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DHS Medicaid Online User Manual - Department of Human Services

1. DMO Valid Provider Provider Invalid Missing Provider 43 This is a required field Number Identification Check your records and try again Only a valid combination of this field and the Tax ID Number as recorded in the HPMMIS database may be entered Version 3 2 43 Last Updated 7 2010 State of Hawaii Q N id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Screen Error Message Valid Provider Provider Authorization Access Restriction Managed Care Only providers are not permitted access to DMO The provider should contact the contracted health plan for recipient verifications Valid Provider Tax ID Number Invalid Missing Provider Identification Create Profile User Name already exists Create Profile User Name Must be at least 6 characters with no leading or trailing blank spaces Create Profile Password Password entered is less ad than six characters Create Profile Confirm Password entered is less Password than six characters or does not match the password entered in the preceding field Create Profile Hint Question No question is entered Version 3 2 Last Updated 7 2010 This is a required field Check your records and try again Only a valid combination of this field and the HPMMIS Provider Number as recorded in the HPMMIS database may be entered This user name has already been registered Modify
2. Remember that a Master Account M Must be initially authenticated with a one time code mailed to the Master Account Holder s address M Activates Individual Accounts before they can be used vi Can never be downgraded to an Individual Account Version 3 2 23 Last Updated 7 2010 ye State of Hawaii o KN id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE User Administration To make changes to an Individual Account select the user whose data is to be updated from the User Name drop down list on the left side of the page Update any necessary details from the list of available fields on the right side of the page and click the Accept Changes button at the bottom of the page To delete an Individual Account select the user to be deleted from the User Name drop down list on the left side of the page Then click the Remove This User button at the bottom of the page It is the responsibility of the Master Account Holder to maintain user accounts for employees who are no longer employed by their company To change a Master Account Holder please follow the instructions detailed in the Appendix B Master Account Change Form Although current users Individual Account Holders are not affected when a Master Account Holder s record is closed new users cannot have their accounts activated until a new Master Account Holder s record is authenticated A confirmation message appears following any action taken on this page to acknowledg
3. Authentication Code fi 111 2222 3333 4444 Figure 10 Authenticate Master Account Authenticate Master Account 1 If you have received an Authentication Code letter then type the Authentication Code into the AUTHENTICATION CODE field exactly as it appears in the letter 2 Press lt Enter gt or click AUTHENTICATE to continue You should be viewing the Main Menu page To learn more about how to proceed refer to the Main Menu section beginning on page 30 Version 3 2 19 Last Updated 7 2010 y oe State of Hawaii o Ne id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Recover Password To be reminded of a forgotten password simply click the Forgot your Password link on the Login page The Recover Password page is displayed prompting entry of a valid USER NAME six digit Med QUEST PROVIDER ID and TAX ID Recover Password Password Recovery Please provide the following information for verification purposes Upon verification your password will be sent to the email address provided by you when you enrolled Indicates a required field Please select the type of identifier being provided ee Med QUEST Provider ID 6 numeric characters National Provider ID 10 alphanumeric characters National Provider ID 7 Please use only letters or numbers for your provider and tax ID numbers no spaces or dashes User Name Provider Number Tax ID Continue Cancel Figure 11 R
4. DOB amp Gender do not include the SSN label or data in the corresponding response 3 2 33 Last Updated 7 2010 n Q Q ae NOTE Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Search by Recipient Name DOB amp Gender Type the recipient s Last Name in LAST NAME field Press lt Tab gt to move the cursor to the FIRST NAME field Type the recipient s First Name in FIRST NAME field Press lt Tab gt to move the cursor to the MIDDLE INITIAL field Type the recipient s Middle Initial if known in MIDDLE INITIAL field Press lt Tab gt to move the cursor to the DATE OF BIRTH field Note that data entry in this field is optional Type the recipient s Date of Birth in DATE OF BIRTH field Press lt Tab gt to move the cursor to the GENDER drop down list Select the recipient s Gender in GENDER fields drop down list and click SUBMIT The use of this field is not required but recommended for Eligibility Enrollment searches First names that contain more than 10 characters have the 10th character replaced with an asterisk to indicate the name has been truncated A period is used in place of a first or last name when an individual does not have a legal given first or last name When opting to enter dates in the MMDDYY format be aware that the application presumes that years ending 00 through 29 are preceded by the century 20 and that years ending 30 through
5. TestName Pwd Exp 12 31 2007 User ID 9876543 Type Master NPI 0123456789 Admin Main Menu Contact Us AFor security purposes your session will be logged out after 15 minutes of inactivity di D Eligibility and Enrollment Status The Claim Status system provides the ability to inquire on the status of a Fee For Service Claim These claims are for persons believed to be covered by Medicaid on a Fee For Service basis The Eligibility and Enrollment Status system provides the ability to verify a recipient s eligibility enrollment and third party coverage If the recipient is enrolled in a Capitated Health Plan please contact the Health Plan for claim inquiries Medical Plan OAHU Neighbor Island Alohacare 973 1650 1 800 434 1002 HMSA 948 6486 1 800 440 0640 Kaiser Permanente 432 7670 1 800 651 2237 Summerlin 951 4630 1 866 266 5280 For Part D Drug enrollment information please contact OAHU Toll free Medicare 1 800 633 4227 Sage Plus 586 7299 1 888 875 9229 Figure 15 Main Menu Version 3 2 30 Last Updated 7 2010 y oe State of Hawaii o ay id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Steps 1 Options for different applications available are listed under the Main Menu heading on the left side of the screen Click Eligibility and Enrollment Status to perform related research on a specific recipient Some applications may not be available to all
6. system date or less than the recipient s Date of Birth Invalid Missing Date s of Service Begin Date of Service Date of Birth Follows Date s of Service Begin Date of Service This is a required field Be sure that the date entered is valid and is in the MMDDCCYY format A Begin Date of Service should not be greater than the system date or the End Date of Service A Date P atoe estante Service should not be less than the recipients Date P atoe estante Birth 57 This is a required field Be sure that the date entered is valid and is in the MMDDCCYY format An End Date of Service should not be greater than the system date or less than the Begin Date of Service 3 2 49 7 2010 Begin Date of Date of Service in Future Service Begin Date of Dates of Service precedes Service Date of Birth End Date of Invalid Missing Date s of Service Service Screen Enrollment Search Eligibility Enrollment Search Eligibility Enrollment Search Version State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE End Date of Service End Date of Service Error Message Be sure that the date entered is valid and is in the MMDDCCYY format A Date of Service should not be greater than the system date or less than the recipients Date of Birth 63 This is a required field Be sure that the date entered is valid and is in the MMDDCCYY format An End Date of Service should not be g
7. 1937 Requested X Recipient Exception Exception Description MICRONESIA CFA COMPACT FREE ASSOC PALAU CFA COMPACT FREE ASSOC Request Dates Beg Date of Service 01 01 2004 End Date of Service 12 01 2004 Medicaid QMB Dual Ind Y QMB Dual Beg End 1 12 01 2004 12 15 2006 Penalized NH Ind N NH Provider i GENERIC NURSING LTC NH Beg End 1 04 28 2005 08 31 2005 NH Provider 2 ACME MEDICAL NF ICF NH Beg End 2 04 28 2005 08 31 2005 Share of Cost Amt 1 f665_ Share of Cost Beg End 1 06 01 2005 08 31 2005 _ Medicare Claim Number Medicare Type Start Date End Date 0123456789 A 12 01 2004 0123456789 B 12 01 2004 Third Party Liability Coverage Type Carrier Name Policy Number Start Date End Date MEDICARE B ONLY 12 01 2004 MEDICARE A AND B 0123456789 12 01 2004 This verification does not constitute s guarantee of payment DHS MOD All Rights Reserved Figure 19 Other Coverage Disclaimer This verification does not constitute a guarantee of payment Eligibility Enrollment records for a recipient may change due to corrections Version 3 2 39 Last Updated 7 2010 n Q 2 ae Steps 1 NOTE Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE You should be viewing the Other Coverage page Note that the enrollment information presented is tailored specifically to your search criteria and presents data that conforms
8. Contact Us The State of Hawaii Automated Voice Response System AVRS is available 24 hrs day 7 days week by calling 1 800 882 4608 The following user manuals can be found under the Provider Resources of the Med QUEST website gt AYRS Quick Reference sheet gt DHS Medicaid Online User Manual gt Eligibility or Enrollment inquiries Contact Oahu 808 524 3370 Med QUEST Customer Service P O Box 700190 Toll Free 1 800 316 8005 Kapolei HI 96709 Med QUEST website www med quest us Hours 7 45 a m to 4 30 p m M F Hawaii Standard Time gt Claims inquiries gt Provider inquiries gt DHS Medicaid Online DMO assistance Contact Oahu 808 952 5570 State of Hawaii Medicaid Fiscal Agent Affiliated Computer Services ACS Toll free 1 800 235 4378 Hours 7 30 a m to 4 30 p m M F Hawaii Standard Time gt Med QUEST Provider Registration Contact 808 692 8174 Med QUEST Provider Registration Health Coverage Management Branch Hours 7 45 a m to 4 30 p m M F Hawaii Standard Time gt Medicaid Waiver Services Provider Registration Contact 808 586 5555 Medicaid Waiver Services Provider Registration 810 Richards Street Suite 501 Honolulu HI 96813 Hours 7 45 a m to 4 30 p m M F Hawaii Standard Time gt State of Hawaii Automated Voice Response System AVRS assistance Contact Toll free 1 800 333 0263 Medifax EDI Client Support Fax 1 615 843 2539 Email customer service medifax c
9. Service Administration T PSD OYS FFS Fee For Service PSD amp OYS U UNDOC FFS EM Undocumented Ineligible Aliens 6 MED PRIS FFS Medicaid Prisoner 8 NON PAY No Payment Permitted Version 3 2 53 Last Updated 7 2010 KAON Q Q wae State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Eligibility Description A brief description of the recipient s eligibility type Code Short Description Description A QUEST ELIG Quest eligible for this date range B QUEST NET ELIG Quest Net eligible for this date range C QUEST ACE ELIG Quest Adult Coverage Expanded eligible for this date range E EMERG ONLY Emergency Services only for this date range F FFS ELIG Fee for service eligible for this date range INPATIENT ELG Inpatient services only for this date range L LTC ELIG Long term care eligible for this date range N NOT ELIG Not eligible for this date range Q NONPAY No payment permitted for this date range End Date Eligibility Enrollment page The date the recipient s insurance coverage expires Medicare page The date the recipient s coverage for the Medicare Type expires Third Party Liability page The date the recipient s insurance coverage expires for the specified carrier Health Plan The name of the recipient s Health Plan Last Mod Date The date and time that a record was last changed Last Mod User The name of the user who made the last c
10. User Administration screen These fields are populated systematically and can not be edited manually 3 2 25 7 2010 n Q 2 ae 1 NOTE Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Remove an Individual Account The User Name drop down list on the left side of the User Administration screen lists all the account holders defined for your Provider ID To select a particular account click the User Name within the drop down list Once you have selected the Individual Account to be removed click REMOVE THIS USER A dialog box appears with the following message Press OK if you would like to remove this user Press lt Enter gt or click OK to accept the changes To confirm that the Individual Account was removed the following message appears above the Details section on the right side of the User Administration screen 7 record was Deleted Click CANCEL to return to the User Administration screen Remove a Master Account To change a Master Account Holder please follow the instructions detailed in the Appendix B Master Account Change Form When a Master Account user is deleted the current users Individual Account Holders are not affected However if a new user is added their account cannot be activated until the new Master Account Holder s record is authenticated 3 2 26 7 2010 KAON Q A NOTE Version Q ae State of Hawaii DEPARTMENT OF
11. of Birth 07 07 1937 Requested Y Recipient Exception Exception Description MICRONESIA CFA COMPACT FREE ASSOC PALAU CFA COMPACT FREE ASSOC Request Dates Beg Date of Service 01 01 2004 End Date of Service 12 01 2004 N i Eligibility Eligibility Description Begin Date End Date DISABLED 09 01 2004 10 31 2004 QUEST ELIG 06 01 2004 08 31 2004 DISABLED 01 01 2004 05 31 2004 Medical Enrollment ANYFFS FEE FOR SERVICE Health Plan ID Name Contract Code Period Start Period End ANYFFS FEE FOR SERVICE ACU FFS 09 01 2004 10 31 2004 HMSAAA HMSA MEDICAL ACU CAP 06 16 2004 08 31 2004 ANYFFS FEE FOR SERVICE ACU FFS 06 01 2004 06 15 2004 ANYFFS FEE FOR SERVICE ACU FFS 03 01 2004 05 31 2004 ACU FFS 01 61 2004 02 29 2004 Rate Code Description AMO7 BLIND DISABLED MALE 40 64 WITH MEDICARE GM17 ST FINCL GEN ASST MALE 40 GM17 ST FINCL GEN ASST MALE 40 AMO7 BLIND DISABLED MALE 40 64 WITH MEDICARE AMO6 BLIND DISABLED MALE 21 39 WITH MEDICARE Health Plan ID Name ANYFFS FEE FOR SERVICE ANYFFS FEE FOR SERVICE Dental Enrollment Contract Code ACU FFS EMO Period Start Period End 09 01 2004 10 31 2004 06 01 2004 08 31 2004 05 01 2002 05 31 2004 Rate Code Description DSOO ABD DENTAL ADULT 21 D100 QUEST DENTAL ADULT 21 D500 ABD DENTAL ADULT 21 Behavioral Health Enrollment Inactive This verification does not constitute guarantee of payment DHS MQD All Rights
12. permitted access to the DHS Medicaid Online system Type a Provider ID number corresponding to the type selected in the PROVIDER NUMBER field Press lt Tab gt to move the cursor to the TAX ID NUMBER field Providers whose current reimbursement type is registered within HPMMIS as Managed Care Only are not permitted to access DMO Such providers should refer to the contracted health plan for recipient verifications Type the Tax ID number that corresponds to the provider ID number in the TAX ID NUMBER field and press lt Enter gt or click CONTINUE You should be viewing the Create Profile page The Provider ID number and Tax ID Number are verified by comparing these inputs with registered data on file Only a valid combination of these two fields permits advancement to the next step in the user account creation process 3 2 11 Last Updated 7 2010 iiy Fi State of Hawaii o ay id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Provide Your Information and Account Type The Create Profile screen displays after entering a valid Provider ID Number and Tax ID Number This screen prompts you to select a User Name Password and to provide a Hint Question and Answer to facilitate the recovery of a forgotten password if necessary in the future If a Master Account does not already exist for a provider then an option is provided to create one However if you are not authorized to create a Master Account then please do not do
13. users NOTE Each provider s Master Account Holder may restrict any of their Account Holders to access one or more applications For more information on setting Group Permissions refer to the Master Account Admin Functionality section beginning on page 23 Version 3 2 31 Last Updated 7 2010 ym State of Hawaii o KN id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Eligibility Enrollment Select the Eligibility and Enrollment Status option to open the Recipient Search page Recipient Search This page allows a search for a specific individual to be conducted prior to viewing their eligibility and enrollment information The SEARCH BY field defines the required and optional data elements necessary to initiate a recipient search You may search by HAWI ID SSN or a combination of Name Date of Birth and Gender If no records are found matching the criteria entered then a message displays notifying you of the results Also if multiple records are found a message displays informing you that more than one record was found and advising you to change the search criteria User Name TestName User ID 9876543 Type Master NPI 0123456789 Main Menu RECIPIENT SEARCH gt Eligibility and Enrollment Status You must first identify a Recipient in order to do an inquiry Indicates a required field SEARCH BY HAW ID 7 HAWI ID ss 10 digit Submit Clear This site displays confidential information from t
14. your desired user name or try a different user name This is a required field Select a user name that is at least six characters long This is a required field Select a password that is at least six characters long This is a required field Be sure that this password matches the password entered in the preceding field This is a required field Type a question that can be used as a verification method for retrieving a forgotten password 44 State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Screen Field HIPAA Error n a This is a required field Type an answer to the duestion in the preceding field that can be used as a verification method for retrieving a forgotten password Error Message Answer No answer is entered Create Profile Create Profile First Name No first name is entered n a This is a required field Type the first name of the user Create Profile Last Name No last name is entered n a This is a required field Type the last name of the user Create Profile Title No job title is entered n a This is a required field Type the job title of the user n a This is a required field Type the area code and telephone number of the user Create Profile Telephone No telephone number is entered Create Profile Email Address No email address is n a This is a required field entered Type the email address of the user No email address is entered or i
15. 7 2010 sy AE State of Hawaii Ne id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Account Created The Account Created page displays account information and confirms that an account has been created An email is sent to the email address supplied when creating a user profile to confirm the creation of an account If a Master Account has been created then you must wait until you receive a letter with the Authentication Code before access to the system is granted If a Master Account exists and an Individual Account has been created an email is sent to the Master Account Holder notifying them that the Individual Account is awaiting review and activation Otherwise the Individual Account Holder must wait until a Master Account is created and the new Master Account Holder activates the Individual Account Home Enrollment Steps Thank you for creating an account with Hawaii Department of Human 1 User Agreement Services Medicaid Online You will be receiving an email confirmation in a few 2 Verification minutes You may start using your account as soon as itis activated 3 Create Profile Provider Information 4 Account Created Provider Name SAMPLE PROVIDER L L C Provider Number 012345 Tau ID Number 012345678 User Name TestName First Name Emile Last Name Schuffhausen Title Dr Address 1001 KAMOKILA BLVD City KAPOLEI State HI Zip Code 96707 Talaphone 808 555 1212 Number Email Address name website
16. 99 are preceded by the century 19 This is of particular importance when entering dates of birth You must type the full date of birth for any recipient born on or before 1929 For example typing 102429 would be interpreted as 10 24 2029 To be sure that you are always providing the most accurate information for the application to process it is recommended that you adopt the habit of entering all dates in the MMDDCCYY format 3 2 34 7 2010 ye State of Hawaii o KN id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Eligibility Enrollment Search Basic recipient information displays as a header on the Eligibility Enrollment Search page including the HAWI ID Name DOB and Gender A Begin Date of Service and an End Date of Service are required to perform a search Any valid recipient data can be viewed Note that the BEGIN DATE OF SERVICE and END DATE OF SERVICE fields cannot be populated with dates greater than the system date since eligibility and enrollment information could change in the future Also no eligibility or enrollment data can be provided prior to 08 01 1994 the earliest system date for which such data is available If we do not list other providers in the drop down list that you may be affiliated with please contact HCMB Provider Registration by calling 808 692 8174 User Name TestName User ID 9876543 Type Master NPI 0123456789 Main Menu ELIGIBILITY ENROLLMENT SEARCH D Eligibility and E
17. DHS Medicaid Online DMO Web Based Eligibility Enrollment Verification Application Walk Through Es n Fi 9 State of Hawaii ay id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Contents Overview RE N EE EI Browser sis MK EA AA OE N AE AR EE N DHS MOD Online Overvi W ee ee Contact Se ea n ee ihe i ee n ie ee stel RE OO GO DE tee Bes ADA OS EO User Agreement ass EE Ee ee ER ee ee ER GE ee DE DRR Idenitify as Valid Brovider is EE GE EG Ee Provide Your Information and Account TYDE sesse ee RA ee ee ee Account Greated ER DE GE Ee Authenticate the Master Account sees ee Re FeEoverPassword EE ESE ERNS VER VER VERMEER NEE ER NEE ER NEE ER NES kes Mee ie Master Account Admin FunctionalitY usseeee esse EE RR EER RR RE EE GEE RR RR EE User Administration ee ee ee ee ee ee ee ee ee ee Individual Account Functionality esse ee EER E EER RR EER RR EER EG Gee ee RR Ee Too le Vlei OE EE EE EE EE EO EO RE EE EE OE N Male EE EE EE RE EE DE DE ER EE eas ElidIDIlWERFOIMERK sea eie ees eke eie ee oe Ra re ia oe ee ee ei Ge Ge Recipient Seale n sok orate DA DE Ee N EE aan Eligibility Enrollment Sea EE RE EE DR DA RR EE RD n slee uas AE RA arenes QINGMCOVGTAGE ER ER GR EE EG RE EG EG E RE Appendix A Error MessageS sesse eek RR RE RR EER ERG ee RR ARK RR RE EER nenna Appendix B Master Account Change Form cccccccsssesssseeeeeeeeeeeeseeeeeeneeees Appendix C GlossafY ee GE Ee GE EK EE E
18. G N GN NG KA ER Ge Ke ee NN ee KEN Ki ed Ge Appendix D DMO EXCIUSIONG cccceeseeeeeeeeeeeeeeeeeeeeeeeeeneeeeeeeeeeseeseeeeneees Change SUMMALY wisscciseciecciienisanssecssenteerivensiansnusiecivacwesuananssendeavaverevausbatawensteres Version 3 2 Last Updated 7 2010 ye State of Hawaii o Ne id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Overview The Department of Human Services DHS Medicaid Online DMO offers providers an alternative method for obtaining recipient data from HPMMIS Hawaii Pre Paid Medical Management Information System Once an account is established and authenticated you may submit inquiries for any valid recipient in HPMMIS and obtain detailed status and payment information for your claims Browser Requirement The DMO requires that you use Microsoft Internet Explorer 5 5 or higher to access data through the Internet This requirement helps ensure our standards for privacy reliability and flexibility If you encounter difficulties when attempting to connect to the web site be sure that you have met these minimum browser requirements Consult your own technical support resources for more information if necessary or use the link pictured below on the homepage to download and install Microsoft Internet Explorer 7 Download Internet Explorer Version 3 2 3 Last Updated 7 2010 yy ME State of Hawaii id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE SET DHS MQD Online Ov
19. HUMAN SERVICES MEDICAID ONLINE Change Password Type a new Password in the PASSWORD field Press lt Tab gt to move the cursor to the CONFIRM PASSWORD field Retype the Password Be sure to select a password that is at least six characters long You may use any combination of characters except for the following Click ACCEPT CHANGES A dialog box appears with the following message Press OK if you would like to save your changes Press lt Enter gt or click OK to accept the password change To confirm that the update was applied successfully to your record the following message appears above the Details section on the right side of the User Administration screen The record has been updated Your Password Expiration date displays in the upper right hand corner of the web page adjacent to other detailed user information Finally although passwords expire every 60 days no restrictions are in place to prevent a password from being recycled 3 2 27 Last Updated 7 2010 yy ME State of Hawaii iN i DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Individual Account Functionality Individual Account Holders have the option to change their account details including their password at anytime Click the User Account link at the top right corner of the page to gain access to the User Account page Main Menu User Account User Name TestName gt Pwd Exp 12 31 2007 User ID 9876543 Type Individual Prov
20. PARTMENT OF HUMAN SERVICES MEDICAID ONLINE Appendix A Error Messages The DMO uses error messages to provide feedback They may appear either in pop up message boxes or as onscreen text Message boxes that appear in pop up windows offer edit messages that catch most error conditions editing items such as date format These are used to prevent syntactical errors from being submitted to the database Error messages displayed in blue text on the web page itself are the result of requests that cannot be processed These messages occur when data fails to pass one or more of the edits used to screen information submitted to the database If any error condition should pass through then the transaction sent to HPMMIS for processing may encounter one of the error messages noted below Screen Error Message HIPAA Error lt any gt Unable to Respond at 42 Connection problem Current Time Be sure that you are using Microsoft Internet Explorer 5 5 or higher to access data through the Internet Consult your own technical support resources for more information to be certain that no internal issues are affecting your ability to connect to DMO Login The page cannot be Be sure that you are using displayed Microsoft Internet Explorer 5 5 or higher The page is currently to access data through unavailable the Internet Consult your own technical support resources for more information to be certain that no internal issues are aff
21. Password J Please choose a hint question and answer to be used to retrieve your password should you forget it Mother s maiden name pet s name etc Choose a Hint Question and Answ Hint Question Answer Individual accounts will be activated by a master account holder for your provider If you have any questions regarding creating an INDIVIDUAL account please contact your local master account holder for more information In order to create an account please provide the following information about yourself User Account Information First Name Password Confirm Password Please choose a hint question and answer to be used to retrieve your password should you forget it Mother s maiden name pet s name etc Choose a Hint Question and Answer Hint Question Answer Individual accounts will be activated by a master account holder for your provider If you have any questions regarding creating an INDIVIDUAL account please contact your local master account holder for more information In order to create an account please provide the following information about yourself User Account Information First Name Last Name Title MED QUEST DIVISION Correspondence Address PO BOX 700190 KAPOLEI HI 96709 Telephone Number z 1 Email Address Confirm Email Address Continue Figure 8 Create Profile Version 3 2 13 Last Updated 7 2010 n 4 State of Ha
22. Reserved Figure 18 Eligibility Enrollment Disclaimer This verification does not constitute a guarantee of payment Eligibility Enrollment records for a recipient may change due to corrections Version 3 2 Last Updated 7 2010 37 n Q Q ae Steps 1 EN Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE You should be viewing the Eligibility Enrollment page Note that the eligibility and enrollment information presented is tailored specifically to your search criteria and presents data that conforms to your Begin Date of Service and End Date of Service Next Step To view the recipients Medicare and other insurance program information corresponding to the dates used in your selection criteria click Other Coverage in the upper left corner of the page and refer to the procedures in the Other Coverage section beginning on page 39 To change the selection criteria but continue research on the same recipient click Search in the upper right corner of the page and refer to the procedures in the Eligibility Enrollment Search section beginning on page 35 To continue eligibility and enrollment research on a different recipient click Recipient Search in the upper right corner of the page and refer to the procedures in the Recipient Search section beginning on page 32 To return to the DMO Main Menu click Main Menu in the upper right corner of the page Details on how to procee
23. The use and disclosure of this information is also subject to the privacy and security requirements of the Administrative Simplification provisions of the federal Health Insurance Portability and Accountability Act Figure 2 Contact Us link via Home page User Name TestName Pwd Exp 12 31 2006 User ID 9876543 Type Master Provider ID 012345 Admin Main Menu Contact Us dm AFor security purposes your session will be logged out after 15 minutes of inactivity A gt Eligibility and Enrollment Status The Claim Status system provides the ability to inquire on the status of a Fee For Service Claim These claims are for persons believed to be covered by Medicaid on a Fee For Service basis The Eligibility and Enrollment Status system provides the ability to verify a recipient s eligibility enrollment and third party coverage If the recipient is enrolled in a Capitated Health Plan please contact the Health Plan for claim inquiries Medical Plan OAHU Neighbor Island Alohacare 973 1650 1 800 434 1002 HMSA 948 6486 1 800 440 0640 Kaiser Permanente 432 7670 1 800 651 2237 Summerlin 951 4630 1 866 266 5280 For Part D Drug enrollment information please contact OAHU Toll free Medicare 1 800 633 4227 Sage Plus 586 7299 1 888 875 9229 Figure 3 Contact Us link via Main Menu page Version 3 2 Last Updated 7 2010 State of Hawaii i amp DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE
24. bility Enrollment screen Alternatively click CLEAR to erase all fields on the form and re enter the data 3 2 36 Last Updated 7 2010 State of Hawaii ale DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE ere Fi o 7 S Eligibility Enrollment The Eligibility Enrollment page displays the results of a search request including a summary of the eligibility and enrollment segments as defined by the search criteria Select the Print button to print a printer friendly version of the Eligibility Enrollment response To view detailed Medicare information and any other insurance progra the search criteria click on the Other Coverage link m information applicable to Navigation to the Recipient Search page the Eligibility Enrollment Search page or Help page is also available by clicking the corresponding link in the upper right hand corner of the page The Help page may be accessed to provide a description for the data presented on each page User Name TestName User ID 9876543 Type Master NPI 0123456789 Date 07 14 2007 Main Menu Eligibility Enrollment rch gt Eligibility and Enrollment Eligibility Enrollment Other Coverage Status gt Claim Status Service Provider Provider ID 0123456789 Type PERSONAL CARE ATTENDANT Name PROVIDER NAME L L C Recipient HAWI ID 0123456789 Gender m KEES DUCK DAREY es _ SOUTH PACIFIC LANGUAGE lame nguage OTHER x i Interpreter Service Date
25. com Login Figure 9 Account Created Version 3 2 17 Last Updated 7 2010 ye State of Hawaii o ay id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Steps Account Created 1 Click Login You should be viewing the Login page To learn more about how to proceed refer to the Login section beginning on page 7 Remember that an Individual Account must be activated by the Master Account NOTE Holder prior to use and that a Master Account can only be activated with an 7 Authentication Code that is mailed to the provider s Correspondence Address Version 3 2 18 Last Updated 7 2010 y oe State of Hawaii o Ne id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Authenticate the Master Account Upon receipt of the Authentication Code letter the new Master Account Holder can login with the selected User Name and Password and when prompted to do so provide the Authentication Code in order to be granted access to the system The code must be typed in exactly as it appears in the letter Please keep in mind that if the Master Account is not activated within 30 days of creation it is deleted from our system Once the Master Account has been authenticated the Authentication Code is no longer needed Vou cannot access your account until vou provide a valid authentication code This code was sent to the mailing address you provided when you enrolled Please enter the code exactly as it appears on the letter Authentication
26. count was created Note that the Master Account Holder has access to Individual Account information including passwords Tax ID The provider information n This is a required field you entered is incorrect Only a valid combination or does not match of the user name with recorded data the six digit Med QUEST Provider ID Number and Tax ID Number as recorded in the HPMMIS database may be entered Check your records and try again or contact your designated administrator Be sure to type the Tax ID number exactly as you entered it when establishing your user account a a HAWI ID Invalid Missing Patient ID 64 This is a required field Be sure that the 10 digit HAWI ID entered is valid 3 2 46 7 2010 Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Field Error Message HIPAA Error HAWI ID The HAWI ID entered is a n a This is a required field secondary HAWI ID Be sure that the 10 digit Use correct HAWI ID HAWI ID entered is valid User entered secondary ID HAWI ID The HAWI ID has multiple This is a required field linked secondary IDs Please call the MQD customer service at 808 524 3370 1 800 316 8005 valid and begins with Be sure that the 10 digit HAWI ID entered is HAWI ID Please enter a 10 character HAWI ID beginning with a zero zero Duplicate Subscriber rf recipients found This is a required field Be sure that the 10 digit HAWI ID e
27. d an email is sent to the address provided at setup that contains account information including the forgotten password Note that the Master Account Holder has access to Individual Account information including passwords for all Individual accounts created for the Provider ID Recover Password Password Recovery Please answer the following question which you provided during enrollment The answer must match our records exactly What is your hint question FT Continue Cancel Figure 12 Recover Password Steps 1 The Hint Question associated with your User Name appears above an open ANSWER field Type the Answer to your Hint Ouestion in the ANSWER field and press lt Enter gt or click CONTINUE NOTE n order to have your password sent to your email address the answer must be typed exactly as it was entered when your account was created 2 Click CANCEL to return to the Login screen Version 3 2 22 Last Updated 7 2010 dy A 5 State of Hawaii o Ne i DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Master Account Admin Functionality Logging in with a Master Account permits the Master Account Holder to administer all other accounts defined for that provider From the Main Menu page click the Admin link at the top right corner of the page to gain access to the User Administration page User Name TestName Pwd Exp 12 31 2007 User ID 9876543 Type Master Nsom 01010101010101010 Admin
28. d begin on page 30 Select the Print button to preview a printer friendly version of the Eligibility Enrollment response 3 2 38 7 2010 sy AE State of Hawaii KN id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Other Coverage This page displays a summary of Medicare information and any other insurance program information if applicable for the recipient during the dates specified in the selected search criteria Select the Print button to print a printer friendly version of the Other Coverage response To view eligibility and enrollment segments for the recipient as defined by the search criteria click on the Eligibility Enrollment link Navigation to the Recipient Search page the Eligibility Enrollment Search page or Help page is also available by clicking the corresponding link in the upper right hand corner of the page The Help page may be accessed to provide a description for the data presented on each page User Name TestName User ID 9876543 Type Master NPI 0123456789 Date 07 14 2007 Main Menu Other Coverage gt Eligibility and Enrollment Eligibility Enrollment Other Coverage Status gt Claim Status Service Provider Provider ID 0123456789 Type PERSONAL CARE ATTENDANT Name PROVIDER NAME L L C Recipient HAWI ID 0123456789 Gender mMm N DUCK DAFFY i SOUTH PACIFIC LANGUAGE jame i nguage OTHER EE Interpreter Service Date of Birth 07 07
29. der There is no limit to the number of Individual Accounts that can be created for a provider In the event that the details of a Master Account must be changed e g to have the Master Account re activated deleted or otherwise changed refer to the Appendix B Master Account Change Form for the appropriate form and instructions If this section does not appear then a Master Account Holder has already been designated for this Provider ID number and the system will only allow an Individual Account to be created You should proceed to step 7 to enter User Account Information for an Individual Account Select either the Individual Account or Master Account button This selection assigns your User Name with the indicated designation For details concerning the different accounts click on Click Here link within this section 3 2 15 7 2010 n Q Q ae NOTE NOTE Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE User Account Information Type your First Name in FIRST NAME field Press lt Tab gt to move the cursor to the LAST NAME field Type your Last Name in LAST NAME field Press lt Tab gt to move the cursor to the TITLE field Type your Title in TITLE field Press lt Tab gt to move the cursor to the first TELEPHONE NUMBER field The system defaults the CORRESPONDENCE ADDRESS field with the Correspondence Address on file for the Provider ID The Authenticati
30. e Date 4 PROVIDER ACKNOWLEDGEMENT Provider s Signature Date For Office Use only Date Received Date Completed Completed by DHS 8013 Rev 09 11 KAON o 7 ol wed State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Appendix C Glossary Begin Date The date the recipient is eligible for insurance coverage Carrier Name The name of the recipient s third party liability insurance carrier Claim Number received tape and A twelve character number used to uniquely identify a claim in the HPMMIS claims processing system It consists of 1 a five character Julian date that is the claim receipt date 2 a one character indicator of the medium by which the claim was 3 a one character type indicator for the source of claims received on 4 a five character sequence number Contract Type The type of contract or service the Health Plan is covering Codes include Type Code Description A ACU CAP Medical Capitated D ACU DEN Dental Capitated E ACU FFS Fee For Service Full Services F ACU FFS EMO Fee For Service Emergency Svcs Only G CH DEN FFS Child Dental Fee For Service H ADLT DEN FFS Adult Dental Fee For Service K MHS CAP ACU Behavioral Health Services Capitated P ALL CAP PAR Partially Capitated R QN FFS Fee For Service Quest Net Adults S ADMN FFS Fee For
31. e of Hawaii o Ne id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Identify a Valid Provider The next step requires that a valid Provider ID number either a 6 digit Med QUEST Provider ID Number or a 10 digit NPI National Provider Identifier and Tax ID Number combination be verified against the HPMMIS Provider Database The system matches the Provider ID and Tax ID Number It is not possible to continue unless an exact match is found Enrollment Steps 1 User Agreement 2 Verification Please provide the following information BEES Pranle Indicates a required field 4 Account Created Please select the type of identifier being provided Med QUEST Provider ID 6 numeric characters National Provider ID 10 alphanumeric characters National Provider ID 7 Please use only letters or numbers for your provider and tax ID numbers no spaces or dashes Provider Number Tax ID Number Continue Figure 7 Verification Version 3 2 10 Last Updated 7 2010 n 4 State of Hawaii ya te 3 Ha Ww NOTE l N NOTE l LY NOTE l Version DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Verification Select the type of provider ID number you are submitting for verification from the drop down list Press lt Tab gt to move the cursor to the PROVIDER NUMBER field Providers whose identification number has been in a terminated status for one year or longer are not
32. e refer to the DHS medicaid Online user manual for more information Home Figure 1 DHS MQD Online Overview Steps 1 Type https hiweb statemedicaid us into the address toolbar and press sEnter Version 3 2 d Last Updated 7 2010 yy ME State of Hawaii id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE SET Contact Us This page can be accessed via the Login page prior to logging in or via the Main Menu after logging in It contains important contact information for provider assistance State of Hawaii Department of Human Services DHS Medicaid Online _ gt Contact Us Overview Terms of Use Thank you for visiting Department of Human Services Medicaid Online Please login or Create a New Account Sign In User Name Password Forgot your Password Click Here Note e User Names and Passwords are case sensitive Download Internet Explorer New Account Click on Create a New Account to create an account with the Department of Human Services Medicaid Online Warning The information provided through the State of Hawaii Department of Human Services Medicaid Program Online Web Application is confidential under state and federal law Use and disclosure of this information is limited to purposes directly related to all aspects of the administration of the State of Hawaii Medicaid Program including the managed care fee for service and Home amp Community Based Waiver Services
33. e sure that the name DOB and gender are correct Resubmit recipient search using HAWI ID if possible This is a required field Be sure that the Last Name entered is valid First Name Invalid Missing Patient 65 This is a required field Name Be sure that the First Name entered is valid Date of Birth Invalid Missing Date of Birth Date of Birth Dates of Service precedes Date of Birth Gender Invalid Missing Patient Gender Code 3 2 7 2010 58 This is a required field Be sure that the Date of Birth entered is valid and in the MMDDCCYY format The Date of Birth should not be greater than the system date Be sure that the date entered is valid is in the MMDDCCYY format and is not greater than the system date This is a required field Be sure that the Gender field is entered and valid 48 Screen Enrollment Search Eligibility Enrollment Search Eligibility Enrollment Search Eligibility Enrollment Search Eligibility Enrollment Search Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE HIPAA uai Error Message This is a required field Be sure that the date entered is valid and is in the MMDDCCYY format A Begin Date of Service should not be greater than the system date or the End Date of Service Be sure that the date entered is valid and is in the MMDDCCYY format A Date of Service should not be greater than the
34. e that the action has been successfully completed User Name TestName Pwd Exp 12 31 2007 User ID 9876543 Type Master Provider ID 012345 User Administration You can only administer and maintain user accounts that have been created for your Provider User Name Details TestName X Date Password Changed 4 16 2007 3 45 21 PM Active M Password Jeeeeeeee Confirm Password O E First Name Test oo Last Name me n Title Senior Address MED QUEST DIVISION P O BOX 700190 KAPOLEI HI 96709 Telephone fsos 555 1212 SS Email hame wepsitecom Hint Question Whatsiteasyas Answer a SS Group Permission Eligibilty Enrollment amp Claim Status SS Last Mod User Tester Name Last Mod Date 4 17 2007 8 26 41 4M Accept Changes Remove This User Figure 13 User Administration Version 3 2 24 Last Updated 7 2010 n Q 2 ae Steps NOTE NOTE EE Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Manage an Account The User Name drop down list on the left side of the User Administration screen lists all the account holders defined for your Provider ID To select a particular account click the User Name within the drop down list A check box labeled Active appears for all accounts classified as Individual Accounts This box can be set as Active when checked or Inactive when blank to manage the status of Individ
35. ecover Password Version 3 2 20 Last Updated 7 2010 n Q Q ae Steps 1 NOTE Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Select the type of provider ID number you are submitting for verification from the drop down list Press lt Tab gt to move the cursor to the USER NAME field Type your User Name in the USER NAME field Press lt Tab gt to move the cursor to the PROVIDER ID field Type a Provider ID number corresponding to the type selected in the PROVIDER NUMBER field Press lt Tab gt to move the cursor to the TAX ID NUMBER field Type the Tax ID number corresponding to the provider ID number in the TAX ID field and press lt Enter gt or click CONTINUE You should be viewing the second Recover Password page Be sure to type the Tax ID number exactly as you entered it when establishing your user account Although the use of a dash is not necessary for the Tax ID number when setting up your account it must be repeated here if it was used initially when creating your account 3 2 21 7 2010 yam State of Hawaii o Ne id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Recover Password Upon entry of a valid User Name Med OUEST Provider ID and Tax ID you are prompted to answer the Hint Question supplied when your user profile was created The question must be answered exactly as it was typed when the account was created Once the correct answer is provide
36. ecting your ability to connect to DMO Login User Name User name entered is less n a Select a user name that is than six characters at least six characters long Version 3 2 42 Last Updated 7 2010 State of Hawaii ay id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Screen Field Error Message HIPAA Error Login User Name Unsuccessful n a Check your login authentication The information and try user name or password again Note that user entered is incorrect names are case sensitive Password Password entered is less n a Select a password that is than six characters at least six characters long Password Unsuccessful Check your login authentication The information and try user name or password again Note that entered is incorrect passwords are case sensitive If needed click on the Forgot your Password link to be reminded of your password Login The account has been n a In order to use the system removed from the you need to create a system new account This may have occurred due to inactivity or by a Master Account Holder removing the account manually Login 5 NPI not on file Contact n a Contact Provider Provider Registration Registration to supply the NPI for your account if you are a provider that is required to use an NPI Login Authorization Access 41 Providers who are ina Restriction term status for more than a year are not permitted access to
37. erview To access these services log onto the DHS Medicaid website at https hiweb statemedicaid us DHS MQD ONLINE OVERVIEW There are two types of accounts that can be created with this system MASTER Accounts and INDIVIDUAL Accounts MASTER ACCOUNTS The option to create a master account is only available if no other master accounts have been created for the provider A master account has all the functionality of Individual accounts However a master account holder will also have the ability to administer all the Individual accounts for the same provider This provides an authorized representative from a provider such as a supervisor or manager the ability to monitor and maintain who can and who cannot access information from the system If you are not authorized to create a master account please do not attempt to create one You will not be able to use it since we require an authentication code which is mailed to an address retained in our system When the sign up process is complete for a master account a letter will be generated and sent to the Provider s Correspondence address on file This letter will contain the authentication code necessary to activate the master account Ifthe master account is not activated within 30 days of creation it will be deleted from our system Please keep in mind that during this time no other master accounts can be created Therefore please do not attempt to create a master account unless yo
38. gible for some category of Medicaid benefits QMB Dual Eligibility Begin End Date The period of time Medicare overlaps with Medicaid The system will pass the earliest intersecting QMB Qualified Medicare Beneficiary dual begin date based on the Begin Date of Service used for the inquiry Rate Code Description The capitation payment method at the time the payment was made Share of Cost Amount The amount the recipient must pay before Medicaid begins covering charges and it applies to Long Term Care LTC recipients Up to three cost share amounts can appear Each cost share amount is followed by the cost share begin and end date Share of Cost Begin Date The beginning date of the recipient s cost share period for the corresponding cost share amount in mm dd yyyy format Version 3 2 Last Updated 7 2010 55 n Q o State of Hawaii EN id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Share of Cost End The ending date of the recipient s cost share period for the corresponding Date cost share amount in mm dd yyyy format Start Date Medicare page The date the recipient became eligible for the Medicare Type Third Party Liability page The date the recipient s insurance became effective for the specified carrier Version 3 2 56 Last Updated 7 2010 Suey Fi State of Hawaii o EN id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Appendix D DMO Exclusio
39. hange to a record Lock In Provider The name of the recipient s lock in provider Up to three providers can appear Medicare Type The type of Medicare plan for which the recipient is eligible NH Nursing Home Provider The name of the recipient s nursing care provider if applicable Version 3 2 Last Updated 7 2010 54 iiy Fi 9 State of Hawaii kN id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE sex Penalized NH An indicator which usually identifies cases in which the client sold assets Nursing Home to qualify for Medicaid In these cases nursing home benefits are not Indicator paid but all other benefits should be paid Y Nursing home should be paid N Nursing home should not be paid however all other benefits should be paid Period End The date on which the recipient s coverage under the specified Health Plan expired Period Start The effective start date of the recipient s coverage under the specified Health Plan Policy Number The number assigned by the carrier to uniquely identify a recipient s insurance plan Provider ID 6 digit provider ID Med QUEST provider ID root number without location code 8 digit provider ID 6 digit Med QUEST provider ID 2 digit location code default is 01 QMB Dual Eligibility A QMB Qualified Medicare Beneficiary indicator identifying individuals who are entitled to Medicare in addition to being eli
40. he Hawaii Department of Human Services Medicaid Administration This information is intended solely for use by the intended recipient hereof If you are not the intended recipient be aware that any disclosure copying distribution or use of the contents of this transmission is prohibited Figure 16 Recipient Search Once a valid recipient is found the Eligibility Enrollment Search page displays Version 3 2 32 Last Updated 7 2010 n Q Steps 1 EN NOTE Version A ae State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE The type of online search you choose depends on the variety and reliability of the information at your disposal Select a set of search criteria by choosing an option from the Search By drop down list To search by HAWI ID proceed to Step 2 To search by Social Security Number proceed to Step 3 To search by the recipient s Name Date of Birth and Gender proceed to Step 4 Click CLEAR to erase all data entered in the search fields Search by HAWI ID Type a valid HAWI ID into the HAWI ID field and press lt Enter gt or click SUBMIT Search by SSN Type a valid Social Security Number into the SSN field and press lt Enter gt or click SUBMIT A successful recipient search conducted with an SSN returns basic recipient information about the recipient including their HAWI ID Name DOB and Gender in addition to the SSN Searches conducted by HAWI ID or by Recipient Name
41. ider ID 012345 D Eligibility and Enrollment Status CPS Eee Date Password gt Claim Status Changed 3 5 2007 12 45 27 PM Password jeeeeee Confirm Password First Name Test Last Name Name Title Tester Address MED QUEST DIVISION P O BOX 700190 KAPOLEI HI 96709 Telephone 808 555 1234 Email name website com Hint Question What is a long palindrome Answer racecar Accept Changes Cancel Figure 14 User Account Version 3 2 Last Updated 7 2010 28 n Q Q Dl Steps A NOTE Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Change Password Type your new Password in the NEW PASSWORD field Press lt Tab gt to move the cursor to the CONFIRM NEW PASSWORD field Retype your Password Be sure to select a password that is at least six characters long You may use any combination of characters except for the following Press lt Enter gt or click ACCEPT CHANGES A subsequent screen appears with the following message Press Ok to save your changes Press lt Enter gt or click OK to accept the changes To confirm that the update was applied successfully to a record the following message appears at the top of the User Account screen Your account has been updated Click Main Menu to return to the DMO Main Menu Your Password Expiration date displays in the upper right hand corner of the web page ad
42. ing to link to a relevant section e Users with access to the Eligibility and Enrollment Status system can view the Eligibility and Enrollment Help page depicted below User Name TestName User ID 9876543 Type Master Provider ID 012345 Main Menu LoaOur Main Menu Help Contents P Eligibility and i Eligibility Enrollment Eligibility Enrollment National Provider Identifier NPI Med QUEST Provider ID Other Coverage Third Party Liability Medicare Medicaid Eligibility Enrollment Eligibility The Eligibility Description is a brief description of the type of eligibility the recipient has Code Short Description Description A QUEST ELIG Quest eligible for this date range B QUEST NET ELIG Quest Net eligible for this date range C QUEST ACE ELIG Quest Adult Coverage Expanded eligible for this date range E EMERG ONLY Emergency Services only for this date range F FFS ELIG Fee for service eligible for this date range I INPATIENT ELG Inpatient services only for this date range L LTC ELIG Long term care eligible for this date range N NOT ELIG Not eligible for this date range Q NONPAY No payment permitted for this date range The Begin Date indicates the date the recipient is eligible for insurance coverage The End Date indicates the date the recipient s insurance coverage expires Figure 20 Eligibility Enrollment Help Version 3 2 41 Last Updated 7 2010 dy ti 5 State of Hawaii o kN id DE
43. jacent to other detailed user information Finally although passwords expire every 60 days no restrictions are in place to prevent a password from being recycled Manage Account Details Press lt Tab gt to move the cursor to any field that requires an update such as FIRST NAME LAST NAME TITLE TELEPHONE EMAIL HINT QUESTION or HINT QUESTION ANSWER Type the new data into the appropriate field s Once the necessary changes have been made click ACCEPT CHANGES A dialog box appears with the following message Press OK to save your changes Press lt Enter gt or click OK to accept the changes To confirm that the update was applied successfully to a record the following message appears at the top of the User Account screen Your account has been updated Changes made to an individual account are effective immediately Click CANCEL to return to abandon any changes thus far Click Main Menu to return to the DMO Main Menu 3 2 29 7 2010 yy ME State of Hawaii iN i DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Applications After logging into the system with an established Master or Individual Account the Main Menu page displays Navigation to different applications within the system starts here Main Menu Click on the Eligibility and Enrollment Status option under the Main Menu heading to access the system To access the Contact Us page click on the Contact Us link in the top right corner User Name
44. losure of this information is limited to purposes directly related to all aspects of the administration of the State of Hawaii Medicaid 4 Account Created Program including the managed care fee for service and Home amp Community Based Waiver Services The use and disclosure of this information is also subject to the privacy and security requirements of the Administrative Simplification provisions of the federal Health Insurance Portability and Accountability Act The Master Account Holder is responsible for ensuring the confidentiality of any information obtained from this web application by persons using the Master Account Holder user ID or any individual user IDs approved by the Master Account Holder The Master Account Holder is responsible for informing itself and its employees and agents of the requirements of all applicable privacy laws and ensuring Compliance with the license agreement That individual accounts are limited to employees who need the information to perform their employment related duties That inactive individual accounts are deactivated and That the Master and individual user IDs and passwords are not lAgree Cancel Figure 6 User Agreement User Agreement 1 Read the user agreement If you accept these terms click AGREE to proceed to the next page 2 Click CANCEL to abandon the user account creation process and return to the home page Version 3 2 9 Last Updated 7 2010 y oe Stat
45. nrollment Status HAWT ID NAME DOB GENDER 0123456789 DUCK DAFFY 07 07 1937 M BEGIN DATE OF SERVICE MMDDCCYY END DATE OF SERVICE MMDDCCYY Max 365 days per date span Submit Clear Verify the identity of the recipient with a separate photo ID If the ID does not match the name on the HAWI ID then report it to the State of Hawaii Department of Human Services Fraud Hotline 808 587 8444 Figure 17 Eligibility Enrollment Search Once a search request has been submitted the Eligibility Enrollment page displays Version 3 2 35 Last Updated 7 2010 n Q te NOTE l N LY Version A ae State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE No eligibility or enrollment data can be provided prior to 08 01 1994 the earliest system date for which such data is available Therefore it serves no purpose to type dates prior to 08 01 1994 in the BEGIN DATE OF SERVICE or END DATE OF SERVICE fields Required Fields Type the Date of Service begin date in the BEGIN DATE OF SERVICE field Note that the date must be equal to or less than today s date Press lt Tab gt to move the cursor to the END DATE OF SERVICE field Type the ending Date of Service in the END DATE OF SERVICE field Note that this date must be equal to or greater than the beginning DOS Ending DOS in the future is not allowed Initiate Search Press sEnter or click SUBMIT to proceed to the Eligi
46. ns Recipient type exclusions Access to data for the following recipient population types is restricted when using the Eligibility and Enrollment system TYPE HAWI ID Eligibility and Claims Enrollment Department of Public Safety PSD OP x Office of Youth Services OYS OJ X Demonstration to Maintain Independence and OD X Employment DMIE Provider exclusions Access to the DHS Medicaid Online DMO application is restricted for providers that fit any of the following criteria 1 Managed Care Only Reimbursement type 04 2 Term status gt 1 year 3 Provider is required to use an NPI but NPI is not on file with Med QUEST s Provider Registration Version 3 2 57 Last Updated 7 2010 Po o State of Hawaii iN id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Location 1 p 37 Figure 18 Eligibility Enrollment Change Summary Previously Stated lt old screen shot gt TE Revision lt updated screen shot gt 2 p 39 Figure 19 Other Coverage lt old screen shot gt lt updated screen shot gt Version 3 2 Last Updated 7 2010
47. ntered is valid Multiple secondary IDs exist Insured ID Number when searching by SSN Resubmit recipient search using HAWI ID if possible Required Application Data This is a required field Missing Be sure that the 9 digit SSN entered is valid More than one recipient n a Multiple recipients found found using the SSN when searching by SSN Name or HAWI ID Be sure that the SSN entered is valid Resubmit recipient search using HAWI ID if possible Subscriber Not Found No primary record found for this SSN Be sure that the SSN entered is valid Resubmit recipient search using HAWL ID if possible Patient Not Found Please correct and resubmit Invalid Missing SSN value lt 9 characters Subscriber Insured ID 3 2 47 7 2010 By Name By Name By Name By Name Search By Name Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Field Error Message Duplicate Subscriber Insured ID Number Please verify name on valid ID or call Med QUEST Customer Service Subscriber Not Found Last Name Invalid Missing Patient Name HIPAA elk Multiple recipients found when searching by Name Resubmit recipient search using HAWI ID if possible No primary record found for this name Be sure that the name DOB and gender are correct Resubmit recipient search using HAWI ID if possible No primary record found for this name B
48. om gt Pharmacy assistance Contact Toll free 1 877 439 0803 Pharmacy Benefit Management Services PBMS Affiliated Computer Services ACS Rx Website www himed guestffs org Figure 4 Contact Us Version 3 2 6 Last Updated 7 2010 yy ME State of Hawaii iN i DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Security The DMO application has been secured to prevent fraudulent use of DHS MQD information Users are required to create an account prior to using the DHS Medicaid Online website The DHS MQD grants permissions to the system and each provider s Master Account Holder manages the Individual Accounts including activities such as account activation granting security and other administrative functions This website does not update a provider s Service Correspondence or Payment Address Please submit form DHS1139 to HCMB Provider Registration P O Box 700190 Kapolei HI 96709 Login In order to access the system a valid User Name and Password are required To create a new account simply click the Create a New Account link die a a 5 ad State of Hawaii Department of Human Services DHS Medicaid Online Contact Us Overview Terms of Use Thank you for visiting Department of Human Services Medicaid Online Please login or Create a New Account Sign In User Name Password Forgot your Password Click Here Note e User Names and Passwords are case sensitive Download In
49. on Code letter for newly created Master Accounts is mailed to this address Type your Area Code into the first TELEPHONE NUMBER field and press lt Tab gt to move the cursor to the second TELEPHONE NUMBER field Type your Prefix into the second TELEPHONE NUMBER field and press lt Tab gt to move the cursor to the third TELEPHONE NUMBER field Type your Suffix into the third TELEPHONE NUMBER field and press lt Tab gt to move the cursor to the EMAIL ADDRESS field Type your Email Address in EMAIL ADDRESS field and press lt Tab gt to move the cursor to the CONFIRM EMAIL ADDRESS field If you are unsure of your email address please check with your IT Department The email noted should be the email address seen by external receivers and not what is used internally within your office email system Retype your Email Address in the CONFIRM EMAIL ADDRESS field and press lt Enter gt or click CONTINUE You should be viewing the Account Created page Before clicking CONTINUE it is recommended that you print this Create Profile page for your records Please be sure to store it in a safe place Otherwise if you forget both your password and hint question you may obtain this information from your Master Account Holder Messages may appear on certain screens or adjacent to required fields that have no data entered or that have been insufficiently populated Refer to the Appendix A Error Messages for more information as needed 3 2 16
50. ord in the future this question will be posed to you It functions as a security gate In order to have your password sent to your email address you must provide the answer exactly as it is entered here 3 2 14 Last Updated 7 2010 n Q 2 ae NOTE Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Individual or Master Account This section appears only if no Master Account has been established for your Provider ID number Providers are responsible for creating their own master account for their Provider ID number It is recommended that Group Billing Offices request that an Individual Account be created under each of their servicing provider s Master Account in order to access claim information for each service provider It is the responsibility of the Master Account Holder to maintain Individual Account access i e to add or remove users limit access When registering providers are required to enter either a 6 digit Med QUEST Provider ID Number or a 10 digit NPI National Provider Identifier along with their Tax ID number This should not be confused with the 8 digit Med QUEST Provider ID number used by other verification systems such as the AVRS The system matches the provider using the Provider ID number and Tax ID number Once a Master Account is created for the Provider ID only individual accounts can be created thereafter There is a limit of one Master Account per provi
51. r Information Select the type of requestor current master account holder new master account holder or provider Supply the reguestors name Supply the requestor s user name Supply the requestor s email address Supply the requestor s contact phone number Signature of the requestor Date v VVVVVV Section 4 Provider Acknowledgment gt Signature of Provider gt Date Filing Instructions Fax the form to the above fax number You will receive an email confirmation upon the completion of the request within 7 business days 51 STATE OF HAWAII Med Quest Division Department of Human Services STATE OF HAWAIVDHS MOD DHS MEDICAID ONLINE WEB ACCOUNT STATUS CHANGE FORM Complete this form to request a Master or Individual Account activated or deleted on the DHS Medicaid Online web verification system Please fax this form to ACS State Healthcare Attention DHS Medicaid Online Admin Fax 808 952 5595 1 PROVIDER INFORMATION Provider ID or NPI Provider Name 2 ACTION TO BE TAKEN Select one _ Activate C Delete Web Account type L Individual Account _ Master Account Account Holder Name User Name 3 REQUESTOR INFORMATION _ Current Master _ New Master Account Holder Account Holder _ Provider Requestor Requestor s Name Requestor s User Name Requestor s Email Requestor s Phone Requestor s Signatur
52. reater than the system date or less than the Begin Date of Service Date of Birth Follows Date s of Service Date of Service in Future End Date of Dates of Service precedes n a A Date of Service should Service Date of Birth not be less than the recipients Date of Birth Begin Date of Service OR End Date of Service 3 2 Last Updated 7 2010 Date of Service not within allowable inguiry period Date of service range must be no greater than 365 days 50 STATE OF HAWAII Med Quest Division Department of Human Services Appendix B Master Account Change Form STATE OF HAWAIVDHS MOD DHS MEDICAID ONLINE WEB ACCOUNT STATUS CHANGE FORM INSTRUCTIONS Rev 09 11 Complete this form to request a Master or Individual Account activated or deleted on the DHS Medicaid Online web verification system Please fax this form to ACS State Healthcare Attention DHS Medicaid Online Admin Fax 808 952 5595 Section 1 Provider Information gt Supply the provider s ID or NPI gt Supply provider s name Section 2 Action To Be Taken gt Select Activate for an account that has been placed in a Deleted status due to inactivity gt Select Delete for an account that is invalid or will no longer be used gt Select the type of web account needing the change in status gt Supply the account holder s name gt Supply the web account s user name used for login Section 3 Requesto
53. so Although a Master Account can be created it remains inactive until authenticated DHS MQD mails a letter to the address specified by the provider containing the Authentication Code necessary to activate the account If you are not authorized to create a Master Account but attempt to create the account the setup process for your provider will be delayed No other users will be able to access the system until a Master Account Holder is created who activates the Master Account and subsequent Individual Accounts Therefore if you are not authorized to create a Master Account simply create an Individual Account Version 3 2 12 Last Updated 7 2010 sy AE State of Hawaii id DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Enrollment Steps Please verify that the following information is related to the provider for which you wish to create an account If it is incorrect and not the provider for which you are authorized to create an account click 1 User Agreement here to return to the provider input form 2 Verification Provider Information 3 Create Profile Provider Name SAMPLE PROVIDER L L C Provider Number 012345 4 Account Created Tax ID Number 012345678 Indicates a required field In order to create your account please provide the following information about yourself Enter a User Name and Password At least 6 characters with no leading or trailing blank spaces User Name Password Confirm
54. t does not match the email address entered in the Create Profile Confirm Email This is a required field Be sure that this email address matches the email address entered preceding field User Name User name entered is less than six characters or does not match recorded data 3 2 45 7 2010 in the preceding field Recover Password This is a required field Only a valid combination of the user name with the six digit Med QUEST Provider Number and Tax ID Number as recorded in the HPMMIS database may be entered Check your records and try again or contact your designated administrator Version Last Updated Screen Password Recover Password Recover Password By HAWI ID Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Field Error Message HIPAA Error Provider ID The provider information n a This is a required field you entered is incorrect Only a valid combination or does not match of the user name with recorded data the six digit Med QUEST Provider Number and Tax ID Number as recorded in the HPMMIS database may be entered Check your records and try again or contact your designated administrator lt User defined The provider information password you entered is incorrect recovery or does not match question gt recorded data This is a required field The question must be answered exactly as it was typed when the ac
55. ternet Explorer New Account Click on Create a New Account to create an account with the Department of Human Services Medicaid Online Warning The information provided through the State of Hawaii Department of Human Services Medicaid Program Online Web Application is confidential under state and federal law Use and disclosure of this information is limited to purposes directly related to all aspects of the administration of the State of Hawaii Medicaid Program including the managed care fee for service and Home amp Community Based Waiver Services The use and disclosure of this information is also subject to the privacy and security requirements of the Administrative Simplification provisions of the federal Health Insurance Portability and Accountability Act Figure 5 Login Version 3 2 7 Last Updated 7 2010 n Q wad te n oi NOTE N NOTE Version LY State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Login Providers whose identification number has been in a terminated status for one year or longer are not permitted access to the DHS Medicaid Online system If you have already established a user account then proceed to step 2 to login else skip ahead to step 3 to create a new user account Type your User Name in the USER NAME field Press lt Tab gt to move the cursor to the PASSWORD field Type your Password and press lt Enter gt or click LOGIN Yo
56. to your Begin Date of Service and End Date of Service Next Step To view the recipient s eligibility and enrollment information corresponding to the dates used in your selection criteria click Eligibility and Enrollment Status in the upper left corner of the page and refer to the procedures in the Eligibility Enrollment section beginning on page 37 To change the selection criteria but continue research on the same recipient click Search in the upper right corner of the page and refer to the procedures in the Eligibility Enrollment Search section beginning on page 35 To continue eligibility and enrollment research on a different recipient click Recipient Search in the upper right corner of the page and refer to the procedures in the Recipient Search section beginning on page 32 To return to the DMO Main Menu click Main Menu in the upper right corner of the page Details on how to proceed begin on page 30 For questions regarding a recipient s eligibility or enrollment please contact the Med QUEST Customer Service for assistance Please refer to the Main Menu for a list of contact numbers Select the Print button to print a printer friendly version of the Other Coverage response 3 2 40 7 2010 yy ME State of Hawaii iN i DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Help The Help page offers descri2ptions for the data presented on each page Scroll down the page or use the hyperlinks available under the Contents head
57. u are authorized to do so since this will delay your setup process Once the Master accountis activated the master account holder will have the ability to activate new individual accounts Keepin mind that even though a master account may not exist for a given provider Individual accounts can still be created These accounts will remain inactive until a master account is created and activated and the master account holder activates them e All master account holders will receive an email each time an individual account is created This email is sent to notify the master that the account was created and is awaiting activation INDIVIDUAL ACCOUNTS Individual accounts can be created regardless of whether a master account already exists for a provider However you cannot use an individual account until a master account holder activates it e When the sign up process is complete for an individual account an email will be sent to the master account holders for the same provider if there is any This will notify them of the new account and remind them to activate it The new individual account will remain inactive for up to 120 days unless a master account holder activates it Ifthe master account holder does not activate the new individual account within 120 days it will be deleted from the system INACTIVITY ON MASTER AND INDIVIDUAL ACCOUNTS The system will change the account to an Inactive status after 90 days of inactivity Pleas
58. u should be viewing the Main Menu page To learn more about how to proceed refer to the Main Menu section beginning on page 30 Click on Click Here adjacent to the Forgot your Password link to be reminded of your password For more information refer to the procedures in the Recover Password section beginning on page 20 Also be aware that your password expires after 60 days You will be notified of the need to update your password when necessary If you have not already created a user account click Create a New Account to initiate this process The User Agreement page displays and is described on the next page 3 2 8 Last Updated 7 2010 sy AE State of Hawaii iN i DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE User Agreement The first step in creating an account requires the acceptance of the Department of Human Services Medicaid Program Online Terms of Use and Conditions If these terms are not accepted you will be redirected back to the home page However once accepted the new account creation process may continue Enrollment Steps Please read the following terms of use and indicate that you agree by clicking the I Agree button at the bottom of the page Warning The information provided through the State of Hawaii 1 User Agreement Department of Human Services Medicaid Program Online Web 2 Verification Application is confidential under state and federal law Use and 3 Create Profile disc
59. ual Accounts A Master Account is always considered Active once the Authentication Code has been entered Therefore this check box does not display when a Master Account Holder has been selected The fields beneath the Details section on the right side of the User Administration screen may be altered as needed in order to manage the details of a particular account Master Account Holders may toggle the status of an account provide updates to a users PASSWORD FIRST NAME LAST NAME TITLE TELEPHONE EMAIL HINT QUESTION or HINT QUESTION ANSWER and set the GROUP PERMISSIONS so that the selected users access is restricted to Eligibility Enrollment Status Claim Status or both Eligibility Enrollment amp Claim Status Once the necessary changes have been made click ACCEPT CHANGES A dialog box appears with the following message Press OK if you would like to save your changes Press lt Enter gt or click OK to accept the changes Alternatively click CANCEL to return to abandon any changes thus far To confirm that the update was applied successfully to a record the following message appears at the top of the User Administration screen Your account has been updated Changes made to any user account are effective immediately In order to more easily monitor updates to user accounts a change made to any account records the name date and time of the user initiating the change This data displays in the bottom two fields of the
60. waii ya te 3 La Ww NOTE l N NOTE l LY N NOTE Version DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Enter a User Name and Password Type the desired User Name in USER NAME field Press lt Tab gt to move the cursor to the PASSWORD field Be aware that both user names and passwords are case sensitive We recommend separating multi word user names with an underscore character For example User_Name Also the user name that you select must be unique to DMO Type your Password and press lt Tab gt to move the cursor to the CONFIRM PASSWORD field Retype your Password and press lt Tab gt to move the cursor to the HINT QUESTION field Be aware that both user names and passwords are case sensitive Also be sure to select a password that is at least six characters long You may use any combination of characters except for the following Finally although passwords expire every 60 days no restrictions are in place to prevent a password from being recycled As a reminder the expiration date of your password displays below your User Name in the upper right hand corner of the Main Menu page after you log in Choose a Hint Question and Answer Type a Question in the HINT QUESTION field and press lt Tab gt to move the cursor to the ANSWER field Type an Answer in the ANSWER field that answers the question posed in the previous field If you attempt to recover a forgotten passw

DHS Medicaid Online User Manual - Department of Human Services

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