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DHS Medicaid Online User Manual - Claims - Med

1. The system will change the account to an Inactive status after 90 days of inactivity Please refer to the DHS medicaid Online user manual for more information Home Figure 1 DHS MQD Online Overview Steps Type https hiweb statemedicaid us into the address toolbar and press Enter Version 3 0 13 Last Updated 11 8 2007 2 Me State of Hawaii ZS DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE SER 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 Contact Us Overview Terms of e 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 SS 20 Note 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 Haw
2. INC Recipient HAWIID 0123456789 DOB 07 07 1937 Name DUCK DAFFY Gender M Claim Header CRN 010203040506 Claims Status APPROVED GONEIBMED Bill Type Service Begin End Dates 2 19 2007 2 19 2007 Status Date 03 09 2007 Medical Record Patient Acct e Price Accounting Summary Line Line Status Srv beg Date Srv End Date Srv Code Billed Payment DI APPROVED 02 19 2007 02 19 2007 99291 517 28 147 45 02 APPROVED 02 19 2007 02 19 2007 93010 52 69 1 71 Totals 576 97 149 16 Figure 19 Claim Status Response Disclaimer The line status of a claim in a Not Adjudicated or Pended status may change due to re adjudication Version 3 0 48 Last Updated 11 8 2007 KAON a A ae teps P NOTE WI NOTE LA A Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE The number of records that match your selection criteria displays in the lower right corner of the page The first record if at least one record matches your selection criteria always displays first Be aware that if the claim is in a Not Adjudicated status then no data appears in the Price Accounting Summary section However it is possible that the line status for a claim may change due to re adjudication Determine whether you need to view other claim records if present that match your selection criteria or whether you require more detailed informatio
3. No email address is entered or it 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 0 56 11 8 2007 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 9 State of Hawaii EN amp DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Screen Field Error Message HIPAA Error Provider ID The provider information n a This is a required field Password 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 Recover User defined The provider information Password password you entered is incorrect recovery or does not match question recorded data This is a required field The question must be answered exactly as it was typed when the account was created Note that
4. Version 3 0 14 Last Updated 11 8 2007 State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Version Last Updated 3 0 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 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 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 Sys
5. answered exactly as it was typed when the account was created Once the correct answer is provided 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 pe 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 Question in the ANSWER field and press Enter or click CONTINUE NOTE In 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 0 31 Last Updated 11 8 2007 X i 5 State of Hawaii e S amp 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
6. 2007 KAON a Q ae A NOTE Version Last Updated State of Hawaii DEPARTMENT OF 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 Enter 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 0 36 11 8 2007 2 Me State of Hawaii EN ZS 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 User Name TestName gt Pwd E
7. ID Begin The Service Provider ID Begin Claim Status Date of Service and End Date of Service and End section Date of Service fields are Date of Service fields are Claim Status required to perform a search required to perform a search Request subsection A list of valid provider IDs is The Service Provider 2 and 3 available in the Service Number defaults to the paragraphs Provider ID drop down list to Provider ID associated with limit you to viewing claims the User Name under your own provider ID The Service Provider ID s or another provider ID with affiliated with a Group Billing which you are affiliated This Provider are sorted within the affiliation must be on record drop down box NPIs for the with HCMB Provider group provider appear at the Registration Values not top of the dropdown field contained in the drop down MQD IDs appear at the list cannot be manually bottom of the list Group overwritten in this field Billing Providers are limited to viewing claims under their own provider ID or another provider ID with which they are affiliated This affiliation must be on record with HCMB Provider Registration Values not contained in the drop down list cannot be manually overwritten in this field Version 3 0 vi Last Updated 11 8 2007 aM s d wad State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Location 10 p 45 Claim Status section Claim Status Request subsection Note foll
8. ID or by Recipient Name DOB amp Gender do not include the SSN label or data in the corresponding response 3 0 42 11 8 2007 KAON a 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 Tab 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 recipients Gender in GENDER fields drop down list and click SUBMIT The use of this field is required for Claim Status searches 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 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 accu
9. KAPOLEI State HI Zip Code 96707 Talaphone 808 555 1212 Number Email Address name website com Login Figure 9 Account Created Version 3 0 26 Last Updated 11 8 2007 gu a Steps NOTE Version Last Updated A ae State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Account Created Click Login You should be viewing the Login page To learn more about how to proceed refer to the Login section beginning on page 16 Remember that an Individual Account must be activated by the Master Account Holder prior to use and that a Master Account can only be activated with an Authentication Code that is mailed to the provider s Correspondence Address 3 0 27 11 8 2007 2 E State of Hawaii e S Z 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 You cannot access your account until you provide a valid authentication code This code was sent to the mailing addres
10. Me State of Hawaii ZS DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE SER DHS MQD Online Overview To access these services log onto the DHS Medicaid website at https hiweb statemedicaid us DHS MQD ONLINE OVERYIEW 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 Whenthe 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 m
11. Med QUEST Provider Registration but does not then access to the Claim Status application for that provider is removed If the provider ID has been in a terminated status for one year or more access to the DHS Medicaid Online system is discontinued 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 Tab 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 and must be equal to or less than today s date If you do not wish to place further constraints on the selection criteria skip to step 9 to initiate the search Press lt Tab gt to move the cursor to the FORM TYPE field Optional Field Type the Claim Number if known in the CLAIM NUMBER field Press lt Tab gt to move the cursor to the PATIENT ACCOUNT NUMBER field Initiate Search Press lt Enter gt or click SUBMIT to proceed to the Claim Status Response List screen Alternatively click CLEAR to erase all fields on the form and re enter the data 3 0 45 11 8 2007 2 3 State of Hawaii e KN s DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Claim Status Response List The Claim Status Response List page displays any claims that match the search criteria Click on an individual CRN Claim Reference Number to view details of that c
12. Messages Error NPI not on File n a Any provider number listed in screen this error message is one that is affiliated with the Group Billing Provider and is required to have an NPI on file with Med QUEST Provider Registration but does not Contact Provider Registration at 808 692 8174 to supply the NPI for the identified provider s 21 pp 53 61 lt Eligibility Enrollment gt lt deleted gt Appendix A Error lt Prior Authorization gt Messages rows pertaining to Eligibility Enrollment and Prior Authorization screens 22 pp 62 63 lt old instructions and form gt lt revised instructions and form gt Appendix B Master Account Change Form Version 3 0 ix Last Updated 11 8 2007 4 23 Aet Location penis State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE p 64 Appendix C Glossary Claim Number Previously Stated 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 received 3 a one character type indicator for the source of claims received on tape and 4 a five character sequence number Revision 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 t
13. Name TestName Pwd Exp 12 31 2007 User ID 9876543 Type Master NPI 0000000000 Admin Remember that a Master Account Kl Must be initially authenticated with a one time code mailed to the Master Account Holder s address Kl Activates Individual Accounts before they can be used Kl Can never be downgraded to an Individual Account Version 3 0 32 Last Updated 11 8 2007 2 E State of Hawaii e ay Z 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 a
14. Web 2 Verification Application is confidential under state and federal law Use and 3 Create Profile disclosure 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 Agree Cancel Figure 6 User Agreement User Agreement Read the user agreement If you accept these terms click I AGREE to proceed to the next page 2 Click CANCEL to abandon the
15. access to 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 0 54 Last Updated 11 8 2007 Screen Valid Provider Provider State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Error Message Authorization Access Restriction Managed Care Only providers are not permitted access to DMO The provider should contact the contracted health plan for recipient verifications Create Profile Create Profile Create Profile Create Profile Create Profile Version Last Updated Valid Provider Tax ID Number Invalid Missing Provider Identification User Name already exists User Name Must be at least 6 characters with no leading or trailing blank spaces Password Password entered is less nli than six characters Confirm Password entered is less Password than six characters or does not match the password entered in the preceding field Hint Question No question is entered 3 0 11 8 2007 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
16. applications may not be available to all users NOTE Each providers Master Account Holder may restrict any of their Account Holders to access one or more applications LT For more information on setting Group Permissions refer to the Master Account Admin Functionality section beginning on page 32 Version 3 0 40 Last Updated 11 8 2007 2 E State of Hawaii e KN s DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Claim Status Select the Claim 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 claim status and payment 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 D Claim Status You must first identify a Recipient in order to do an inquiry Indicates a required field SEARCH BY HAW ID j HAWI men 10 diait This site displays confidential information from the Hawaii Dep
17. options may not be available to all users 3 p 12 Consult your own technical Consult your own technical Browser support resources for more support resources for more Requirement information if necessary or use information if necessary or use section the link pictured below on the the link pictured below on the 2 paragraph last homepage to download and homepage to download and sentence install Microsoft Internet install Microsoft Internet Explorer 6 0 Explorer 7 Version 3 0 iii Last Updated 11 8 2007 4 wad penis 3 A State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Location Previously Stated Revision 4 p 30 1 Type your User Name in the 1 Select the type of provider ID Password Recovery USER NAME field Press number you are submitting section Tab to move the cursor to for verification from the drop Steps the PROVIDER ID field down list Press Tab to 2 Type the six digit Med move the cursor to the USER QUEST Provider ID number NAME field in the PROVIDER ID field 2 Type your User Name in the Press Tab to move the USER NAME field Press cursor to the TAX ID field Tab to move the cursor to 3 Type the Tax ID number the PROVIDER ID field corresponding to the provider 3 Type a Provider ID number ID number in the TAX ID field corresponding to the type and press Enter or click selected in the PROVIDER CONTINUE You should be NUMBER
18. page The date the recipient is eligible for insurance coverage 29 p 68 1 Managed Care Only 1 Managed Care Only Appendix D DMO Reimbursement type 05 Reimbursement type 04 Exclusions Provider Exclusions 30 p 68 3 Provider is required to use Appendix D DMO an NPI but NPI is not on file Exclusions with Med QUEST Provider Exclusions Version 3 0 Last Updated 11 8 2007 penis SZ State of Hawaii e S Z DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Overview The Department of Human Services DHS Medicaid Online DMO offers providers an alternative method for obtaining claim data from HPMMIS Hawaii Pre Paid Medical Management Information System Once an account is established and authenticated you may 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 0 12 Last Updated 11 8 2007 2
19. that the 10 digit HAWI ID entered 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 HAWI ID if possible Patient Not Found Please correct and resubmit Invalid Missing SSN value 9 characters Subscriber Insured ID 3 0 58 11 8 2007 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 ZER 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 re
20. the PROVIDER NUMBER field 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 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 0 20 11 8 2007 X Ca NE State of Hawaii e S amp 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 op
21. time of the user initiating the change This data displays in the bottom two fields of the User Administration screen These fields are populated systematically and can not be edited manually 3 0 34 11 8 2007 KAON a A 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 Enter 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 1 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 0 35 11 8
22. user account creation process and return to the home page Version 3 0 18 Last Updated 11 8 2007 2 E State of Hawaii e ay Z 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 Ze BEI 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 D 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 0 19 Last Updated 11 8 2007 KAON e un Aut te S I Ww NOTE l N NOTE l UJ NOTE l Version Last Updated State of Hawaii 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
23. 31 00 Total 147 45 H Record 1 of 2 b bl Figure 20 Accounting Details Version 3 0 50 Last Updated 11 8 2007 KAON a Q d Steps 1 NOTE NOTE Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE The number of detailed accounting lines records within the selected claim displays in the lower right corner of the page The first detailed accounting line record displays by default unless a specific line number within the Price Accounting Summary section of the Claim Status Response page was deliberately selected Line status for a claim with a Not Adjudicated status may change due to re adjudication Scroll through the detailed accounting lines records to view the accounting details Use the appropriate scroll buttons in the bottom right corner of the page Click D to view the next record Click M to view the last record Click 4 to view the previous record Click I4 to view the first record Next Step To view other claim records that match the selection criteria click Claim Status in the upper left corner of the page and refer to the procedures in the Claim Status Response section beginning on page 46 To change the selection criteria but continue research on the same recipient click Claim Search in the upper right corner of the page and refer to the procedures in the Claim Status Request section beginning on page 44 To continue claims re
24. Account Holder L Provider Requestor s Name Requestor s User Name Requestor s Email Requestor s Phone Requestor s Signature Date 4 PROVIDER ACKNOWLEDGEMENT Provider s Signature Date For Office Use only Date Received Date Completed Completed by DHS 8013 Rev 09 07 KAON a Q d 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 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 two character indicator of the medium by which the claim was received and 3 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 C
25. DHS Medicaid Online DMO Web Based Claim Status eee e o e e e ge df a d 4 e a gna t F g areas un D O p 7 o a at 9 ry GS SEU rem VW T tr Se F s e a 7 07 3 1 PX ex Se ef di Application Walk Through p 3 State of Hawaii S amp DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Contents Change SUMMARY ASTRID I T IT iii OW SW or m 12 Browser Heouirement un 12 DHS MQD Online OvervieW AEN 13 Contac US patei tr D EE CS 14 eibi D 16 Moe ec n 16 User Agreement m 18 Identify a Valid PTOVIGGE EE 19 Provide Your Information and Account Type 21 POE COMME CGA EE 26 Authenticate the Master Account essssssseeeneeessesrrerrnrrreseerrrnrrnnnnnsererrnnnnnn 28 ee ere EE 29 Master Account Admin Functionality eeceeeeeeeeeeeeeeeeee 32 Te ut Et e MR E ER 33 Individual Account Functionality eeeeeeeeeeeeeeee enne 37 flee Ier vi o Lc cL 39 Mai MeL tcc th ie thc tin ce tn er aii ee an er eee etn dee ada ee ai ce apn 39 Glaim Status pere 41 HeclplenE Seat Chis aerem rie eee tae eles 41 Claim Status Heouest ee 44 Claim Status Response let 46 Claim Status Hesponse ee 48 Accounting Detalls eegener 50 Help pcrea eaaa eaa ena Tn 52 Appendix A Error Messages eeccceceeeeeeeee
26. ME field Press Tab to move the cursor to the PASSWORD field Type your Password and press Enter or click LOGIN You should be viewing the Main Menu page To learn more about how to proceed refer to the Main Menu section beginning on page 39 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 29 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 as described on the next page 3 0 17 11 8 2007 2 Me State of Hawaii EN ZS 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
27. Main Menu 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 Manage Account Details Press Tab 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 Enter 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 0 38 11 8 2007 2 Me State of Hawaii EN ZS 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 Claims Status option under the Main Menu heading to access the system To access the Contact Us p
28. QMB Qualified Medicare Beneficiary indicator identifying individuals who are entitled to Medicare in addition to being eligible 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 0 Last Updated 66 11 8 2007 KAON a 9 State of Hawaii S amp DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Share of Cost End Date The ending date of the recipient s cost share period for the corresponding 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 0 67 La
29. age click on the Contact Us link in the top right corner User Name TestName Pwd Exp 12 31 2007 User ID 9876543 Type Master NPI 0123456789 j Menu Lo Lzogr ut Main Menu Contact Us AFor security purposes your session will be logged out after 15 minutes of inactivity A D Claim 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 0 39 Last Updated 11 8 2007 X Ca 5 State of Hawaii e S amp DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Steps 1 Options for the different applications available are listed under the Main Menu heading on the left side of the screen Click Claim Status to begin research on an individual claim s status or payment information Some
30. aii 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 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 aammmmm AFor security purposes your session will be logged out after 15 minutes of inactivity A D Claim 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 C 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
31. amp DEPARTMENT 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
32. and Password At least 6 characters with no leading or trailing blank spaces User 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 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 answerto 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 e d Email Address Confirm Email Address Contin
33. apitated H QN FFS Fee For Service Quest Net Adults S ADMN FFS Fee For 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 CRN Claim Reference Number See Claim Number Version 64 Last Updated 11 8 2007 KAON a Q d 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 D
34. are affecting 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 0 53 Last Updated 11 8 2007 9 State of Hawaii EN amp 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 S 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 in a Restriction term status for more than a year are not permitted
35. artment 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 Claim Status Request page displays Version 3 0 41 Last Updated 11 8 2007 KAON a Steps 1 E NOTE Version Last Updated Q ae State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Determine which method to use when performing a recipient search This depends on the variety and reliability of the information at your disposal Select a set of search criteria by choosing one 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 recipients Name Date of Birth and Gender proceed to Step 4 Click CLEAR to erase all data entered in the search fields Search by HAW ID Type a valid HAWI ID into the HAWI ID field and press Enter or click SUBMIT Search by SSN Type a valid Social Security Number into the SSN field and press Enter 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
36. assword Forgot your Password Click Here Note e User Names and Passwords are case sensitive Download Internet Euplorer 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 0 16 Last Updated 11 8 2007 KAON a Q ae te NOTE H N NOTE UJ Version Last Updated 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 NA
37. aster accounts can be created Therefore please do not attempt to create a master account unless you are authorized to do so since this will delay your setup process Once the Master account is 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 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 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
38. ate The date and time that a record was last changed Last Mod User The name of the user who made the last change 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 0 Last Updated 65 11 8 2007 gus 4 9 State of Hawaii EN amp DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE SER 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
39. ccepted formats MMDDYY or MMDDCCYY and is not greater than the system date or prior to the Begin Date of Service Claim Status End Date of You cannot enter a future This is a required field Request Service date for the End Date of Be sure that the End Date Service Please enter a of Service entered is new date valid is in one of the two accepted formats MMDDYY or MMDDCOCY Y and is not greater than the system date or prior to the Begin Date of Service Claim Status End Date of The End Date of Service This is a required field Request Service cannot be prior to the Be sure that the End Date Begin Date of Service of Service entered is valid is in one of the two accepted formats MMDDYY or MMDDCOCY Y and is not greater than the system date or prior to the Begin Date of Service Version 3 0 61 Last Updated 11 8 2007 p i 3 State of Hawaii S amp DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Appendix B Master Account Change Form STATE OF HAWAII DHS MQD DHS MEDICAID ONLINE WEB ACCOUNT STATUS CHANGE FORM INSTRUCTIONS Complete this form to request to have a Master Account 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 Section 2 Action requested Select Activate for an account that has been placed in a Dele
40. cord found for this name Be 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 0 11 8 2007 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 59 9 State of Hawaii EN amp DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Screen Error Message HIPAA Error Claim Status Error NPI not on File n a Any provider number listed Request Provider ID in this error message is one that is affiliated with the Group Billing Provider and is required to have an NPI on file with Med QUEST Provider Registration but does not Contact Provider Registration at 808 692 8174 to supply the NPI for the identified provider s Claim Status Begin Date of Please enter Begin Date Request Service of Service This is a required f
41. e 2 a one character indicator of the medium by which the claim was received 3 a one character type indicator for the source of claims received on tape and 4 a five character sequence number The Status Date is the effective date of the claim s adjudication The Medical Record Number is the hospital s number for the patient s medical record It s used by the hospital to file the patient s lab results doctor s and nurses notes drug administration record operative report etc that happened during the patient s hospital stay The Patient Account Number is the unique number submitted by the provider to identify a recipient s claim s The Patient Status is the two digit code on a UB 92 claim form that indicates the patient s status Discharged Transferred Patient etc for the billing period on the claim The Service Provider ID is the identifier used to uniquely identify the individual or entity who provided the service This identifier will be either a six digit number Med QLIEST Provider ID or 10 character value National Provider ID or NPI depending upon the provider The Received Recipient ID is the recipient ID that was submitted with the claim The Bill Type is a three digit code on the UB 92 claim form that identifies the facility type bill classification and frequency Figure 21 Claim Status Help Version 3 0 52 Last Updated 11 8 2007 X Ca NE State of Hawaii e EN
42. e Master NPI 0123456789 Main Menu CLAIM STATUS REQUEST D Claim Status HAWIID NAME GENDER 0123456789 DUCK DAFFY 07 07 1937 M SERVICE PROVIDER ID 0123456789 D BEGIN DATE OF SERVICE zn END DATE OF SERVICE 1 CLAIM NUMBER fC Subrnit Clear HIGH ASSURAN Figure 17 Claim Status Request Once a search request has been submitted the Claim Status Response page displays Version 3 0 44 Last Updated 11 8 2007 gus a S Aet Steps NOTE Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Required Fields For most providers the Provider ID number is already displayed in the SERVICE PROVIDER ID drop down list Group Billing Providers should select the Service Provider ID from those available in the drop down list Note that the Service Provider ID displays in the HPMMIS Provider ID format even if a corresponding NPI exists Press lt Tab gt to move the cursor to the BEGIN DATE OF SERVICE field If a provider ID has been terminated for any reason and even if a new provider ID was created in place of it the provider must use a web account belonging to the provider ID and or NPI submitted on the original claim to view associated data Group providers may continue to select from their list of associated provider IDs and or NPls as usual However if a provider affiliated with the Group Billing Provider is required to have an NPI on file with
43. eeeeeeeeeeeeeeseeeeneneeeeeeeeeeeneneeenenees 53 Appendix B Master Account Change Form eeeeeeeeeeee 62 Appendix C Glossary rare ener rir are raton eec eara auia oe Eng ater ya ako ERC 64 Appendix D DMO Exclusions eeeeeeeeeeeeeeeeeeeenee eene 68 Version 3 0 Last Updated 11 8 2007 Ter s d A State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Change Summary HN Location Previously Stated Revision 1 Figures throughout old screen shots updated screen shots document 2 p 12 The Department of Human The Department of Human Overview section Services DHS Medicaid Services DHS Medicaid 1 paragraph Online DMO offers providers Online DMO offers providers an alternative method for an alternative method for obtaining prior authorization obtaining claim data from recipient and claim data from HPMMIS Hawaii Pre Paid HPMMIS Hawaii Pre Paid Medical Management Medical Management Information System Once an Information System Once an account is established and account is established and authenticated you may obtain authenticated you may submit detailed status and payment inquiries for any valid recipient information for your claims in HPMMIS and obtain detailed status and payment information for your claims and view prior authorization cases events and activities These
44. er in the ANSWER field that answers the question posed in the previous field If you attempt to recover a forgotten password 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 0 23 11 8 2007 KAON a A 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 Pr
45. es or dashes User Name Provider Number Tax ID Continue Cancel Figure 11 Recover Password Version 3 0 29 Last Updated 11 8 2007 KAON a Q Aue 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 Tab to move the cursor to the USER NAME field Type your User Name in the USER NAME field Press Tab 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 Tab 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 Enter 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 0 30 11 8 2007 2 E State of Hawaii e ay Z DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Recover Password Upon entry of a valid User Name Med QUEST Provider ID and Tax ID you are prompted to answer the Hint Question supplied when your user profile was created The question must be
46. esponse List subsection lt new subsection inserted gt p 51 Claim Status section Accounting Details subsection Note following Step 1 Line status for a claim with a Not Adjudicated status may change due to re adjudication p 51 Claim Status section Accounting Details subsection Step 3 4 paragraph To conduct eligibility and enrollment research on a recipient 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 40 deleted p 52 Eligibility Enrollment Section Eligibility Enrollment section deleted p 52 Prior Authorization Section Prior Authorization section deleted 3 0 11 8 2007 Version Last Updated viii Ter s d ed State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE 3 Location Previously Stated Revision 1 row for the Claim Status Request 19 p 52 e Users with access to the lt deleted gt Help section Eligibility and Enrollment 1 and 3 bullets Status system can view the following 1 Eligibility and Enrollment paragraph Help page depicted Figure 28 below e Users with access to the Prior Authorization Inquiry system can view the Prior Authorization Help page depicted in Figure 30 on page 61 20 p 60 Claim Status Request Appendix A Error Service Provider ID
47. field Press Tab viewing the second Recover to move the cursor to the Password page TAX ID NUMBER field 4 Type the Tax ID number corresponding to the provider ID number in the TAX ID field and press Enter or click CONTINUE You should be viewing the second Recover Password page 5 p 39 To access the Prior Click on the Claims Status Applications section Authorization Inquiry Eligibility option under the Main Menu Main Menu and Enrollment Status or heading to access the subsection Claims Status system click on System 1 paragraph one of the options listed under the Main Menu 6 p 40 Options for the different Options for the different Applications section applications available are applications available are Main Menu listed under the Main Menu listed under the Main Menu subsection heading on the left side of heading on the left side of Step 1 the screen the screen Click Claim Status to begin Click Claim Status to begin research on an individual research on an individual claim s status or payment claim s status or payment information information Click Eligibility and Enrollment Status to perform related research on a specific recipient Click Prior Authorization Inquiry to search and display the status of prior authorization information Version 3 0 iv Last Updated 11 8 2007 4 ad penis 3 A State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Locatio
48. has already been registered Modify 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 55 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 question 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
49. hat is the claim receipt date 2 a two character indicator of the medium by which the claim was received and 3 a five character sequence number 24 p 64 G CH DEN FFS Child Appendix C Dental Fee Glossary For Contract Type Service new rows for Type H ADLT DEN FFS Adult G H and S Dental Fee For Service S ADMN FFS Fee For Service Administra tion 25 p 64 Claim Reference Number Appendix C Glossary See Claim Number CRN 26 p 65 C QUEST ACE ELIG Quest Appendix C Adult Glossary Coverag Eligibility e Description Expande new rows for Type C d eligible for this date range Version Last Updated 3 0 11 8 2007 y e State of Hawaii e ay 1 DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Previously Stated Revision 27 p 65 Case Information page lt deleted gt Appendix C The date the recipient s Glossary insurance coverage expires 2 half of entry for for the specified carrier End Date Event Information page The date the recipient s coverage for the Medicare Type expires Activity Information page The date the recipient s insurance coverage expires 28 p 67 Case Information page deleted Appendix C The date the recipient s Glossary insurance became effective 2 half of entry for for the specified carrier Start Date Event Information page The date the recipient became eligible for the Medicare Type Activity Information
50. ield Be sure that the Begin Date of Service entered is valid is in one of the Claim Status Begin Date of Invalid date entered for Request Service Begin Date of Service field This is a required field Be sure that the Begin Date of Service entered is valid is in one of the two accepted formats MMDDYY or MMDDCOCY Y and is not greater than the system date Claim Status Begin Date of You cannot enter a future n This is a required field Request Service date for the Begin Date Be sure that the Begin of Service Please enter Date of Service entered two accepted formats MMDDYY or MMDDCOCY Y and is not greater than the system date n a n a a a new date is valid is in one of the two accepted formats MMDDYY or MMDDCOCY Y and is not greater than the system date Version 3 0 60 Last Updated 11 8 2007 9 State of Hawaii EN amp DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Screen Error Message HIPAA Error Claim Status End Date of Please enter End Date of This is a required field Request Service Service Be sure that the End Date of Service entered is valid is in one of the two accepted formats MMDDYY or MMDDCCYY and is not greater than the system date or prior to the Begin Date of Service Claim Status End Date of Invalid date entered for This is a required field Request Service End Date of Service Be sure that the End Date field of Service entered is valid is in one of the two a
51. ion the search results Press Optional Fields Tab to move the cursor to Steps 5 6 and 8 the STATUS field 6 Select a Status from those available in the drop down list so that only claims of this status are included in the search results Press Tab to move the cursor to the CLAIM NUMBER field 8 Type the Patient Account Number if known in the PATIENT ACCOUNT NUMBER field Version 3 0 vii Last Updated 11 8 2007 gms Aet Location 12 p 45 Claim Status section Claim Status Request subsection Optional Fields State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Previously Stated 7 Type the Claim Number if known in the CLAIM NUMBER field Press Tab to move the cursor to the PATIENT ACCOUNT Revision renumbered 5 Type the Claim Number if known in the CLAIM NUMBER field Press Tab to move the cursor to the PATIENT ACCOUNT Request subsection Initiate Search Step 9 screen Alternatively click CLEAR to erase all fields on the form and re enter the data Step 7 NUMBER field NUMBER field 13 p 45 lt renumbered gt Claim Status 9 Press lt Enter gt or click 6 Press lt Enter gt or click section SUBMIT to proceed to the SUBMIT to proceed to the Claim Status Claim Status Response Claim Status Response screen Alternatively click CLEAR to erase all fields on the form and re enter the data pp 46 47 Claim Status section Claim Status R
52. laim 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 Main Menu Claim Status Response D Claim Status Provider Service Provider ID 0123456789 Service Provider Name PROVIDER NAME L L C Recipient HAWIID 0123456789 DOB 07 07 1937 Name DUCK DAFFY Gender M Claim Status Response List ERN Service Begin Service End Claim Status 070203040506 1 19 2007 1 19 2007 APPROVED 070403040506 2 19 2007 2 19 2007 APPROVED Figure 18 Claim Status Response List Version 3 0 46 Last Updated 11 8 2007 gu a A ae Steps 1 NOTE Version Last Updated State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Claims Claim Reference Numbers that match your selection criteria display in the Claim Status Response List in the lower portion of the page Click on the CRN of a claim to view the the header record and detail lines on the Claim Status Response page If no CRNs match your selection criteria click Claim Search in the upper right corner of the page to return to the Claim Status Request page and modify your selection criteria For more information refer to the procedures in the Claim Status Request section beginning on page 44 Alternatively click Recipient Search in the upper right corner of the page to return to the Recipient Search page and initiate you
53. n Previously Stated Revision 7 p 40 These options may not be Some applications may not be Applications section available to all users available to all users Main Menu Each provider s Master Account Each provider s Master Account subsection Holder may restrict any of Holder may restrict any of 1 Note following their Account Holders to their Account Holders to Step 1 using either the Claim Status access one or more or Eligibility Enrollment applications Status application If For more information on setting necessary the Master Group Permissions refer to Account Holder may grant the Master Account Admin any of their Account Holders Functionality section to access to both beginning on page 21 Eligibility Enrollment amp Claim Status For more information on setting Group Permissions refer to the Master Account Admin Functionality section beginning on page 21 8 p 40 If you are registered with Med deleted Applications section QUEST as a provider classified Main Menu with Reimbursement Type 06 subsection H amp CBS Fee For Service amp 2 Note following Managed Care provider or Step 1 Reimbursement Type 07 H amp CBS and Managed Care provider then the Prior Authorization menu option appears as shown below Version 3 0 Last Updated 11 8 2007 gm Aet State of Hawaii DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Location Previously Stated Revision 9 p 44 The Service Provider
54. n about the current record To view other claim records that match the selection criteria proceed to step 3 To view more detailed information about the current record skip ahead to step 4 If zero records match your selection criteria click Claim Search in the upper right corner of the page to return to the Claim Status Hequest page and modify your selection criteria For more information refer to the procedures in the Claim Status Request section beginning on page 44 Alternatively click Recipient Search in the upper right corner of the page to return to the Recipient Search page and initiate your selection criteria from the beginning For more information refer to the procedures in the Recipient Search section beginning on page 41 Scroll through the records that match your selection criteria to locate your target record Use the appropriate scroll buttons in the bottom right corner of the page Click to view the next record Click M to view the last record Click 4 to view the previous record Click I4 to view the first record Once a target record has been identified you may view more detailed payment information in one of two ways Click Accounting Details in the upper left corner of the page to view the first line of detail on the selected claim s Accounting Details page and scroll through subsequent lines as needed Alternatively click a specific line number within the Price Accounting Summary sectio
55. n to view the corresponding line s detail on the Accounting Details page 3 0 49 11 8 2007 2 E State of Hawaii e ay Z DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Accounting Details The Accounting Details page displays a scrollable list of detail lines if applicable within the selected claim that provide details of the payment amount such as the Sequence Number Payment Status Payment Date and Payment Type Navigation to the Recipient Search page Claim 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 Main Menu Accounting Details D Claim Status tatus Accounting Details Provider Bill Provider ID 0123456789 Service Provider ID 0123456789 Bill Provider Name PROVIDER NAME L L C Service Provider Name SERVICE PROVIDER INC Recipient HAWIID 0123456789 DOB 07 07 1937 Name DUCK DAFFY Gender M Price Accounting Summary 00999666333000 Line Line Status Srv Beg Date Srv End Date Srv Code Billed Amt Allowed AmtPayment Amt 01 APPROVED 02 19 2007 02 19 2007 99291 517 28 147 45 147 45 Accounting Detail Seq Pmt Status Pmt Date Type Amount 0i PAID 03 17 2007 MEDICARE COINSURANCE 16 45 0i PAID 03 17 2007 MEDICARE DEDUCTIBLE 1
56. ovider ID only individual accounts can be created thereafter There is a limit of one Master Account per provider 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 0 24 11 8 2007 KAON a 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 default
57. owing Step 1 Previously Stated If a provider ID has been terminated for any reason and even if a new provider ID was created in place of it the provider must use a web account belonging to the provider ID and or NPI submitted on the original claim to view associated data Group providers may continue to select from their list of associated provider IDs and or NPIs as usual If the provider ID has been in a terminated status for one year or more access to the DHS Medicaid Online system will be discontinued Revision If a provider ID has been terminated for any reason and even if a new provider ID was created in place of it the provider must use a web account belonging to the provider ID and or NPI submitted on the original claim to view associated data Group providers may continue to select from their list of associated provider IDs and or NPIs as usual However if a provider affiliated with the Group Billing Provider is required to have an NPI on file with Med QUEST Provider Registration but does not then access to the Claim Status application for that provider is removed If the provider ID has been in a terminated status for one year or more access to the DHS Medicaid Online system is discontinued 11 p 45 5 Select a Form Type from deleted Claim Status those available in the drop section down list so that only claims Claim Status of this type are included in Request subsect
58. ox can be set as Active when checked or Inactive when blank to manage the status of Individual 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 Enter 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
59. populated Refer to the Appendix A Error Messages for more information as needed 3 0 25 11 8 2007 e State of Hawaii ay Z 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 vou 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 Merification minutes You may start using your account as soon as it is activated 3 Create Profile Provider Information 4 Account Created Provider Name SAMPLE PROVIDER L L C Provider Number 012345 Tax ID Number 012345678 User Name TestName First Name Emile Last Name Schuffhausen Title Dr Address 1001 KAMOKILA BLVD City
60. r selection criteria from the beginning For more information refer to the procedures in the Recipient Search section beginning on page 41 3 0 47 11 8 2007 2 E State of Hawaii e KN s DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Claim Status Response The Claim Status Response page displays the results of a search request including a summary of the header record and detail lines within the selected claim Scroll buttons in the bottom right corner of the page may be used to view other claims that match your selected search criteria if applicable To view detailed payment information for a claim line either click on the Accounting Details link on the page and scroll through the list of detail lines within the selected claim or click directly on one of the line numbers shown within the Price Accounting Summary section of the selected claim Navigation to the Recipient Search page Claim 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 Main Menu Claim Status Response Claim Status ist Claim Status Accounting Details Provider Bill Provider ID 0123456789 Service Provider ID 0123456789 Bill Provider Name PROVIDER NAME L L C Service Provider Name SERVICE PROVIDER
61. rate information for the application to process it is recommended that you adopt the habit of entering all dates in the MMDDCCYY format 3 0 43 11 8 2007 2 E State of Hawaii e KN s DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Claim Status Request Basic recipient information displays as a header on the Claim Status Request page including the HAWI ID Name DOB and Gender The Service Provider ID Begin Date of Service and End Date of Service fields are required to perform a search The Service Provider Number defaults to the Provider ID associated with the User Name The Service Provider ID s affiliated with a Group Billing Provider are sorted within the drop down box NPls for the group provider appear at the top of the dropdown field MQD IDs appear at the bottom of the list Group Billing Providers are limited to viewing claims under their own provider ID or another provider ID with which they are affiliated This affiliation must be on record with HCMB Provider Registration Values not contained in the drop down list cannot be manually overwritten in this field 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 If you are a NPI provider who wishes to view claims under your old Med QUEST provider ID number you must create and use an account under that provider number User Name TestName User ID 9876543 Typ
62. s the CORRESPONDENCE ADDRESS field with the Correspondence Address on file for the Provider ID The Authentication 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 Tab to move the cursor to the third TELEPHONE NUMBER field Type your Suffix into the third TELEPHONE NUMBER field and press Tab to move the cursor to the EMAIL ADDRESS field Type your Email Address in EMAIL ADDRESS field and press Tab 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 Enter 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
63. s you provided when you enrolled Please enter the code exactly as it appears on the letter Authentication 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 Enter 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 39 Version 3 0 28 Last Updated 11 8 2007 2 E State of Hawaii e ay Z 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 Hecover 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 vou when vou enrolled Indicates a required field Please select the type of identifier being provided Med QUEST Provider ID 6 numeric characters National Provider ID 10 alphanumeric characters National Provider ID D Please use only letters or numbers for your provider and tax ID numbers no spac
64. search 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 41 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 39 For questions regarding a claim please contact the Med QUEST Fiscal Agent ACS for assistance Please refer to the Main Menu for a list of contact numbers 3 0 51 11 8 2007 2 eS State of Hawaii EN ZS DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Help The Help page offers descriptions for the data presented on each page Scroll down the page or use the hyperlinks available under the Contents heading to link to a relevant section e Users with access to the Claim Status system can view the Claim Status Help page depicted in Figure 21 below User Name TestName User ID 9876543 Type Master Provider ID 012345 Main Menu Help Contents Claim Status Claim Status Response Claim Header Price Accounting Summary National Provider Identifier Med QUEST Provider ID Accounting Details Price Accounting Summary Accounting Details Claim Status Response Claim Header The Claim Number is 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 dat
65. st Updated 11 8 2007 DE 3 NE State of Hawaii e EN amp DEPARTMENT OF HUMAN SERVICES MEDICAID ONLINE Appendix D DMO Exclusions 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 0J X Demonstration to Maintain Independence and DD A 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 1 year 3 Provider is required to use an NPI but NPI is not on file with Med QUEST Version 3 0 68 Last Updated 11 8 2007
66. ted status due to inactivity Select Delete for an account that is invalid or will no longer be used Select the type of web account needing the change in status Supply the account holder s name Supply the web account s User name used for login VVVV Section 3 Requestor Information gt Select the Requestor s role gt Supply the Requestor s name Supply the Requestor s contact information gt Signature of Requestor Section A Provider Acknowledgment Signature of Provider Fax the form to the above fax number You will receive an email confirmation upon the completion of the request within 7 business days Version 3 0 62 Last Updated 11 8 2007 LINDA LINGLE LILLIAN B KOLLER DIRECTOR GOVERNOR HENRY OLIVA DEPUTY DIRECTOR STATE OF HAWAII DHS MQD DHS MEDICAID ONLINE WEB ACCOUNT STATUS CHANGE FORM Complete this form to request to have a Master Account 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 Delete Web Account type Individual Account _ Master Account Account Holder Name User Name 3 REQUESTOR INFORMATION L Current Master New Master Requestor Account Holder
67. tem AVRS assistance Contact Toll free 1 800 333 0263 Medifax EDI Client Support Fax 1 615 843 2539 Email customer service medifax com gt Pharmacy assistance Contact Toll free 1 877 439 0803 Pharmacy Benefit Management Services PBMS Affiliated Computer Services ACS Rx Website www himed questffs orq Figure 4 Contact Us 11 8 2007 15 2 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 N a a a J Te 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 P
68. the Master Account Holder has access to Individual Account information including passwords Recover Tax ID The provider information n This is a required field Password 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 64 ipi HAWI ID Invalid Missing Patient ID This is a required field Be sure that the 10 digit By HAWI ID HAWI ID entered is valid Version 3 0 57 Last Updated 11 8 2007 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 i recipients found This is a required field Be sure
69. tion is provided to create one However if you are not authorized to create a Master Account then please do not do 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 0 21 Last Updated 11 8 2007 e State of Hawaii s 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 Greate Profile Provider Name SAMPLE PROVIDER L L C Provider Number 012345 4 Account Created Tas ID Number 012345678 Indicates a required field In order to create your account please provide the following information about yourself Enter a User Name
70. ue Figure 8 Create Profile Version 3 0 22 Last Updated 11 8 2007 KAON e un Aut te S kA uU NOTE l N NOTE l LA A NOTE Version Last Updated State of Hawaii 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 Answ
71. uthenticated A confirmation message appears following any action taken on this page to acknowledge 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 T Date Password Changed 4 16 2007 3 45 21 PM Active M Password eseeeece Confirm Password OO First Name rest Last Name ame n Title Jeng Address MQD CSB P O BOX 700190 KAPOLEI HI 96709 Telephone fsos 555 1212 Email namegwebstecom Hint Question What siteasyas Answer a Group Permission JEligibilty Enrollment amp Claim Status sl 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 0 33 Last Updated 11 8 2007 KAON a A Aue Steps NOTE NOTE ke 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 b
72. xp 12 31 2007 User ID 9876543 Type Individual Provider ID 012345 Main Menu User Account Eligibility and Enrollment Status STS OPS TS oa Date Password gt Claim Status Changed 3 5 2007 12 45 27 PM Password eeeeee Confirm Password First Name Test Last Name Nme n 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 GONEIBMED 4 foo Accept Changes Cancel Figure 14 User Account Version 3 0 37 Last Updated 11 8 2007 KAON a Q ae 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 Enter 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

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