided in desktop Section 1 5 of this manual Provider Internet ePEAP User Manual February 1 2008 33 Step Action Result Click on the ePEAP Provider Enrollment Automation Project link in the Other Links section of the window The ePEAP Menu window opens 3 Select the Enrollment Information option The ePEAP Enrollment Information window opens 4 Click the Address Information link The ePEAP Provider Address Information window opens 5 Click
33. cter Character Character N A Character 0 0 10 2000 10 50 The ePEAP Review Changes window is used to review and submit data update requests that were entered during the current ePEAP session This window can be accessed from the PA PROMISe Internet Provider Main Page by selecting ePEAP Provider Enrollment Automation Project From here select Enrollment Information and then click the Review Submit button In addition this window is automatically displayed each time the user makes a valid change and clicks the Continue button on any other ePEAP window Provider Internet ePEAP User Manual 49 February 1 2008 Layout PENNS VAAN 22 PEAP _ Review Your Changes Changes Requested For Provider ID 300180963 DOGOOD JAMES L Service Location 0001 Change Medicare Number 0122245678 Current Requested Medicare Type X Railroad DME Provider Internet ePEAP User Manual February 1 2008 50 After reviewing and clicking the Submit Changes button the following window will display Review Your Changes Contact Information This information may be used to contact you about this request This information will not be used for any other purpose After completing the Contact Information and clicking the Submit button the following window will display PENNS VAWANA 25 PEAP _ Changes Are Complete Your provider information has been updated as you requested If you wish to view your r
34. e a Fee Assignment Step Action Result 1 Click the Select link next to the fee assignment to be terminated from the list in the Active Groups box The window expands to include fields in which this information can be edited 2 Highlight the Fee Assignment you wish to terminate 3 Select the End Date on which to terminate The End Date is displayed the fee assignment 4 Click the Continue button The Review Your Changes window opens Click Continue to return to the Enrollment Information window Other Options Step Action Result 1 Click the Fee Assignment Menu button Return to the Fee Assignment Menu window 2 Click the ePEAP Menu button Return to the ePEAP Menu window Click the Help button Describes the fields on the ePEAP window 4 Click the Review Submit button Opens the Review Your Changes window Provider Internet ePEAP User Manual 42 February 1 2008 Step Action Result 5 Click the Exit button The ePEAP Main window opens Field Descriptions Field Description Data Type Length Begin Date Date when current provider service location Date 8 began fee assignment to the group CCYYMMDD End Date Date when current provider service location Date 8 will end fee assignment to the group CCYYMMDD Exit Exits ePEAP Button 0 Fee Assign Menu Opens the Fee Assignment window Button 0 Group ID Provider ID number of the gro
35. elect to receive RAs on line Radio Button 0 line By Email Select to receive Bulletins by email Radio Button 0 Provider Internet ePEAP User Manual February 1 2008 63 Field Description Data Type Length By US Mail to your Select to receive Bulletins by US mail Radio Button 0 mail to address Cancel Sends user back to previous window Button 0 Continue Forwards user to Review Request window Button 0 My Email address is Display update mail to email address Character 100 Valid mail to email address is required to receive Bulletins by email NPI NPI of the group Character 10 Receive paper RAs Select to receive RAs by US mail Radio Button 0 via US mail Retype Email Confirm email address is correct Character 100 address View Specialties Opens a window displaying the specialty Hyperlink code s associated with the provider service location View Taxonomy Opens a window displaying the taxonomy Hyperlink 0 code s associated with the NPI Provider Internet ePEAP User Manual February 1 2008 64 7 View Active Service Locations The Active Service Locations window is used by providers to display all active Service Locations for the provider This window is accessed by clicking the Active Service Locations link in the ePEAP Menu Layout of Medical Assistance Programs Your Provider ID 300180963 DOGOOD JAMES L Status Active NPI 1234567893 View Taxo
36. equest again please select Recent Requests from the ePEAP Menu The Tracking Number for this Request was 1321 64401 Thank you for using ePEAP Continue l ePEAP Menu Provider Internet ePEAP User Manual February 1 2008 51 The following message is displayed if your request cannot be updated immediately DPW will review and process the request manually Your request has been submitted to DPW for review View request status at Recent Requests on the ePEAP Menu Tracking Number 771 64145 Accessibility and Use To access the ePEAP Review Your Changes window and review approve and submit your changes complete the steps in the following step action tables To Access the Review Your Changes Window Step Action Result 1 Sign on to the PA PROMISe _ Internet application using instructions provided in Section 1 5 of this manual The Provider Main Page appears on the desktop 2 Click on the ePEAP Provider Enrollment Automation Project link in the Other The ePEAP Menu window opens Links section of the window 3 Select and process one of the Menu options to change provider information After requesting and submitting changes this window will open The Review Your Changes Window opens To Review Approve and Submit Your Changes Step Action Result 1 Review the displayed information for accuracy 2 If displayed information is correct and
37. er Manual 56 February 1 2008 Field Description Data Type Length Submit Date Date request was submitted Date 8 CCYYMMDD Tracking Identifies requests submitted through ePEAP displays Character 10 as a link to a request document View Displays selected request at bottom of window Hyperlink 0 ePEAP Menu Opens the ePEAP menu window Button 0 Provider Internet ePEAP User Manual February 1 2008 57 5 Terminate MA Enrollment You can use the ePEAP Terminate Medical Assistance Participation window to end your Medical Assistance participation at a service location This window is accessed by clicking the Terminate MA Enrollment link in the ePEAP Menu Layout ted PENNSYIMANAL Z pEAP Your Provider ID 300180963 DOGOOD JAMES L Status Active NPI 1234567893 View Taxonomy ePEAP Access Full Access Service Location 0001 123 HOPE RD HARRISBURG 17011 Provider Type 31 PHYSICIAN View Specialties Terminate Medical Assistance Participation To terminate your participation as an MA Provider at this Service Location 1 Enter an End Date 2 Optionally enter Comment Provider ID 300180963 Service Location 0001 Effective End Date April 0117 1 2007 8 erra menu Accessibility and Use To access the ePEAP Terminate Medical Assistance Participation window and terminate your participation as a MA provider at this service location complete the steps in the following step action tab
38. es window opens 5 Click the Exit button Exits ePEAP and returns to the Provider Main Page of PA PROMISe Provider Internet ePEAP User Manual 25 February 1 2008 Field Descriptions Field Description Data Type Length Add to List Links to the Add Address window Hyperlink 0 Address Complete address street city state and ZIP code Character 87 Address Menu Opens the Address Menu window Button 0 Assigned to Your Indicates relationship if any of this address to the Character 50 Service Location current service location Possible values are No or any combination of Service Location Address Mail to Address Pay to Address and or Home Office Address ePEAP Menu Opens the ePEAP menu window Button 0 Exit Exits ePEAP Button 0 Handicap Access Values Yes or No indicate handicap access Character 3 status Help Describes fields on the ePEAP window Button 0 Phone Fax Phone and fax numbers for the address Character 20 Review Submit Reviews the request summary and submit request Button 0 document Select Links to the Edit Address window Hyperlink 0 3 2 2 ePEAP Add a New Address w_epeap_new_add The ePEAP Add a New Address window is used to specify a new Pay to Mail to and or Home Office address for a provider s service location This window is accessed from the PA PROMISe Internet Provider Main Page by clicking the ePEAP Provider Enrollment Automation P
39. field edits for the ePEAP Internet system are listed in this section Error Message Enter Address to continue You must update at least one item to continue City can only contain letters spaces and hyphens Enter comments to continue NPI must be numeric NPI must be 10 digits in length Your NPI and Taxonomy selections already match what is on file for this Service Location You must select at least one Taxonomy Code The number entered is not a valid NPI number Please verify and re enter This NPI has been discontinued and cannot be used Please verify and re enter This NPI is associated with another individual Please verify and re enter This individual is associated with a different NPI Only one NPI is allowed per legal entity for individuals This NPI is associated with another legal entity Please verify and re enter To Correct Enter the first street address Enter the first street address Enter a valid city name Enter in comments Enter a numeric value Enter a 10 digit value Changes must be made for the page to submit At least one taxonomy code checkbox must be selected for the page to submit Re enter the NPI N A N A N A N A Provider Internet ePEAP User Manual 72 February 1 2008 Field County Effective Date Effective End Date End Date Fax Fax Error Code 5665 5666 5667 5669 5675 10 CO nN wld Error Message
40. formation 4 Click the Enrollment Information button The update is cancelled and the Enrollment Information window opens 5 Click the ePEAP Menu button Returns to the ePEAP Menu window 6 Click the Help button Describes the fields on the ePEAP window 7 Click the Exit button The ePEAP Main window opens Field Descriptions Field Description Data Type Length ACH Indicates whether provider service Character 1 location receives payment electronically Possible values are Y yes N no Birth Date Provider s date of birth Drop Down List Box 0 Cancel Cancel transaction clear contents Button 0 Click here Contact information when a Medicare HyperLink 0 number needs to be updated Comment do not use relevant supporting information to Character 200 this box to request justify a request changes Continue Moves to the next logical page or form Button 0 DEA Provider s DEA number indicates the Character 9 provider is a prescribing physician Effective Date Beginning date for a Medicare billing Date CCYYMMDD 8 number Read only as of 2 1 2008 End Date Ending date for a Medicare billing Date CCYYMMDD 8 number Read only as of 2 1 2008 Enrollment Returns to the Enrollment Information Button 0 Information window Exit Exit ePEAP Button 0 Gender Provider s gender if an individual Drop Down List Box 0 otherwise leave blank Provider Internet ePEAP User Manual 18 February 1
41. ge Bulletins Remittance Advice RA Bulletins 1 Select bulletin delivery methad 2 If Email option is selected an email address is required and will be used as your mail to email address 3 If US is selected the bulletin will be sent to your mail to address NOTE To view bulletins on the web click here Remittance Advice 1 Select an RA option 2 If the On Line option is selected you will not receive RAs by mail 3 If US Mail is selected the RAs will be sent by mail after your request has been processed NOTE With either RA option you can still view your RAs on this website After making changes please click the Continue button to complete your request BULLETINS How do you want to receive newly issued bulletins OBy Email My Email address is Retype Email address 9 By US Mail to your mail to address REMITTANCE ADVICE Remittance advices are available on line through the PROMISe website Do you wish to O Access RAs on line through PROMISe and eliminate receipt of paper RAs Receive paper RAs via US mail ePEAP Menu Confirmation Window Bulletins Microsoft Internet Explorer BULLETINS 7 Press OK to terminate the mailing of hard copy bulletins and to begin receiving bulletin notifications via email Cancel Press to return Provider Internet ePEAP User Manual February 1 2008 61 Confirmation Window Remittance Advice
42. he window to open the ePEAP Menu Under Provider Options click the Provider Enrollment link to open the ePEAP Enrollment Information window Click on the Base Information link to open the ePEAP Basic Enrollment Information window Provider Internet ePEAP User Manual February 1 2008 15 Layout PENN SUD Welfare ACH DEA Tape Bill UPIN License Start Issued By MA Enrollment CEOE Co c c c Dates peser 72225 inse piae Start 01 01 2004 poses MedcaeB wpuoerzr End 12 31 2209 perdi ed 0012336666 Joc Ms beer ESSE 22991231 0 0 Medicare Indicator Information ociation from Service Loc Enrollment Information Provider Internet ePEAP User Manual February 1 2008 16 Accessibility and Use To process ePEAP Base Information change requests complete the steps in the following step action tables To Access the ePEAP Basic Enrollment Information Window Step Action Result 1 Sign on to the PROMISe _ Internet application using instructions provided in Section 1 5 of this manual The Provider Main Page appears on the desktop 2 Click on the ePEAP Provider Enrollment The ePEAP Menu window opens Automation Project link in the Other Links section of the window 3 Select the Enrollment Information option The ePEAP Enrollment Information window opens 4 Click the Base Information link The ePEAP Basic Enrollment
43. he ePEAP window Assigns new address as the Home Office address for current service location Mail to Address for current service location Pay to Address for current service location Phone number for the specific address code Resets the form Opens the Review Your Changes window Returns to the ePEAP menu window 3 2 4 ePEAP Manage Email Address w epeap man email addr Data Type Character Button Button Button Button Number Character Radio Button Button Check Box Check Box Check Box Character Button Button Button Length 87 10 The ePEAP Manage Email Address window is used by providers to update the email address to which messages from the Medical Assistance program are sent Provider Internet ePEAP User Manual 32 February 1 2008 This window is accessed from the PA PROMISe Internet Provider Main Page through the ePEAP Provider Enrollment Automation Project link which opens the ePEAP Menu Click the Enrollment Information link to open the Enrollment Information window then the Address Information link to open the Provider Address Information window Click the Manage E mail Address link to open the Manage E mail Address window Several edits ensure the validity of an email address If an IP address is given instead of a symbolic name the system ensures the IP address is valid For domain names the system verifies that the domain name is validly composed and
44. he provider to manage the delivery of both the MA Bulletins and Remittance Advices Layout Manage Remittance Advice Only PENNS ER Water DEAP Your Provider ID 300180963 DOGOOD JAMES L Status Active NPI 1234567893 View Taxonomy ePEAP Access Full Access Service Location 0001 123 HOPE RD HARRISBURG 17011 Provider Type 31 PHYSICIAN View Specialties Manage Remittance Advice RA Remittance Advice 1 Select an RA option 2 If the On Line option is selected you will not receive RAs by mail 3 If US Mail is selected the RAs will be sent by mail after your request has been processed NOTE With either RA option you can still view your RAs on this website After making changes please click the Continue button to complete your request REMITTANCE ADVICE Remittance advices are available on line through the PROMISe website Do you wish to O Access RAs on line through PROMISe and eliminate receipt of paper RAs Receive paper RAs via US mail ePEAP Menu Help EI Provider Internet ePEAP User Manual February 1 2008 60 Layout Manage Bulletins and Remittance Advice PEN N Welfare Office of Medical Assistance Programs OMAP Your Provider ID 300276278 DOGOOD MEDICAL ASSOCIATES Status Active NPI 1384654368 View Taxonomy ePEAP Access Full Access Service Location 0001 123 E MAIN ST CAMP HILL PA 17011 6312 Provider Type 31 PHYSICIAN View Specialties Mana
45. ided in desktop Section 1 5 of this manual 2 Click on the ePEAP Provider Enrollment The ePEAP Menu window opens Automation Project link in the Other Links section of the window 3 Select the Enrollment Information option The ePEAP Enrollment Information window opens 4 Click the Address Information link The ePEAP Provider Address Information window opens 5 Click the Manage Active Addresses link The Manage Active Addresses window opens To Update Address Related Information Step Action Result 1 Click the Select link next to the address to be updated The Edit Address Related Information window opens You can change the phone number fax number and or handicap access status for this address You may also assign this address to replace the current Pay to Mail to and or Home Office Address for your service location 2 Click the Add to List hyperlink The Add New Pay To Mail To and or Home Office Address window opens This window is used to specify an address and assign it to replace the current Pay to Mail to and or Home Office address for your service location Other Options Step Action Result 1 Click the Address Menu button Return to the Provider Address Information window 2 Click the ePEAP Menu button Opens the ePEAP Menu window 3 Click the Help button Describes the fields on the ePEAP window 4 Click the Review Submit button The Review Your Chang
46. iew Contact 771 64145 4124 2006 4 06 50 In Process View 921 64230 11 20 2006 2 35 46 PM View 922 64231 11 20 2006 2 42 17 PM Complete View 923 64232 11 20 2006 2 42 37 PM Complete View 947 64240 11 21 2006 1 16 51 Complete View 949 654241 11 21 2006 1 1936 PM Complete View 954 64243 11 21 2006 230 20 Complete View 956 64244 11 21 2006 24845 Complete View 1027 64238 12 8 2006 11 06 34 Complete View 1072 64207 119 2007 9 20 08 Complete View Cancel Contact 1074 64208 1419 2007 9 25 21 Recanad View 1089 64323 123 2007 11 21 45 AM Complete View 1090 64324 1 24 2007 8 27 18 AM Complete View 1091 64325 1 24 2007 3 40 50 Complete Des en Provider Internet ePEAP User Manual February 1 2008 54 The following window is displayed after selecting a request and clicking View Your Provider ID 300180963 DOGOOD JAMES L Status Active 1234567893 View Taxonomy ePEAP Access Full Access Service Location 0001 123 HOPE RD HARRISBURG PA 17011 Provider Type 31 PHYSICIAN View Specialties Recent Requests Options Tracking Submit Date Status View Contact 636 64096 9 28 2005 3 08 30 In Process View Contact 637 64097 10 3 2005 3 39 47 PM In Process View Contact 639 64098 10 7 2005 8 36 02 AM In Process View Contact 771 64145 4 24 2006 4 06 50 PM In Process View 921 64230 11 20 2006 3 35 46 PM Complete View 922 64231 11 20 2006 3 42 17 PM Complete View 923 64232 1
47. information for the current provider In addition the user can assign or unassign this address as the Pay to Mail to or Home Office address for the current provider service location This window is accessed from the PA PROMISe Internet Provider Main Page by clicking the ePEAP Provider Enrollment Automation Project link which opens the ePEAP Menu Click the Enrollment Information link to open the Enrollment Information window and then click the Address Information link to open the Provider Address Information windows Click the Change Phone Fax button to open the Edit Address Related Information window Layout IE Your Provider ID 300180963 DOGOOD JAMES L Status Active NPI 1234567893 View Taxonomy ePEAP Access Full Access Service Location 0001 123 HOPE RD HARRISBURG PA 17011 Provider Type 31 PHYSICIAN View Specialties Edit Address Related Information Instructions You may use the form below to change the phone number fax number and or handicap access status for this address You may also assign this address to replace the current Pay to Mail to and or Home Office Address for your Service Location After making desired changes please click Continue Address 234 NEW HAVEN RD CAMP HILL PA 17011 Phone 17 ys 1234 Ext 567 Fax M Handicap Access G Yes ONo Assign to Service Location 0001 as Check all that apply Payto Address Mail to Address Home Office Address 0
48. it displays cannot be modified by the user This window is accessed by clicking the View Provider Group Members link in the ePEAP Menu When the results for this window exceed 1000 records only the first 1000 records are displayed and the Displaying results drop down list appears to specify the range group being displayed Results beyond the first 1000 are viewed by selecting a range of results from the drop down list and pressing the View Results button Layout E Provider Group Members Microsoft Internet Explorer provided by EDS COE Provider Group Members Group Provider ID 300275278 Location 0001 Group 1006000 MEDICAL ASSOCIATES Member Service Location Provider Type Effective Date End Date Member Name Number 300180963 0001 31 04 01 2006 0441 2006 DOGOOD JAMES L 300180963 0001 31 04 19 2006 0149 2007 DOGOOD JAMES L 300180963 0001 31 01 24 2007 12 31 2288 DOGOOD JAMES L Accessibility and Use To access and view the ePEAP Provider Group Members window complete the steps in the following step action tables To Access the ePEAP Provider Group Members Window Step Action Result 1 Select the View Provider Group Members The Provider Group Members window link in the ePEAP Menu opens Provider Internet ePEAP User Manual February 1 2008 70 To View More Than 1000 Records Step Action Result
49. ive this Provider Internet ePEAP User Manual February 1 2008 44 message please contact Provider Enrollment at PROMISe state pa us with a subject line of NPI registration problem In your email please include the error message text and number details about the entry as well as a contact name and phone number The NPI taxonomy zip code combination is already being used The same NPI taxonomy nine digit ZIP Code combination can only be associated with one service location The above error message will be displayed if you attempt to associate this same combination with another service location If you receive this error message please contact Provider Enrollment at PROMISe state pa us with a subject line of NPI registration problem In your email please include the error message text and number details about the entry as well as a contact name and phone number Accessibility and Use To access the ePEAP Manage NPI and Taxonomy Codes window complete the steps in the step action table s To Access the Manage NPI and Taxonomy Codes Window Step Action Result 1 Sign on to the PA PROMISe Internet The Provider Main Page appears on the application using instructions provided in desktop Section 1 5 of this manual 2 Click on the ePEAP Provider Enrollment The ePEAP Menu window opens Automation Project link in the Other Links section of the window 3 Select the Enrollment Information option The eP
50. k will access the enrollment options of the ePEAP system The links in the Request Changes box of the ePEAP Enrollment Information window are used to access the windows listed below Base Information Opens the Basic Enrollment Information window e Address Information Opens the Provider Address Information window e Fee Assignment Information Opens the Fee Assignment Information window Manage NPI Taxonomy Opens the Manage NPI and Taxonomy Codes window These windows are described in this chapter Layout E M N 5 p of Pai Welfare mn Your Provider ID 300180963 DOGOOD JAMES L Status Active NPI 1234567893 View Taxonomy ePEAP Access Full Access Service Location 0001 123 RD HARRISBURG 17011 Provider Type 31 PHYSICIAN View Specialties Enrollment Information Instructions Base Information Address Information 1 Select an item to update 2 Make changes Fee Assignment Information 3 Review Request Summary 4 Submit Requests Manage NPI Taxonomy Review Submit Accessibility and Use To access the ePEAP Enrollment functions complete the steps in the following step action tables To Access the ePEAP Enrollment Information Window Step Action Result 1 Select the ePEAP Menu link The ePEAP Menu window opens Provider Internet ePEAP User Manual February 1 2008 13 Step Action Result Select the Enrollment Information opti
51. les To Access the ePEAP Terminate Medical Assistance Participation Window Step Action Result Sign on to the PROMISe Internet The Provider Main Page appears on the application using instructions provided in desktop Section 1 5 of this manual 2 Click on ePEAP Provider Enrollment The ePEAP Menu window opens Automation Project link in the Other Links section of the window 3 Select the Terminate MA Enrollment The ePEAP Terminate Medical Assistance option Participation window opens Provider Internet ePEAP User Manual February 1 2008 58 To Terminate Your Participation as a MA Provider at this Service Location Step Action Result 1 Select an Effective End Date month day and year from the drop down box 2 Click the Continue button The Review Your Changes window opens to verify your request 3 Click the Cancel button This enrollment termination process will be ended and will not complete 4 Click the Continue To Make Changes Opens the ePEAP Menu button to make additional changes 3 Click the Cancel All Changes button to The message This request has been cancel all changes cancelled is displayed Click the Continue button to return to the ePEAP menu window 6 Click the Submit Changes button to submit Request for MA enrollment termination is the changes submitted Other Options Step Action Result 1 Click the ePEAP Menu bu
52. ment Window Step Action Result Sign on to the PA PROMISe _ Internet The Provider Main Page appears on the application using instructions provided in desktop Section 1 5 of this manual Click on the ePEAP Provider Enrollment 2 Automation Project link in the Other The ePEAP Menu window opens Links section of the window 3 Select the Enrollment Information option me OON window opens 4 Click the Fee Assignment Information The ePEAP Fee Assignment Information link window opens 5 Click the Add A Group For Fee The ePEAP Add A Group For Fee Assignment link Assignment window opens To Add a Group for Fee Assignment Information Step Action Result 1 Enter the provider ID number of the group being added in the Provider ID of Group field 2 Enter the service location number of the group being added in the Service Location of Group field 3 Click the Continue button The Review Your Changes window opens Click Continue to return to the Enrollment Information window Other Options Step Action Result 1 Click the Fee Assignment Menu button Opens the Fee Assignment Menu window 2 Click the ePEAP Menu button Opens the ePEAP Menu window 3 Click the Help button Describes the fields on the ePEAP window 4 Click the Review Submit button The request summary is reviewed and submitted 5 Click the Exit button Opens the PA PROM
53. no The Contact Information window is other changes are required click the displayed Submit Changes button 3 If additional changes are required click the The previous maintenance window will be Continue to Make Changes button displayed 4 To cancel all entered changes click the The message This request has been Cancel button cancelled is displayed Provider Internet ePEAP User Manual 52 February 1 2008 To Enter Contact Information Step Action Result 1 Enter the following information in the Contact Information window Name required Phone required Fax E mail required 2 If the displayed information is correct click the Submit button 3 To clear the entered information click the Reset button 4 To cancel the requested changes click the Cancel button The message Changes Are Complete is displayed The previous maintenance window is displayed Field Descriptions Field Description Data Type Length Cancel Cancels the update process Button 0 Cancel All Cancels all entered ePEAP change requests Button 0 Changes Continue Continues the update process Button 0 Continue to Make Continues the ePEAP update process Button 0 Changes Email The email address of the contact person for the ePEAP Character 35 change request Exit Exits ePEAP Button 0 Fax The fax number of the contact person for the ePE
54. nomy ePEAP Access Full Access Service Location 0001 123 HOPE RD HARRISBURG PA 17011 Provider Type 31 PHYSICIAN View Specialties Active Service Locations for MAID 300180963 Medicare Service Location NPI Physical Site Address Options Indicator 0001 1234567893 DOGOOD JAMES L View Specialties X Currently Logged In 123 HOPE RD View Taxonomy HARRISBURG PA 17011 1234567893 DOGOOD JAMES L View Specialties Pending 234 NEW HAVEN RD iew Taxonom CAMP HILL PA 17011 5 DOGOOD PHYSICIAN SERVICES View Specialties 123 HOPE RD HARRISBURG PA 17011 Accessibility and Use To access the ePEAP Active Service Locations window view all service locations associated with a provider ID and review specialties or taxonomy codes associated with a service location complete the steps in the following step action tables Provider Internet ePEAP User Manual February 1 2008 65 To Access the ePEAP Active Service Locations Window Step Action Result Sign on to the PA PROMISe Internet The Provider Main Page appears on the application using instructions provided in desktop Section 1 5 of this manual Click on the ePEAP Provider Enrollment 2 Automation Project link in the Other The ePEAP Menu window opens Links section of the window 3 Select the Active Service Locations option Ihe eben seve service Locations window opens To View Specialties Associated With a Service Loc
55. ns 2 Click the Mail to Change Address link The Manage Active Addresses window opens 3 Click the Home Office Change Address The Manage Active Addresses window link opens 4 Click the Email Change Email link The Manage Email Address window opens Click the Pay to Change Phone Fax link The Edit Address Related Information window opens 6 Click the Mail to Change Phone Fax The Edit Address Related Information link window opens 7 Click the Home Office Change The Edit Address Related Information Phone Fax link window opens Other Options Step Action Result 1 Click the Enrollment Information button Return to the Enrollment Information window 2 Click the ePEAP Menu button Return to the ePEAP Menu window Click the Help button Describes the fields on the ePEAP window 4 Click the Exit button The ePEAP Menu window opens Provider Internet ePEAP User Manual 22 February 1 2008 Step Action Result Click the Review Submit button The Review Your Changes window opens Click the New Service Location Request Form link A copy of the Pennsylvania Promise New Service Location Application is downloaded to the user s computer for printing Field Descriptions Field Description Data Type Length Change Address Displays the Manage Active Addresses window Button 0 Change Email Displays the Manage Email window Button 0 Change Phone Fax Displays the Edit Address windo
56. o terminate 2 Selectthe date to terminate the fee assignment 3 Review your Pay to Address and change if needed Active Fee Assignments Fee Assign Menu Layout After Selection PENNS YIN 5 PEAP Manage Fee Assignments Instructions 1 Selectthe fee assignment you wish to terminate 2 Selectthe date to terminate the fee assignment 3 Review your Pay to Address and change if needed Active Fee Assignments Group ID Svc Loc Group Name Begin Date End Date 001155484 0006 MANRIQUE SHROFF ASSOC 04 15 2007 12 31 2299 Provider Internet ePEAP User Manual February 1 2008 41 Accessibility and Use To access the ePEAP Manage Fee Assignment window and terminate an active fee assignment complete the steps in the step action table s To Access the Manage Fee Assignment Window Step Action Result 1 Sign on to the PA PROMISe Internet application using instructions provided in Section 1 5 of this manual The Provider Main Page appears on the desktop 2 Click on the ePEAP Provider Enrollment The ePEAP Menu window opens Automation Project link in the Other Links section of the window 3 Select the Enrollment Information option The ePEAP Enrollment Information window opens 4 Click the Fee Assignment Information The ePEAP Fee Assignment Information link window opens 5 Click the Manage Fee Assignments link The ePEAP Manage Fee Assignments window opens Terminat
57. on from the ePEAP Menu The Enrollment Information window opens To Request Changes to Basic Enrollment Information Step Action Result 1 Select Base Information The Basic Enrollment Information window opens To Request Changes to Provider Address Information Step Action Result 1 Select Address Information The Provider Address Information window opens To Request Changes to Fee Assignment Information Step Action Result 1 Select Fee Assignment Information The Fee Assignment Information window opens To Manage NPI Codes and Associated Taxonomy Codes Step Action Result 1 Select the Manage NPI Taxonomy button The Manage NPI and Taxonomy Codes window opens To Review and Submit Completed Changes Step Action Result 1 Select the Review Submit button The Review Your Changes window opens Other Options Step Action Result 1 Click the ePEAP Menu button Opens the ePEAP Menu window 2 Click the Help button Displays the ePEAP Help window 3 Click the Exit button Opens the PA PROMISe Provider Main Page Provider Internet ePEAP User Manual 14 February 1 2008 Field Descriptions Field Description Data Type Length Address Accesses the Provider Address Information window Hyperlink 0 Information used to change the Address Phone FAX data for
58. on and provide an answer Security Question What is your mother s maiden Answer Submit Registration You will need the following information available to complete your registration e Valid provider ID and service location e Social Security number or Federal Tax ID IRS EIN Valid e mail address The User Registration window allows you to request access to the PA PROMISe Web site by submitting the necessary information requested in this online form Read the appropriate disclaimers and fill in the web form with identifying information and e mail address If you need more information to complete the required fields please refer to section 2 1 4 of the Provider Internet User Manual After completing the User Registration form click the Submit Registration button to submit the form If all required information is present proceed to the Statement of Entitlement page also referred to as the Web Agreement Page to confirm that you have read and understood the Provider Internet ePEAP User Manual February 1 2008 disclaimer This page must be signed and submitted before gaining access to the PA PROMISe Web application If you do not sign and submit the agreement you are logged out of the system and returned to the logon window PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE Statement of Entitlement By entering my full name in the space provided below and transmitting this form electronically I state I am
59. one Fax Provider ID Provider ID of Group Service Location of Group Code Error Message 2 Fax number must be 10 digits 3 Medicare number must be 0 9 or A Z 4 Medicare number must be at least 6 characters in length 1 You must change at least one pay to value to continue 2 Pay to code must be numeric 3 Phone number must be numeric 4 Phone number must be 10 digits 8 Phone number must be numeric 9 Phone number must be 10 digits 3 The fax number must be numeric 4 The fax number must be 10 digits 1 Enter Provider Number to continue 2 Provider Number must be numeric 3 digits 4 This Provider ID is the same one signed on to ePEAP 1 Provider ID must be numeric 2 Provider ID must be nine digits 3 Enter Provider ID to continue 4 Service Location must be 4 characters To Correct Enter a 10 digit fax number Enter an alphanumeric Medicare number Enter a Medicare number with 6 10 characters Select new pay to value from the drop down list Select new pay to value from the drop down list Enter a 10 digit phone number Enter a 10 digit phone number Enter in a 10 digit phone number Enter in a 10 digit phone number Enter in a 10 digit fax number Enter in a 10 digit fax number Enter in a 9 digit provider number Enter in a 9 digit provider number Provider Number must be 9 Enter in a 9 digit provider number Enter a new 9 digit group provider number Ente
60. ovider Internet ePEAP User Manual 10 February 1 2008 Accessibility and Use To access the ePEAP Menu complete the steps in the step action table s To Access the ePEAP Menu Step Action Result 1 Access the PA PROMISe Provider Internet The Provider Internet application opens using the instructions provided in Section 1 5 This application is accessed from the DPW Web site by clicking the PROMISe Online link Step by step instructions are found in the Provider Internet User Manual 2 Log into the application by entering your The Provider Main Page opens Logon ID and Password and click the Log On button 3 Click the ePEAP Provider Enrollment The ePEAP Menu opens Automation Project link To Access Options Step Action Result 1 Click the Enrollment Information link The Enrollment Information window opens 2 Click the Recent Requests link The Recent Requests window opens Click the Terminate MA Enrollment link The Terminate Medical Assistance Participation window opens 4 Click the Manage Bulletins Remittance The Manage Bulletins Remittance Advice link Advice window opens Or Click the Manage Remittance Advice link The Manage Remittance Advice window opens 5 Click the Active Service Locations link The Active Service Location window opens For Groups Only Step Action Result 1 Select the Verify Provider Membership link The Verify Provider Membership In
61. ovider for this ePEAP Number 9 session Uses number assigned to provider at time of enrollment in MA program ePEAP Access EPEAP access levels include Read Only Character 16 access or Full access Your access level is always displayed in the upper right corner of an ePEAP page ePEAP Menu Returns to the ePEAP Menu window Button 0 3 2 ePEAP Provider Address Information epeap add info The ePEAP Provider Address Information window is available to the provider community and displays the current Pay to Mail to Home Office and Email addresses associated with the user s service location The window includes Change buttons that allow the user to change any of the displayed address information This window is accessed from the PA PROMISe Internet Provider Main Page by clicking on the ePEAP Provider Enrollment Automation Project link which opens the ePEAP Menu Click the Enrollment Information link to open the Enrollment Information window and then click the Address Information link Note This window cannot be used to add a new service location or modify a service location s physical address To add a new service location or change a service location address click the New Service Location Request Form to download a copy of the form that must be printed filled out and submitted to DPW for approval and processing Provider Internet ePEAP User Manual February 1 2008 20 Layout PENNSVIMANI 5 PEAP
62. ow listing the provider s group members Please note The For Groups Only box is only displayed if you are logged on with a Group Provider ID Click the View Helpful Hints link to view a printable list of helpful tips Provider Internet ePEAP User Manual February 1 2008 Layout of Public Welfare Otfice of Medical Assistance Programs Your Provider ID NPI Service Location Provider Type 300180963 1234567893 View Taxonomy 0001 31 PHYSICIAN DOGOOD JAMES L Status ePEAP Access 123 HOPE RD HARRISBURG PA 17011 Active Full Access View Specialties Provider Options Enrollment Information Recent Requests Terminate MA Enrollment Manage Bulletins Remittance Advice Active Service Locations ePEAP Menu View Helpful Hints Layout Groups Only epartmient of Public Welfare Office of Medical Assistance Programs OMAP 300276278 1384654368 View Taxonomy 0001 31 Your Provider ID NPI Service Location Provider Type PHYSICIAN DOGOOD MEDICAL ASSOCIATES Status ePEAP Access 123 E MAIN ST CAMP HILL PA 17011 6312 Active Full Access View Specialties Provider Options Enrollment Information Recent Requests Terminate MA Enrollment Manage Bulletins Remittance Advice Active Service Locations ePEAP Menu For Groups Only Verify Provider Membership View Provider Group Members View Helpful Hints Pr
63. phanumeric Character Adds a set of Medicare fields in which the Button user can enter information about a new Medicare number Fields added are Medicare number Medicare Type Effective Date and End Date Unlabelled field following Your Provider Character ID Name of current provider as used on official Commonwealth records Provider Type for current Service Location Unlabelled field following Provider Type Describes provider type Character Character Length 40 10 10 50 50 Provider Internet ePEAP User Manual 19 February 1 2008 Field Description Data Type Length Reset Clears the contents of the form fields on a Button 0 page Review Submit Reviews the Request Summary and Button 0 Submit Request document Service Location Current provider service location for this Character 4 ePEAP session Service Location Unlabelled field following Service Character 78 Address Location Abbreviated address of current service location Status Status of provider service location Will Character 8 display Active or Inactive Tape Bill Provider submits claims via tape Character 1 UPIN Unique Provider Identification Number Character 6 assigned to each Medicare provider View Active Service Displays active service locations for the HyperLink 0 Locations current Provider ID View Taxonomy Opens the w epeap view taxonomy N A 0 window in a new window Your Provider ID Identifies current pr
64. r a 9 digit provider number Enter a 9 digit provider number Enter a 9 digit provider number Enter a 4 character service location Provider Internet ePEAP User Manual 74 February 1 2008 Error Field Code Error Message To Correct State 10 You must enter a state Select a valid state from drop before continuing down list Your e mail address for 1 Enter an Email address to Enter an email address messages from etc continue 2 Email Address you typed Enter a valid email address was invalid 3 Email destination is Enter a valid email address invalid 4 Email address appears Enter a valid email address incorrect must end in a three letter domain or two letter country Zip Code 11 Zip code must be numeric Enter in a 5 digit zip code number 12 Zip code must be 5 digits Enter in a 5 digit zip code number Provider Internet ePEAP User Manual February 1 2008 75
65. roject link which opens the ePEAP Menu Click the Enrollment Information link to open the Enrollment Information window and then click the Address Information link to open the Provider Address Information windows Click the Change Address button to open the Manage Active Addresses window Then click the Add to List link Note This window cannot be used to add a new service location or modify a service location s physical address To add a new service location or change a service location address click the New Service Location Request Form from the Provider Address Information window to download a copy of the form This form must be printed filled out and submitted to DPW for approval and processing Provider Internet ePEAP User Manual February 1 2008 26 Layout Add New Pay To Mail To and or Home Office Address Instructions You may use the form below to specify an address and assign it to replace the current Pay to Mail to and or Home Office address for your Service Location After completing the form please click Continue Address City State Zip Code County for Pennsylvania Addresses Phone Ext Fax Handicap Access Oves No Assign to Service Location 0001 as Check all that apply Payto Address Mailto Address C Home Office Address C Continue Required Accessibili
66. s epeap new add 3 2 3 ePEAP Edit Addr wepeap edit addi enserrer noirits nenne aee tbe pe daca eue de 3 2 4 ePEAP Manage Email Address epeap man email 2 4 22 2 10 000000000000 32 3 3 ePEAP Fee Assignment Information epeap fee assign info 35 3 3 1 ePEAP Add a Group for Fee Assignment epeap grp fee assign 37 3 3 2 ePEAP Manage Fee Assignments w epeap add fee enma nennen 40 3 4 ePEAP Manage NPI Taxonomy w epeap manage 43 3 5 ePEAP Review Changes epeap review changes nennen 49 4 RECENT REQUESTS d Gon et nec da reda eB de ada Op UR iuo 5 TERMINATE MA ENROLLMENT 6 MANAGE BULLETINS REMITTANCE ADVICE eee eese teet seta sone tastes tosta so neta an 60 7 VIEW ACTIVE SERVICE LOCA TIONS eee eeeeeee eese tosta tosta sone ta stato sets suse ta sone sees ense tasse tan 65 8 VERIFY PROVIDER MEMBERSHIP IN MY enses testen tuse saten sana 68 9 VIEW PROVIDER GROUP MEMBERS eere eese eene sten tn seta tuse tasses suse ta sone tasses ense 70 10 FIELD EDITS FOR THIS DOCUMENT eese esee eene etn seta seta setas tta sess esses seas sepas neo
67. s Request was 955 54244 Thank you for using ePEAP Continue 3 Click the Continue button The ePEAP Main Menu window opens Other Options Step Action Result 1 Click the Enrollment Information button Return to the Enrollment Information window 2 Click the ePEAP Menu button Return to the ePEAP Menu window 3 Click the Help button Describes the fields on the ePEAP window 4 Click the Exit button The ePEAP Main window opens 5 Click the Cancel button Cancels all entries changes and returns to the Enrollment Information window Provider Internet ePEAP User Manual 48 February 1 2008 Step Action Result Click the Reset button window open Cancels all entries changes but leaves the Manage NPI and Taxonomy Codes Field Descriptions Field Description Cancel End manage NPI Taxonomy request Continue Moves to the next logical page or form NPI Text entry field for the service location NPI Read only if already on file in PROMISe Reset Restores the page to initial values Taxonomy Code Taxonomy Code taxonomy code on file Selector taxonomy on file Taxonomy Description taxonomy on file 3 5 Unlabelled field New instance for each active Unlabelled field New instance for each active Unlabelled field New instance for each active ePEAP Review Changes epeap review changes Data Type Length Button Button Chara
68. ss items cannot be removed you can only add Mail to Address a function to this service location Home Office Address 4 Click the Continue button The Review Your Changes window opens Other Options Step Action Result 1 Click the Cancel button The update is cancelled and returns to the Provider Address Information window 2 Click the Reset button The contents on this page are cleared 3 Click the Address Menu button Returns to the Provider Address Information window Provider Internet ePEAP User Manual February 1 2008 31 Step Action Result 4 Click ePEAP Menu Returns to the ePEAP Menu window 5 Click the Help button Describes the fields on the ePEAP window 6 Click the Review Submit button The Review Your Changes window opens 7 Click the Exit button Returns to the ePEAP Menu window Field Descriptions Field Address Address Menu Cancel Continue Exit Ext Fax Handicap Access Help Home Office Address Mail to Address Pay to Address Phone Reset Review Submit ePEAP Menu Description Selected address Complete address street city state and ZIP code Returns to the Provider Address Information window Cancels the update process Continues the update process Exits ePEAP Phone extension number Fax number for the specific address code Indicates by Yes or No whether address is handicapped accessible Describes the fields on t
69. t you can access the Provider Main Page of PA PROMISe The Provider Main Page window is your home page for the PA PROMISe Internet application It provides links to the online provider services including ePEAP To access ePEAP click on the ePEAP Provider Enrollment Automation Project link located in the Other Links box Provider Internet ePEAP User Manual February 1 2008 The ePEAP Provider Enrollment Automation Project link takes you to the ePEAP Menu shown below E 9 Department of Put Welfare Your Provider ID 300276278 DOGOOD MEDICAL ASSOCIATES Status Active NPI 1384654368 View Taxonomy ePEAP Access Full Access Service Location 0001 123 E MAIN ST CAMP HILL PA 17011 6312 Provider Type 31 PHYSICIAN View Specialties ePEAP Menu Provider Options For Groups Only Enrollment Information Verify Provider Membership Recent Requests View Provider Group Members Terminate MA Enrollment Manage Remittance Advice Active Service Locations View Helpful Hints Note You are encouraged to use the Help function within when necessary Click the Help button located between the ePEAP Menu and Exit buttons to access this online assistance Please direct any unresolved questions regarding ePEAP to the Provider Enrollment Unit at 717 772 6140 1 6 Windows The PA PROMISe Internet ePEAP windows provide you with the ability to electronically maintain
70. t Changes opens 5 Complete the requested contact information The following confirmation fields Name Phone and E Mail are required window is displayed fields Click Submit Provider Internet ePEAP User Manual February 1 2008 46 Action Step d H PLF FERMO apama of Pati Welfare Result PEAP Your Provider ID 30018063 DOGOOD JAMES L Pradana NPI 1234567683 View Taxonomy amp PEAP Access Ful Access Service Location 0001 123 HOPE RD HARRISBURG PA 17011 Provider Type 51 PHYSICIAN Mow Changes Are Complete Your provider informato Requests from the e ce whe c in NPI w ur Service ation be nec ary 10 fonwerd the NPI documentason received from NPPES in order to validate the NPI number just entered The documentation must be mailed to the following address Bureau of Fee For Service Programs Division of Operations Provider Enrollment Section PO BOX 8045 Harrisburg PA 17105 8045 Until your NPI number validation from NPPES has been received and processed by DPW claims may not process correctly You must include a copy of this page with your Gocumentstion Provider ID 200120963 Service Location 2001 NPI 1234567893 EJ 6 As noted in the window above forward a copy of your NPI assignment documentation to the listed address and include a printout of the page showing your Provider ID Service Location and NPI number
71. ter the ZIP Code The first five digits are required the next four ZIP 4 are optional 5 Click the County drop down list and select the Pennsylvania county for this address 6 Enter the Phone Number Include area code and extension if applicable 7 Enter the Fax Number Enter the fax number if available 8 Enter Yes or No for Handicap Access 9 Assign to Current Location nnnn as Check all boxes that apply Pay to Address Mail to Address Home Office Address 10 Click the Continue button The Review Your Changes window opens Other Options Step Action Result 1 Click the Cancel button The update is cancelled and returns to the Manage Pay to Mail to and or Home Office Address window Provider Internet ePEAP User Manual 28 February 1 2008 Step Action Result 2 Click the Reset button The contents on this page are cleared 3 Click the Address Menu button Returns to the Provider Address Information window Click ePEAP Menu Returns to the ePEAP Menu window Describes the fields on the ePEAP window Click the Review Submit button The Review Your Changes window opens 4 5 Click the Help button 6 7 Click the Exit button Returns to the ePEAP Menu window Field Descriptions Field Address Address Menu Cancel City Continue County Exit Ext Fax Handicap Access Help Home Office Address Mail to Address Pay to Address Phone
72. the Change Email link The Manage E mail Address window opens To Add or Modify E mail Address Step Action Result 1 If an existing email address needs to be changed highlight the existing e mail address and press the Delete key Old e mail address is deleted from the field 2 Type in your new e mail address Click the Continue button The Review Your Changes window opens 4 Click the Continue To Make Changes A confirmation window opens Click button to continue with the change Continue to return to the Enrollment Information window Other Options Step Action Result Click the Cancel button to cancel the Opens the Provider Address Information change window 2 Click the Reset button Clears the e mail field 3 Click the Address Menu button Opens the Provider Address Information window 4 Click ePEAP Menu Opens the ePEAP Menu window 5 Click the Help button Describes the fields on the ePEAP window 6 Click the Review Submit button Opens the Review Your Changes window 7 Click the Exit button Opens the ePEAP Menu Provider Internet ePEAP User Manual 34 February 1 2008 Field Descriptions Field Description Data Type Length Address Menu Opens the Address Menu window Button 0 Cancel Cancels the update process Button 0 Continue Opens the Review Your Changes window Button 0 Exit Exits ePEAP Button 0 Help Describes the fields on the
73. the ePEAP Menu button Opens the ePEAP Menu 3 Click the Help button Describes the fields on the ePEAP window 4 Click the Review Submit button Opens the Review Your Changes window 5 Click the Exit button Opens the PA PROMISe Provider Main Page Field Descriptions Field Description Data Length Add a Group for Fee Opens the ePEAP Add a Group for Fee Hyperlink 0 Assignment Assignment window used to add fee assignments for the current provider service location Enrollment Opens the Enrollment Information window Button 0 Information Exit Exits ePEAP Button 0 Help Describes the fields on the ePEAP window Button 0 Manage Assignment Removes a group to end the fee assignment Hyperlink 0 Info Review Submit Opens the Review Your Changes window Button 0 ePEAP Menu Opens the ePEAP Menu window Button 0 3 3 1 ePEAP Add a Group for Fee Assignment w_epeap_grp_fee_assign The ePEAP Add a Group for Fee Assignment window is used by providers to add fee assignments for the current provider service location This window is accessed from the PA PROMISe Internet Provider Main Page through the ePEAP Provider Enrollment Automation Project link which opens the ePEAP Menu Click the Provider Internet ePEAP User Manual February 1 2008 37 Enrollment Information link to open the Enrollment Information window then the Fee Assignment Information link to open the Fee Assignment Information
74. the person whom I represent myself to be herein and I affirm the information within this web application is complete and accurate and made subject to the penalties of 18 Pa C S 54904 relating to unsworn falsification to authorities In addition I acknowledge that misstating my identity or assuming the identity of another person may subject me to misdemeanor or felony criminal penalties for identity theft pursuant to 18 Pa C S 54120 or other sections of the Pennsylvania Crimes Code Sign by typing your full name below To Accept User Agreement Step Action Response 1 Type your name in the space provided 2 Click the Submit button The logon process continues To Reject User Agreement Step Action Response 1 Click the Submit button without typing The user is logged out of the system your name Provider Internet ePEAP User Manual February 1 2008 15 Provider Main Page P E N Welfare Office of Medical Assistance Programs OMAP Main Claims Eligibility Trade Files Account Reports Mailbox Help Log Off Tuesday 17 April 2007 08 50 am Provider Main Page Link to Provider 3001809630001 Other Links ePEAP Claim Submission ePEAP Provider Enrollment Automation Project Claim Inquiry OMAP Provider Information Eligibility Verification DPW Outpatient Fee Schedule After completing the steps necessary to establish a new provider accoun
75. tton Opens the ePEAP Menu window 2 Click the Help button Describes the fields on the Recent Requests window 3 Click the Exit button Opens the PA Provider Main Page Field Descriptions Field Description Data Type Length Cancel End termination request Button 0 Continue Opens the Review Your Changes window Button 0 Effective End Date provider officially terminates enrollment asa Drop down 14 Date Medical Assistance provider List Box Exit Exit ePEAP Button 0 Help Describes the fields on the ePEAP window Button 0 ePEAP Menu Returns the user to the ePEAP menu window Button 0 Provider ID Nine digit provider number Character 9 Service Location Four digit service location number Character 4 Provider Internet ePEAP User Manual 59 February 1 2008 6 Manage Bulletins Remittance Advice The Manage Bulletins Remittance Advice window is used by providers to suppress or reinstate mail delivery of Medical Assistance Bulletins and paper Remittance Advices RAs This window is accessed by clicking the Manage Bulletins Remittance Advice link in the ePEAP Menu If a logged on provider does not normally receive Medical Assistance Bulletins from the Pennsylvania Department of Public Welfare only the Manage Remittance Advice RA window below will be displayed If the provider receives both RAs and MA Bulletins the second window below Manage Bulletins Remittance Advice will display This will allow t
76. ty and Use To access the Add a New Address window and perform address maintenance tasks complete the steps in the following step action tables To Access the Add a New Address Information window Step Action Result 1 Sign on to the PA PROMISe _ Internet The Provider Main Page appears on the application using instructions provided in desktop Section 1 5 of this manual 2 Click on the ePEAP Provider Enrollment The ePEAP Menu window opens Automation Project link in the Other Links section of the window 3 Select the Enrollment Information option The ePEAP Enrollment Information window opens Provider Internet ePEAP User Manual February 1 2008 27 Step Action Result Click the Address Information link The ePEAP Provider Address Information window opens 5 Click the Change Address link The Manage Active Addresses window opens 6 Click the Add to List link The Add New Pay To Mail To and or Home Office Address window opens This window is used to specify a new address and assign it to replace the current Pay to Mail to and or Home Office address for your service location To Update Address Information Step Action Result 1 Enter the new information in the Address Two lines are provided for the address one field line must be completed at a minimum 2 Enter the City Select a State from the drop down list 4 En
77. up Number 9 Group Name Actives a provider group name Character 50 Help Describes the fields on the ePEAP window Button 0 Review Submit Opens the Review Your Changes window Button 0 Sve Loc Service location of the group Character 4 ePEAP Menu Opens the ePEAP menu window Button 0 34 ePEAP Manage NPI Taxonomy epeap manage npi taxonomy The ePEAP Manage NPI Taxonomy window is used to capture a providers NPI number and associated taxonomy codes If the NPI is not currently on file the NPI field will appear blank and be available for data entry If the NPI is on file the NPI field will display the value and will be read only All potentially valid taxonomy codes and descriptions for the provider will appear below the NPI field with a corresponding checkbox Taxonomy codes that are already associated with the NPI and are active will be checked To check the valid combinations of provider type specialty to taxonomy codes see the Provider Type and Specialty to Taxonomy Crosswalk on the DPW website This window can be accessed from the PA PROMISe Internet Provider Main Page and select ePEAP Provider Enrollment Automation Project From here select Enrollment Information and then Manage NPI Taxonomy Codes This window is accessible by the provider community Provider Internet ePEAP User Manual February 1 2008 43 Layout Office of Medical Assistance Programs OMAP PENNS nae PEAP Your Provider ID 300
78. w Button 0 Enrollment Opens the Enrollment Information window Button 0 Information Exit Exit ePEAP Button 0 Help Describes the fields on the ePEAP window Button 0 Review Submit Opens the Review Your Changes window Button 0 ePEAP Menu Returns the ePEAP user to the ePEAP menu Button 0 window 3 2 1 ePEAP Manage Active Addresses epeap man act addr The ePEAP Manage Active Addresses window displays all addresses assigned to the ePEAP user s Provider ID It is used to select alternate Pay to Mail to and Home Office addresses for the user s service location This window is accessed from the PA PROMISe Internet Provider Main Page by clicking the ePEAP Provider Enrollment Automation Project link which opens the ePEAP Menu Click the Enrollment Information link to open the Enrollment Information window and then click the Address Information link to open the Provider Address Information window Then click the Change Address link to open the Manage Active Addresses window Provider Internet ePEAP User Manual 23 February 1 2008 Layout Department of Public Welfare Office of Medical Assistance Programs OMAP PEAP _ Your Provider ID 300180963 DOGOOD JAMES L NPI 1234567893 View Taxonomy Service Location 0001 123 HOPE RD HARRISBURG 17011 Status Active ePEAP Access Full Access Provider Type 31 PHYSICIAN View Specialties Manage Pay to Mail to and or Home Office Address
79. window Click the Add a Group for Fee Assignment link to display the Add a Group for Fee Assignment window Layout PENNS Your Provider ID 300180963 DOGOOD JAMES L Status Active NPI 1234567893 View Taxonomy ePEAP Access Full Access Service Location 00011 123 HOPE RD HARRISBURG PA 17011 Provider Type 31 PHYSICIAN View Specialties Add a Group for Fee Assignment Enter the Provider ID and Service Location of the Group to add Click Continue Select the date to begin fee assignment Click Continue Review Request and Submit Ov Nae Add this Group Provider ID of Group Service Location of Group Fee Assign Menu ePEAP Menu Review Submit The following error message is displayed if there is a conflict between your provider type and specialty and the group being added for fee assignment If this happens and it is not a data entry error please send an email to promise state pa us with the subject line Enrollment Fee Assignment detailing the assignment you are trying to complete This fee assignment is not allowed because your provider type and specialty do not correspond to the provider type and specialty of the Group Accessibility and Use To access the ePEAP Add a Group for Fee Assignment window and add a group complete the steps in the following step action tables Provider Internet ePEAP User Manual February 1 2008 38 To Access the Add A Group for Fee Assign
80. your current fee assignments and terminate any of them Add a Group for Fee Assignment Manage Fee Assignments Accessibility and Use To access the ePEAP Fee Assignment Information window and update fee assignment information complete the steps in the following step action tables To Access the ePEAP Fee Assignment Information window Step Action Result 1 Sign on to PA PROMISe Internet application using instructions provided in Section 1 5 of this manual The Provider Main Page appears on the desktop 2 Click on the ePEAP Provider Enrollment Automation Project link in the Other Links section of the window The ePEAP Menu window opens 3 Select the Enrollment Information option The ePEAP Enrollment Information window opens 4 Click the Fee Assignment Information The ePEAP Fee Assignment Information link window opens Provider Internet ePEAP User Manual 36 February 1 2008 To Update Fee Assignment Information Step Action Result 1 To add a fee assignment to a group click The Add a Group for Fee Assignment the Add a Group for Fee Assignment link window opens 2 To edit fee assignment information already The Fee Assignments window opens assigned to a group click the Manage Fee Assignment link Other Options Step Action Result 1 Click the Enrollment Information button Opens the Enrollment Information window 2 Click

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