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Louisiana Medicaid Management Information System (LMMIS)

1. leeeeeseeeeeeieesee nenne een nnne nnn anna nenas 36 5 5 Add View Notes and Emails eeeseeeee eese enne nennen nnns 38 25 0 Remittance ReDOLIS inroescduse axdisdeeseixuE M auMest o xx ura eev cum ucevasu e edu usaM usa ES 39 6 0 ELIGIBLE PROFESSIONAL EP USERS INITIAL LOGON 40 6 1 File Update FOrm ss sssssss sss esse OT TS E 42 62 Payee T LeS Tn eT 43 65 COMAC PONS ON uc irae Pes cinereus nx xut we prs tinndeen tedden ties pas ss ERE USE 44 64 Practice CharacterisliCS veisicicvisecseccsveniavessracebaatveankuattaanbenteneevaadeuasveakuuaubans 45 6 5 Eligible Professional Participation 48 6 5 1 CMS EHR Certification ID 1 eere eres e rere renean sana nna a aaa anna hs 50 E PICIS Te oL n 50 6 5 3 Certified Health IT Product List eneon 50 66 Documentation UDload oreste eoe been vEnE oc kx uuu Rav oU VE oes yeu CNN ieee 51 6 7 Patient Encounter Volume eee eee enne naeh nnn 55 6 8 Eligible Professionals Review and Attestation 56 6 9 Application Certification eesees eese eene eee nnne nnn 57 6 10 Confirmation of Submission 1 eeeeeee eee nennen nennen nnns 58 7 0 ELIGIBLE PROFESSIONAL EP USE
2. bee A HL b DL E nene a ime 7 Date Revised 9 08 2015 14 EHR Provider Application User Manual 4 3 Eligible Hospital Participation Enter the appropriate response in the text boxes for EHR Vendor EHR Product EHR Product Number EHR Version Number and CMS EHR Certification ID All fields are required Molina L Connect Home Menu UserManual Logout Louisiana Medicaid EHR Incentive Payment Program Eligible Hospital Eligible Hospitals must answer the following questions regarding their facility You must input data and upload supporting documentation Provide the following information regarding your certified EHR system If you have an EHR Module provide information on all modules that make up the certified bundle Enter the vendor product name number and version and click ADD after each entry EHR Vendor EHR Product EHR Product Number EHR Version Number l L O CMS EHR Certification ID Product s 1 Date Added Vendor Product Product Number Version Disregard 04 23 2013 second year testing 8789769 8 E Submit Disregards For an authoritative comprehensive listing of ONC certified Complete EHRs and EHR Modules go to http onc chpl force com ehrcert CHPLHome Date Revised 9 08 2015 15 EHR Provider Application User Manual Clicking on the red link provides the following pop up reminder F AIL Help Windows Internet Explorer d n x le htt
3. 9 LAConnect eae ree ES ehr incentive program Louisiana Medicaid EHR Incentive Payment Program Contact Person Please verify or update the contact information on file Primary Contact Secondary Contact First Name First Name Last Name Last Name Middle Name Middle Name Phone Phone Email Email Job Title Job Title Required Please use the tab key to navigate between fields Save and Continue gt gt Copyright 2013 Molina Medicaid Solutions fonts Reserved Click the Save and Continue button Clicking on the red link provides the following pop up reminder Contact Person Help Windows Internet Explorer m le http 192 60 37 68 SPrevWebl EHRJhelp canbacE heip htn Ea This screen requires a provider to enter a primary contact with the option of specifying a secondary contact Contacts will receive notifications related to the provider s attestation case If a provider already has a contact associated the fields will be pre populated with the mformation as it appears in our records after which the provider can update or simply review it as needed before clicking the Save and Continue button If the provider is found to not yet have a primary contact associated contact information for a primary contact must be entered all fields are required Entering a secondary contact 1s not required however if you enter any information in any field all fields must then be completed
4. Date Revised 9 08 2015 27 EHR Provider Application User Manual 5 0 Eligible Hospital EH Users Subsequent Logons After the initial logon subsequent logons to the EHR application provide a menu screen with a variable number of main links On the Enrollment side Update Enrollment Information on a pending application New Enrollment for Payment Year X Latest Registration Application Report View Attachments View Notes and Emails On the Payment side Remittance Reports The screen shot below showing the Update Enrollment Information link is displayed if the Provider has submitted a case but it has not yet been approved K Molina X AConnect ins Hana E ehr incentive program Louisiana Medicaid EHR Incentive Payment Program Menu Enrollment Update Enrollment Information Latest Registration Application Report Add View Attachments Add View Notes and Emails Payments Remittance Reports Copyright 2013 Melina Medicaid Solutions All Rights Reserved Date Revised 9 08 2015 28 EHR Provider Application User Manual If the Provider s latest case was paid prior to January 1 for EH and April 1 for EP the Provider will see a link entitled New Enrollment for Payment Year X where X is the next or current year of program participation Molina L Connect e dede Louisiana Medicaid EHR Incentive Payment Program Menu Enrollment New Enrollment for Payment Year 2 Latest
5. 3 weeks Note Change in direct deposit information for this initiative also changes the direct deposit for ALL Medicaid payments CMS Registration Site Molina Last Name e Provider ID See First Name Provider Name Middle Name E Provider Type Suffix L Provider Specialty Address P Pay To Name Provider Type OS Pay To Address Provider Specialty Y RouingNumberendingin CMS CCN Account Number ending In _i O O S SC COCOCO COC NPI P EFT Account Indicator TIN EFT Status S Email Address T NBI CEE Payee NPI P mebrake Taxoomy T Payee TIN e Tiebreaker Zip4 a TIN ee Continue gt gt opyright 2013 Molina Medicaid Solutions All Rights Reserved The user should scan the information in the text boxes noting especially the items marked with asterisks if any Those items have been marked because the information they contain in the CMS Registration and Attestation Site and the Molina system is different The user may click on the File Update Form to make any corrections or accept these differences and continue to the Payee Information screen by clicking on the Continue button Date Revised 9 08 2015 41 EHR Provider Application User Manual 6 1 File Update Form If you click the File Update Form link the form will be displayed by your Adobe Reader sof
6. shown below Molina LAConnect iste Louisiana Medicaid EHR Incentive Payment Program Notes Please use this screen to add any notes pertinent to your application Emails generated by this application will automatically be stored here Click on the Open link to view a note l Open 4 23 2013 9 20 01 AM z361abc Open 4 4 2013 12 11 27 PM testi xj 213 characters entered Maximum number of characters stored is 7990 Create New Note lt lt Return to Menu Copyright 2013 Molina Medicaid Solutions All Rights Reserved You are enabled to view existing notes emails or to add new notes emails Note If the Provider s latest case has been paid prior to January 1 for EH and April 1 for EP the Notes page will be read only You will be enabled to view notes but not post new ones Any existing notes are displayed in the grid at the top of the Notes page Use the scroll tool to browse the listings Click on the Open link to view the specified file The contents of the note email are displayed in the NOTE text box Click on the Return to Menu button when you are finished viewing notes emails Date Revised 9 08 2015 38 EHR Provider Application User Manual 5 6 Remittance Reports Clicking on the Remittance Reports link displays the Remittance Reports page similar to the one shown below A LAConnect Louisiana Medicaid EHR Incentive Payment Program Remittance Reports Belo
7. 1 through March 31 For EHs the Program Year is January 1 through December 31 Only one incentive payment is allowed per Program Year e g an EP submitting an attestation on March 2 2013 is participating in Program Year 2012 An EP submitting an attestation on April 20 2013 is participating in Program Year 2013 Payment Year indicates the number of years a provider has participated in the program For EPs payment year can range from 1 to 6 For EHS payment year ranges from 1 to 4 Providers participating in the Medicaid Incentive Payment Program are not required to participate in consecutive years however providers must attest to AUI by 2016 90 day To attest for the Medicaid EHR Incentive Program you will need to have met eligibility requirements for a consecutive 90 day reporting period Providers have the option of choosing a consecutive 90 day period within the previous calendar year OR a consecutive 90 day period within the preceding 12 month period The point of reference for the 90 day period is date of attestation Program Year refers to the year in which an EP or EH has submitted an attestation and has participated in the program For EPs the Program Year is April 1 through March 31 For EHs the Program Year is January 1 through December 31 Only one incentive payment is allowed per Program Year e g an EP submitting an attestation on March 2 2013 is participating in Program Year 2012 An EP submitting an attestation on
8. April 20 2013 is participating in Program Year 2013 Payment Year indicates the number of years a provider has participated in the program For EPs payment year can range from 1 to 6 For EHs payment year ranges from 1 to 4 Providers participating in the Medicaid EHR Incentive Payment Program are not required to participate in consecutive years however providers must attest to AUI by 2016 E pe Tl internet Ia 100 4 Date Revised 9 08 2015 34 EHR Provider Application User Manual 5 3 Latest Registration Application Report Click on the Latest Registration Application Report link to view print an Adobe pdf file version of the data you have submitted see 4 10 Electronic Health Records Incentive Payment System Registration Application Report for Payment Year 2 5 7 2013 CMS Registration Site Molina Provider ID Name Pay To Name Address Pay To Address Provider Type Provider Type Provider Specialty Provider Specialty NPI NPI TIN TIN Email Address Tiebreaker Taxonomy Tiebreaker Zip 4 Routing Number Account Number Sanctioned Eligibility End Date Cancel Reason Code Payee Information Payee TIN matches Molina file Payee NPI Payee TIN Payee Address Contacts Primary Secondary Name Name Phone Phone Email Email Job Title Job Title Attestation Time Period Begin End Total Medicaid Patient Encounters Total Patient Encounters Medicaid Patient Volume 96 Qua
9. COC NPI P EFT Account Indicator TIN EFT Status S Email Address T NBI CEE Payee NPI P mebrake Taxoomy T Payee TIN e Tiebreaker Zip4 a TIN ee Continue gt gt opyright 2013 Molina Medicaid Solutions All Rights Reserved The user should scan the information in the text boxes noting especially the items marked with asterisks if any Those items have been marked because the information they contain in the CMS Registration and Attestation Site and the Molina system is different The user may click on the File Update Form to make any corrections or accept these differences and continue to the Payee Information screen by clicking on the Continue button Date Revised 9 08 2015 11 EHR Provider Application User Manual 4 1 File Update Form If you click the File Update Form link the form will be displayed by your Adobe Reader software Print out the form complete it and mail it to MOLINA PROVIDER ENROLLMENT UNIT P O BOX 80159 BATON ROUGE LA 70898 0159 Your updated provider data will be matched against information on file at the National Level Repository Click the Continue button on the CMS Registration EFT page Date Revised 9 08 2015 12 EHR Provider Application User Manual 4 2 Pavee Information The Payee Information page enables you to verify and or update the payee information If the Payee TIN from CMS does not match the Payee TIN from the Molina
10. Incentive Payment Program Welcome to LAConnect Louisiana Medicaid s Electronic Health Record EHR Incentive Payment Program You have entered the site where Eligible Professionals EPs and Eligible Hospitals EHs can complete their state level attestations to receive incentive payments for adoption implementation and upgrade of meaningful use of certified electronic health record technology You can proceed only if you have successfully registered with the Centers for Medicare and Medicaid Services CMS If you have not registered click here to register with CMS During the state level attestation process you will be required to complete and submit certain documentation See below the documentation you must upload for your type of attestation Eligible Professional Meaningful Use Patient Volume Worksheet MU Spreadsheet Click Continue to begin attestation process Copyright 2013 Molina Medicaid Solutions All Rights Reserved Date Revised 9 08 2015 61 EHR Provider Application User Manual 7 2 1 Meaningful Use Attestation Period The Meaningful Use Attestation screen is added to the end of the attestation process for New Enrollment for Year X users It enables them to enter their Meaningful Use Attestation Period begin and end dates Both dates are mandatory fields J Molina x AConnect Home Menu User Manual Logout enr ince IIVE DI aegram Louisiana Medicaid EHR Incentive Payment Program Meaningful Us
11. Office of Inspector General the Federal Government and any other duly authorized agences of the State the right to inspect and review all records pertaining to participation in the EHR Incentive Payment Program Upon request by the Louisiana Department of Health and Hospitals DHH I agree to provide additional supportive documentation to ensure that the requirements of the program have been met I understand that in all instances of improper or duplicate payments DHH will pursue repayment This attestation serves to certify that the foregoing information is true accurate and complete I understand that Medicaid EHR incentive payments submitted under this provider number will be from Federal funds and that any falsification or concealment of material fact may be prosecuted under Federal and State laws Digital Signature of Applicant Preparer Name Preparer Initials Relationship to Applicant Logon User ID Save and Submit gt gt Click on the Save and Submit button Date Revised 9 08 2015 26 EHR Provider Application User Manual 4 9 Confirmation of Submission Molina L Connect M de MERE Louisiana Medicaid EHR Incentive Payment Program Confirmation of Submission Thank you for applying to the Louisiana Medicaid EHR Incentive Payment Program Please allow 3 to 6 weeks for payment Email communication will be sent to the Primary Contact if additional information is needed and when your attestation is approved
12. PLE oO CMS EHR Certification ID Product s 2 Date Added Vendor Product Product Number Version Disregard 05 06 2013 vendor 1 product 1 number 1 1 x 05 06 2013 test12345 test12345 test12345 test12345 rm Submit Disregards For an authoritative comprehensive listing of ONC certified Complete EHRs and EHR Modules go to http L onc chpl force com ehrcert CHPLHome Date Revised 9 08 2015 48 EHR Provider Application User Manual Clicking on the red link provides the following pop up reminder F AIL Help Windows Internet Explorer d n x le http 192 60 37 68 5ProvWebl EHRJhelp aiu help htm ka This screen requires the provider to enter information regarding their certified EHR system For an eligible professional EP this is the second screen of attestation for an eligible hospital EH it is the first If the provider is updating an existing case and has already completed this screen of attestation the fields will be pre populated with the information found in our records The provider may then update or simply review the information before clicking the Save and Continue button If this is a new attestation case the provider must fill out all required fields before proceeding Note that dates must be entered in proper mm dd yyyy format A validation will also be performed to check whether or not the EHR code entered is CMS certified the result of this validation will appear
13. Provider File the CMS Payee NPI and TIN will be pre populated and you will be able to enter other payee info name and address A paper check will be created If the Provider wants to be the recipient of the payment he she will receive this screen PES ess Clicking on the red link provides the Momia At LAConnect tm ww following pop up reminder Louisiana Medicaid EHR Incentive Payment Program Payee Information Enter payee information below Payee is the individual or entity to whom the incentive payment will be made payable and issued You must upload a completed Form W 9 for the payee Make sure the information you enter below matches the information on the completed Form W 9 The information entered will be used for the issuance of the EHR incentive payment and associated 1099 only It will not affect the routing of Medicaid reimbursements This screen displays where the incentive payment will be sent If the You have the option of receiving the incentive payment via Electronic Funds Transfer EFT or paper check If you wish to provider specified the payment be sent to them all the fields on this receive the payment via EFT enter your routing and account numbers in the appropriate fields below Louisiana Medicaid screen will be read only and will include the Routing and Account is not responsible for a lost payment if you enter incorrect account information If incorrect information is entered numbers if previously provide
14. Registration Application Report View Attachments View Notes and Emails Payments Remittance Reports Copyright 2013 Molina Medicaid Solutions All Rights Reserved If the Provider s latest case has been paid after the dates above neither the Update Enrollment Information nor the New Enrollment for Payment Year X link will be displayed In the last condition the View Attachments page and the Notes page will be read only when they are visited Molina LAConnect Home Menu UserManual Logout Louisiana Medicaid EHR Incentive Payment Program Menu Enrollment Latest Registration Application Report View Attachments View Notes and Emails Payments Remittance Reports Copyright 2013 Molina Medicaid Solutions All Rights Reserved Date Revised 9 08 2015 29 EHR Provider Application User Manual 5 1 Update Enrollment Information If Displayed After clicking the Update Enrollment Information link an updated welcome screen is displayed It enables the user to view add to and correct all of the information previously entered as described in section 4 0 Molina X LAConnect Home Menu User Manual Logout ehr incentive program Louisiana Medicaid EHR Incentive Payment Program Welcome to LAConnect Louisiana Medicaid s Electronic Health Record EHR Incentive Payment Program You have entered the site where Eligible Professionals EPs and Eligible Hospitals EHs can complete their state le
15. Type Provider Specialty NPI TIN Tiebreaker Taxonomy Tiebreaker Zip 4 Routing Number Account Number Sanctioned Eligibility End Date Cancel Reason Code Secondary Name Phone Email Job Title Attestation Time Period Begin End Total Medicaid Patient Encounters Total Patient Encounters Please indicate whether the patient encounters volume calculation was based on individual Individual Provider provider or Group Practice Clinic Level methodology Medicaid Patient Volume 96 Do you provide more than 90 of your services in an inpatient hbspital or ER Do you practice predominantly in an FQHC or RHC where 30 percent of the patient volume is derived from needy individuals Are you a Physician Assistant who practices in an FQHC RHC led by a physician assistant CMS EHR Certification ID Vendors Date Added Vendor Product Product Number Version Disregard Uploaded Documents File Name Upload Date Disregard Meaningful Use Digital Signature Preparers Name Preparer s Initials Relationship to Applicant Logon ID Date Revised 9 08 2015 64 EHR Provider Application User Manual 7 4 Add View Attachments Clicking on the Add View Attachments links displays the Upload Documents page similar to the one shown below Please refer to section 6 6 J Molina X LAConnect Home Menu User Manual Logout Louisiana Medicaid EHR Incentive Payment Program Document Upload Depending o
16. a file type other than one of those listed above a message similar to the one shown below is displayed Upload Error The follow error occurred during the file upload That file type is not allowed Please select a file with an extension of doc docx txt rtf xls xlsx Zip wpd pdf ppt pptx html htm msg csv bmp or jpg to upload Close Note There is a 7 megabyte maximum file size permitted If you exceed the 7 megabyte limit you Will receive the following message Upload Error An error occurred during the upload This could be caused by a file larger than 7MB Please limit uploads to files less than 7MB Contact the system administrator if you have any questions Date Revised 9 08 2015 De EHR Provider Application User Manual Click on the file name and then click on the Open button The name of the selected file will be displayed in the text box next to the Browse button Note If you do not select a document to upload you will receive the following message Upload Error The following error s occurred s Select a document to upload Please correct and resubmit Next type a name for the file in the Document Title text box Ensure that the document title is something meaningful For instance if it is evidence of your patient encounter volume then name it Patient Encounter It is important that the Document Title be in the following format DOCUMENT TYPE 7 digit INDIVIDU
17. file larger than 7MB Please limit uploads to files less than 7MB Contact the system administrator if you have any questions Date Revised 9 08 2015 EHR Provider Application User Manual Click on the file name and then click on the Open button The name of the selected file will be displayed in the text box next to the Browse button Note If you do not select a document to upload you will receive the following message Upload Error The following error s occurred s Select a document to upload Please correct and resubmit Next type a name for the file in the Document Title text box Ensure that the document title is something meaningful For instance if it is evidence of your patient encounter volume then name it Patient Encounter It is important that the Document Title be in the following format DOCUMENT TYPE 7 digit INDIVIDUAL Provider ID YYYYMMDD Then click on the Upload button Note If you do not enter text into the Document Title box you will receive the following message Upload Error The following error s occurred s Enter a Document Title Please correct and resubmit If you do not select a document to upload nor enter text in the Document Title box you will receive the following message Upload Error The following error s occurred s Select a document to upload s Enter a Document Title Please correct and resubmit Date Revised 9 08 2015 20 EHR Pr
18. for payment Registration Application Report Copyright 2013 Molina Medicaid Solutions All Rights Reserved The Confirmation of Submission page enables you to review your input data by clicking on the Registration Application Report link An Adobe pdf file similar to the one shown below will be displayed which you can print for your records Electronic Health Records Incentive Payment System Attestation Registration Application Report for Payment Year 1 Time Period Begin End 5 7 2013 Total Medicaid Patient Encounters Total Patient Encounters H icaid Patient Volume 96 CMS Registration Site Molina Qualified EHR Amount From Step 5 dicc Medicaid Share from Step 6 Name Pay To Name Address Pay To Address CMS EHR Certification ID Provider Type Provider Type Vendors Provider Specialty Provider Specialty Date Added Vendor Product Product Number Version Disregard NPI NPI TIN TIN Email Address Tiebreaker Taxonomy Uploaded Docu ments Tiebreaker Zip 4 File Name Upload Date Disregard Routing Number Account Number Sanctioned ai dienes ema Digital Signature Cancel Reason Code Preparers Name Preparer initials Relationship to Applicant Payee Information Logon ID Payee TIN matches Molina file Payee NPI Payee TIN Payee Address Contacts Primary Secondary Name Name Phone Phone Email Email Job Title Job Title Click the End button to return to the initial application screen
19. in the program For EPs the Program Year is April 1 through March 31 For EHs the Program Year is January 1 through December 31 Only one incentive payment Is allowed per Program Year e g an EP submitting an attestation on March 2 2013 is participating in Program Year 2012 An EP submitting an attestation on April 20 2013 is participating in Program Year 2013 Payment Year indicates the number of years a provider has participated in the program For EPs payment year can range from 1 to 6 For EHs payment year ranges from 1 to 4 Providers participating in the Medicaid EHR Incentive Payment Program are not required to participate in consecutive years however providers must attest to AUI by 2016 pe grew a R y Date Revised 9 08 2015 63 EHR Provider Application User Manual 7 3 Latest Registration Application Report Click on the Latest Registration Application Report link to view print an Adobe pdf file version of the data you have submitted see section 6 10 CMS Registration Site Name Address Provider Type Provider Specialty NPI TIN Email Address Payee Information Payee TIN matches Molina file Payee NPI Payee TIN Payee Address Contacts Primary Name Phone Email Job Title Electronic Health Records Incentive Payment System Registration Application Report for Payment Year 2 5 7 2013 Molina Provider ID Pay To Name Pay To Address Provider
20. notes emails Note If the Provider s latest case has been paid prior to January 1 for EH or April 1 for EP the Notes page will be read only You will be enabled to view notes but not post new ones Any existing notes are displayed in the grid at the top of the Notes page Use the scroll tool to browse the listings Click on the Open link to view the specified file The contents of the note email are displayed in the NOTE text box Click on the Return to Menu button when you are finished viewing notes emails Date Revised 9 08 2015 66 EHR Provider Application User Manual 7 6 Remittance Reports Clicking on the Remittance Reports link displays the Remittance Reports page similar to the one shown below A LAConnect Louisiana Medicaid EHR Incentive Payment Program Remittance Reports Below is a table of any remittance reports on file for this provider To view a remittance report click the Download link that appears beside it Provider Id Provider Name Total Records 0 Page h of 1 First Previous Next Last lt lt Ratum to Menu Copyrighk ZE 3 3 Moles Medingid Solutions 20 Rights Aarati In instances in which you have a large number of Remittance Reports you can control the number of pages displayed by using the drop down list function Page F of 1 Click on the down arrow to show the possible number of pages to display at once if available On the table tha
21. you to navigate to the file you want to upload Date Revised 9 08 2015 18 EHR Provider Application User Manual Choose file Look in amp REST 01 2011_Molina_phonelist pdf 4JAMB_Billing_Ins doc Annual_Review_Form_Template_ MMS jrs pdf bookmark htm Fe My Recent Documents t Cisco IP Phone Instructions pdf Desktop Contact List from Old Cell Phone docx drive mapping info doc vr Employee Self Evaluation Form MMS jrs docx Uis IENROLLMENT_GENERIC_FORM_2011 doc ENROLLMENT GENERIC FORM 2011 pdf K ExcelFL xls L 3 My Network ILIFT doc Places E EZ File name X Files of type fan Files v Cancel fa Note You may upload any file of the following types doc docx txt rtf xls xlsx Zip wpd pdf ppt pptx html htm msg csv bmp jpg If you attempt to upload a file type other than one of those listed above a message similar to the one shown below is displayed Upload Error The follow error occurred during the file upload That file type is not allowed Please select a file with an extension of doc docx txt rtf xls xlsx Zip wpd pdf ppt pptx html htm msg csv bmp or jpg to upload Close Note There is a 7 megabyte maximum file size permitted If you exceed the 7 megabyte limit you Will receive the following message Upload Error An error occurred during the upload This could be caused by a
22. 1 objectives and measures for its EHR reporting period in 2014 the provider would be required to report CQMs by attestation using the same measure sets and reporting criteria outlined for providers who elect to use only 2011 Edition CEHRT If a provider elects to use a combination of 2011 Edition and 2014 Edition CEHRT and chooses to attest to the 2014 Stage 1 objectives and measures or Stage 2 objectives and measures the provider would be required to submit CQMs in accordance with the requirements and policies established for clinical quality measure reporting for 2014 in the Stage 2 final rule and subsequent rulemakings Also a provider must submit CQMs in accordance with the requirements and policies established for 2014 in those rulemakings if the provider elects to use only 2014 Edition CEHRT for the entire duration of its EHR reporting period in 2014 regardless of the stage of meaningful use that the provider chooses to meet Providers are permitted under the EHR incentive Programs to use a different reporting period for the CQMs in 2014 than for the objectives and measures of meaningful use under Section 495 6 This means that providers could use an earlier quarter of data derived from their 2011 Edition CEHRT to report CQMs if they use the option allowing attestation to the 2013 Stage 1 objectives and measures using 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT In addition if a provider chooses to use a combination of
23. 13 large docx View m 1 Submit Deletes Sort By ID Ascending H Sort Note If the Provider s latest case has been paid prior to January 1 for EH and April 1 for EP the Upload Documents page will be read only Document uploading will be disabled However you Will still be able to view existing uploaded documents You can adjust the way the uploaded documentation is displayed in the grid by using the Sort By function Click on the Sort button to see the drop down list of sort options Click on the desired sort option The display of the documentation in the grid will be adjusted in accordance with the selected sort option Date Revised 9 08 2015 65 EHR Provider Application User Manual 7 5 Add View Notes and Emails Clicking on the Add View Notes and Emails link displays the Notes page similar to the one shown below Molina LAConnect G Louisiana Medicaid EHR Incentive Payment Program Notes Please use this screen to add any notes pertinent to your application Emails generated by this application will automatically be stored here Click on the Open link to view a note l Open 4 23 2013 9 20 01 AM z361abc Open 4 4 2013 12 11 27 PM testi x gt 213 characters entered Maximum number of characters stored is 7990 Create New Note lt lt Return to Menu Copyright 2013 Molina Medicaid Solutions All Rights Reserved You are able to view existing notes emails or to add new
24. 2011 and 2014 Edition CEHRT and attests to the 2013 Stage 1 meaningful use objectives and measures that provider may use the 2011 Edition CEHRT for 60 days of a 90 day reporting period and 2014 Edition CEHRT for 30 days nf the rannrtinn nerind and nnl reanart nn COME far that R0 dav nerind Providers may 2011 CEHRT in which the f you are scheduled to report Stage 1 or Stage 2 Ae in ives e 2013 Stage 1 objectives and 2013 CQMs S l ombination of 2011 amp 2014 CEHRT f you are scheduled to report Stage 1 e 2013 Stage 1 objectives and 2013 COMs or e 2014 Stage 1 objectives and 2014 CQMs f you are scheduled to report Stage 2 e 2013 Stage 1 objectives and 2013 COMs or e 2014 Stage 1 objectives and 2014 COMs or e Stage 2 objectives and 2014 COMs 2014 CEHRT f you are scheduled to report Stage 1 e 2014 Stage 1 objectives and 2014 COMs f you are scheduled to report Stage 2 e Stage 2 objectives and 2014 CQMs or s 2014 Stage 1 objectives and 2014 COMS Date Revised 9 08 2015 EHR Provider Application User Manual 5 2 New Enrollment for Year X If Displayed After clicking the New Enrollment for Year X link an updated welcome screen is displayed It enables the user to view add to and correct all of the information previously entered as described in section 4 0 as well as give users access to the Meaningful Use MU Spreadsheet X L Connect Louisiana Medicaid EHR Incentive Payment Program Welcome to LACo
25. AL Provider ID YYYYMMDD Then click on the Upload button Note If you do not enter text into the Document Title box you will receive the following message Upload Error The following error s occurred s Enter a Document Title Please correct and resubmit If you do not select a document to upload nor enter text into the Document Title box you will receive the following message Upload Error The following error s occurred s Select a document to upload s Enter a Document Title Please correct and resubmit Date Revised 9 08 2015 53 EHR Provider Application User Manual Users may click the Upload link for a tool tip as seen below ca NN 79 Once you have uploaded documentation each time you return to the Eligible Professional page the uploaded documentation is displayed in a grid at the bottom of the page Attachments 3 ID Date Added Document Title View Disregard 218 04 23 2013 second bmp lz 219 04 23 2013 second test jpg View ai 220 04 23 2013 still testing jpg p Submit Disregards Sort By D Ascending v Sort If you upload a file by mistake you can request that the file be disregarded by clicking on the check box in the Disregard column to the right Attachments 3 ID Date Added Document Title View Disregard 218 04 23 2013 second bmp gi 219 04 23 2013 second test jpg View s 220 04 23 2013 still testing jpg F Submit Disregards Sort By lip Asce
26. Back button and return to the CMS registration site to that the check be sent to another party the address fields will be make appropriate changes updatable and the revised address information saved for future reference The remaining lines are listed as pay to information on your Louisiana Medicaid Provider Enrollment File If this information is Incorrect DO MOT PROCEED click the Back button and return to our registration screen for instruction on contacting Louisiana Medicaid Provider Enrallment to make appropriate changes Payee NPL Payee TIN Payee Mame Payee Street Payee City Payee State Payee Zip Payee Routing Humber ending in Payee Account Number ending n Required Please use the tab key t navigate between fields Back Capri kE 2023 Zakat Ma elution earthen Feared Click the Continue button If the Provider wants to assign the payments to another entity they will receive this screen XE LAConnect ew Clicking on the red link provides the Louisiana Medicaid EHR Incentive Payment Program S tti pop up reminder Payee Information Help Windows Internet Explorer c ni x Payee Information Your CMS registration indicated that you have assigned your incentive payment to someone else as indicated in the NPI and or TIN fields below A 1099 form will be sent to this payee A paper check will be mailed to the payee DO NOT PROCEED until you verify the payee information indicated
27. HR Provider Application User Manual Clicking on the red link provides the following pop up reminder 2 Meaningful Use Windows Internet Explorer Bl x Program Year refers to the year in which an EP or EH has submitted an attestation and has participated in the program For EPs the Program Year is April 1 through March 31 For EHs the Program Year is January 1 through December 31 Only one incentive payment is allowed per Program Year e g an EP submitting an attestation on March 2 2013 Is participating in Program Year 2012 An EP submitting an attestation on April 20 2013 is participating in Program Year 2013 Payment Year indicates the number of years a provider has participated in the program For EPs payment year can range from 1 to 6 For EHS payment year ranges from 1 to 4 Providers participating in the Medicaid Incentive Payment Program are not required to participate in consecutive years however providers must attest to AUI by 2016 90 day To attest for the Medicaid EHR Incentive Program you will need to have met eligibility requirements for a consecutive 90 day reporting period Providers have the option of choosing a consecutive 90 day period within the previous calendar year OR a consecutive 90 day period within the preceding 12 month period The point of reference for the 90 day period is date of attestation Program Year refers to the year in which an EP or EH has submitted an attestation and has participated
28. Manual Clicking on the red link provides the following pop up reminder Patient Encounter Volume Help Windows Internet Explorer Ale This screen requires the provider to enter patient encounter data and the begin and end dates of the consecutive 90 day period used to determine eligibility This information can be obtained from a provider s completed Patient Volume Worksheet Medicaid encounter for an EP is defined as services rendered on any one day to a Medicaid enrolled individual regardless of payment liability Includes zero pay claims and CHIP encounters Medicaid encounter for an EH is defined as services rendered to a Medicaid enrolled individual per inpatient discharge or services rendered in an emergency room regardless of payment liability Includes zero pay claims and CHIP encounters Needy individuals are defined as individuals that meet one of following 1 Were furnished medical assistance paid for by Louisiana Medicaid or Children s Health Insurance Program CHIP funding including Louisiana Medicaid out of state Medicaid programs or a Medicaid or CHIP demonstration project approved under section 1115 of the Act 2 Were furnished uncompensated care by the provider or 3 Were furnished services at either no cost or reduced cost based on a sliding scale determined by the individuals ability to pay Clinics or group practices will be permitted to calculate patient volume at the group practice clinic level but on
29. Minutes from intemal meetings held to address Issues stemming from vendor delays Date Revised 9 08 2015 30 EHR Provider Application User Manual Click on the Resources tab of the CEHRT Flexibility Rule Eligibility Form spreadsheet to view the help file Louisiana Department of Health and Hospitals Medicaid Incentive Program for Meaningful Use of EHR Using 2011 Edition CEHRT Only S Final Rule Flexibility Update issued September 4 2014 page 52913 states that all eligible hospitals and CAHs that use only 2011 Edition CEHRT for their EHR reporting period in 2014 must meet the meaningful use objectives and associated measures for Stage 1 under 42 CFR 495 6 that applied for the 2013 payment year regardless of their current stage of meaningful use Using Combination of 2011 and 2014 CEHRT R Final Rule Flexibility Update issued September 4 2014 page 52918 states that providers who use a combination of 2011 Edition and 2014 Edition CEHRT will be presented with a choice of 2013 Stage 1 objectives and measures or 2014 Stage 1 objectives and measures and Stage 2 objectives and measures if they were previously scheduled to begin Stage 2 Providers using a combination of 2011 Edition and 2014 Edition CEHRT who choose to attest to the 2013 Stage 1 meaningful use objectives and measures will report on only those objectives and measures and attest to the CQMs that were applicable for 2013 Providers using a combination of 2011 Editio
30. Molina x AConnect Home Menu UserManual Logout ehr incentive program Louisiana Medicaid EHR Incentive Payment Program Welcome to LAConnect Louisiana Medicaid s Electronic Health Record EHR Incentive Payment Program You have entered the site where Eligible Professionals EPs and Eligible Hospitals EHs can complete their state level attestations to receive incentive payments for adoption implementation and upgrade of meaningful use of certified electronic health record technology You can proceed only if you have successfully registered with the Centers for Medicare and Medicaid Services CMS If you have not registered click here to register with CMS During the state level attestation process you will be required to complete and submit certain documentation See below the documentation you must upload for your type of attestation Eligible Professional Meaningful Use Patient Volume Worksheet Click Continue to begin attestation process Copyright 2013 Molina Medicaid Solutions All Rights Reserved 7 2 New Enrollment for Year X If Displayed After clicking the New Enrollment for Year X link an updated welcome screen is displayed It enables the user to view add to and correct all of the information previously entered as described in section 6 0 as well as give users access to the Meaningful Use MU Spreadsheet Molina x AConnect Home Menu UserManual Logout enr incentive program Louisiana Medicaid EHR
31. National Coordinator for Health Information Technology s Certified Health IT Product List is provided with the following link http onc chpl force com ehrcert CHPLHome Date Revised 9 08 2015 17 EHR Provider Application User Manual 4 4 Documentation Upload Depending on your attestation type and payment year certain documents must be uploaded Upload Instructions e Use the browse button to select the file to be uploaded e he maximum document size is 7MB e You must enter text in the Document Title box The Document Title must describe the document you are uploading e See the appropriate table below for document requirements Failure to upload all necessary documents will result in your application being rejected Required Documents for Upload Eligible Professional e T Meaningful Use Patient Volume Worksheet Patient Volume Worksheet e Formw 9 NEW J W 9 e Formw 9 NEW J e Formw 9 NEW W 9 e Formw 9 NEW Proof of Purchase E Application Stage 1 or Stage TT Report from EHR System NEW Required Documents for Upload Eligible Hospital e EH Payment Calculator e Cost Reports e Proof of Purchase e An uploaded document can be deleted during the business day that it was uploaded by using the Submit Deletes button However if you must delete a document that was uploaded on a previous business day contact EHR staff at ehrincentives la gov A dialogue box will open which enables
32. RS SUBSEQUENT LOGONS 59 Date Revised 09 08 2015 T EHR Provider Application User Manual 7T 1 Update Enrollment Information If Displayed 61 7 2 New Enrollment for Year X If Displayed 61 7 2 1 Meaningful Use Attestation Period oer 62 7 3 Latest Registration Application Report 64 7 4 AAddiView Attachments sect ox sas cn autre x Vs ux ha t in atus id Ga vilem n uuu 65 7 5 Add View Notes and Emails eeeseeeee eee e enne nnn 66 0 Jq emittance Reports vti vto Pea oon p e uxo a uou UON D veb QUE 67 Date Revised 09 08 2015 Iii EHR Provider Application User Manual 1 0 OVERVIEW The Electronic Health Records Incentive Payment program is based on provisions of the American Recovery and Reinvestment Act of 2009 ARRA intended to provide incentive payments to eligible professionals EP and eligible hospitals EH participating in Medicaid to adopt and meaningfully use electronic health record EHR technology The purpose of EHR Provider application is for eligible professionals EP and eligible hospitals EH to complete the registration process they initiated when they registered with the CMS by creating an attestation case This enrollment through the EHR Provider application is possible onl
33. Revised 9 08 2015 32 EHR Provider Application User Manual Molina x AConnect Home Menu UserManual Logout enr incentive program Louisiana Medicaid EHR Incentive Payment Program Meaningful Use Payment Year 3 Meaningful Use Attestation Period Enter Your MU attestation period begin and end dates If you represent a dually eligible hospital and have completed Medicare attestation you should enter the MU attestation period used for your Medicare attestation Begin Date 1 1 2013 F8 mm dd ccyy End Date 3 31 2013 FS mm dd ccyy Required Please use the tab key to navigate between fields Save and Continue gt gt Copyright 2013 Molina Medicaid Solutions All Rights Reserved Note If an invalid date range other than 90 days for payment year 2 or 1 1 xx 12 31 xx for payment year 3 is entered the following error message appears Please populate all required fields dates cannot be in the future the Begin Date must be before the End Date and ensure the date range is at least 90 days for payment year 2 or 365 days for payment year 3 33 Date Revised 9 08 2015 EHR Provider Application User Manual Clicking on the red link provides the following pop up reminder gt Meaningful Use Windows Internet Explorer Bl Program Year refers to the year in which an EP or EH has submitted an attestation and has participated in the program For EPs the Program Year is April
34. U and MU EP EH PVW 1234567 20121015 e An uploaded document can be deleted during the business day that it was uploaded by using the Submit Deletes button However if you must delete a document that was uploaded on a previous business day contact EHR staff at ehrincentives la gov Document Title Browse Attachment s 3 ID Date Added Document Title View Delete 683 08 23 2013 test txt View E 684 08 23 2013 test txt View r 688 10 16 2013 test3 pptx View Iv 1 Submit Deletes Sort By ib Ascending Sort lt lt Return to Menu Copyright 2013 Molina Medicaid Solutions All Rights Reserved Date Revised 9 08 2015 36 EHR Provider Application User Manual Note If the Provider s latest case has been paid prior to January 1 for EH and April 1 for EP the Upload Documents page will be read only Document uploading will be disabled However you Will still be able to view existing uploaded documents You can adjust the way the uploaded documentation is displayed in the grid by using the Sort By function Click on the Sort button to see the drop down list of sort options Click on the desired sort option The display of the documentation in the grid will be adjusted in accordance with the selected sort option Date Revised 9 08 2015 37 EHR Provider Application User Manual 5 5 Add View Notes and Emails Clicking on the Add View Notes and Emails link displays the Notes page similar to the one
35. X DEPARTMENT OF aa HEALTH a AND HOSPITALS Buh Medicaid MOLINA Medicaid Solutions Louisiana Medicaid Management Information System LMMIS Electronic Health Records EHR Incentive Payment Provider User Manual Date Created 04 30 2013 Date Revised 09 08 2015 Prepared By Technical Communications Group EHR Provider Application User Manual PROJECT INFORMATION Document Title Louisiana Medicaid Management Information System LMMIS EHR Application Provider User Manual Technical Communications Group Molina Medicaid Solutions LMMIS QA Revision History Description of Change LIFT 02 17 2011 Initial draft 6958 03 04 2011 Screen shots replaced and text modified in response 6958 Randy to UAT Sheehan Per Jason Harang Updated Section 1 0 All 6958 Randy instances of NLR were changed to CMS All instances Sheehan of 12 months were changed to 15 months Sections 4 6 and 4 7 were swapped since they were in reverse order 03 11 2011 Updated the link to enrollment help in 2 0 6958 Randy Sheehan 03 21 2012 Updated screenshots in 3 0 added 4 2 updated 4 4 6958 Randy added 4 4 1 through 4 4 7 updated 4 7 4 8 4 9 and Sheehan 4 10 updated 6 0 added 6 1 updated 6 2 6 3 6 4 6 5 6 7 6 8 and 6 9 Updated 1 0 updated 2 1 corrected typo in 6 6 6958 Randy header obscured provider data in 7 6 Sheehan 04 19 2012 Updated 6 4 and 6 6 6958 Randy Sheehan 04 30 2013 Updated manual verbiage and scre
36. bore intenet va Atom 7 Internet fa 100 A B7 Record Failed No B7 Hecord Date Revised 9 08 2015 EHR Provider Application User Manual 3 2 Welcome Email Once registered with CMS this email is received informing users that they are eligible to apply for an incentive payment through Louisiana Medicaid EHR program Dear Based on information received from CMS regarding your registration for EHR incentives you are ELIGIBLE to apply for an incentive payment through Louisiana Medicaid Louisiana Medicaid has launched its online EHR application which providers can access through lamedicaid com After entering lamedicaid com login using your individual provider logon credentials and click on the LAConnect EHR link Please allow two business days from receipt of this email before you log on to attest If you have any questions email ehrincentives la gov Date Revised 9 08 2015 9 EHR Provider Application User Manual 4 0 Eligible Hospital EH Users Initial Login When Eligible Hospital EH user logs in for the first time after having registered with CMS the Eligible Hospital welcome screen is displayed Louisiana Medicaid EHR Incentive Payment Program Welcome to LAConnect Louisiana Medicaid s Electronic Health Record EHR Incentive Payment Program You have entered the site where Eligible Professionals EPs and Eligible Hospitals EHs can complete their state level attestations to rece
37. by an asterisk You may make changes to these payee fields as necessary and click continue once completed Do not leave any fields blank Payee pt Payee TIN Payee Name Payee Street A Payee City RM Payee State Es 9 0 ll O O gl Payee Zip 7 9 0 N This screen displays where the incentive payment will be sent If the provider specified the payment be sent to them all the fields on this screen will be read only and will include the Routing and Account numbers if previously provided to Molina If the provider specified that the check be sent to another party the address fields will be updatable and the revised address information saved for future reference Required Please use the tab key to navigate between fields Click the Continue button Date Revised 9 08 2015 43 EHR Provider Application User Manual 6 3 Contact Person The Contact Person page enables you to verify and or update the contact information Click on any of the text boxes to type in the update Molina LAConnect NE ehr incentive program Louisiana Medicaid EHR Incentive Payment Program Contact Person Please verify or update the contact information on file Primary Contact Secondary Contact First Name First Name Last Name Last Name Middle Name Middle Name Phone Phone Email Email Job Title Job Title Required Please use the tab key to navigate between fields Save and Co
38. caid Provider Support Center call toll free 1 877 598 8753 Search LAMedicaid Search ClaimCheck Radiology Util Mgmt About Medicaid Billing Information CCN Coordinated Care Networks Info Click Here to Enter a Recovery Request Dental Providers Disaster EDI Information EHR Incentives FAQ Fee Schedules Forms Files User Manuals Helpful Numbers HIPAA Billing Instructions amp Companion Guides HIPAA Information Center Home Medical Equipment amp Supplies Pay For Performance Pharmacy amp Prescribing Providers Provider Enrollment Implementation of January 2011 Lab Radiology Rate Reductions 2 09 11 CommunityCARE 2 0 Utilization Reports Now Available 2 02 11 Hospice Re Election After Revocation or Discharge 2 01 11 FY 2011 Community Hospital DSH Act 540 UCC Survey 1 20 11 CommunityCARE 2 0 FAQ s 1 20 11 Emergency Rules January 2011 Rate Reductions Summary 1 14 11 Announcement PRECERT INQUIRY Application to be released for Inpatient Hospitals and Physician Providers 1 13 11 CommunityCARE 2 0 Attestation Form and Attestation Instructions 1 11 11 Procedure Codes Payable to Optometrists 1 07 11 CommunityCARE 2 0 Provider Notice 1 06 11 Pediatric Critical Care Codes Omitted from 9 22 amp 10 6 Physician Claim Adjustments 1 04 11 2011 HCPCS Update 1 04 11 Dental Procedure Code Policy Revision Update Effective 1 1 11 12 29 10 NPI Paper Changes 12 23 10 Attention Non Physic
39. cation ID is NOT the product number It will consist of a 15 digit alphanumeric code with no dashes or spaces 6 5 2 Disregards Once you have specified a vendor the record for the vendor is displayed in a manner similar to that shown below You are able to remove the vendor by clicking on the Disregard check box and then on the Submit Disregards button Products 1 Date Added Vendor Product Product Number Version Disregard 03 21 2012 Acurus Solutions Inc Capella IG 2524 11 0076 1 E Submit Disregards 6 5 3 Certified Health IT Product List A convenient link to the Office of National Coordinator for Health Information Technology s Certified Health IT Product List is provided with the following link http onc chpl force com ehrcert CHPLHome Date Revised 9 08 2015 50 EHR Provider Application User Manual 6 6 Documentation Upload Use the Documentation Upload feature to attach the required supporting documentation Begin by clicking on the Browse button to choose a file to upload Upload Documents Ta v E L Page gt Safety lt Tools Molina LAConnect EL dee Louisiana Medicaid EHR Incentive Payment Program Document Upload Depending on your attestation type and payment year certain documents must be uploaded Upload Instructions Use the browse button to select the file to be uploaded s The maximum document size is 7MB e You must enter text in the Document Title box The Document Tit
40. ck on the Back button to return to the Eligible Hospital AIU Participation page 4 6 EH Payment Calculation The EH Payment Calculation page is designed to be used in conjunction with the EH Incentive Payment worksheet Text boxes are provided for you to enter the Overall EHR amount from Step 5 of the worksheet and the Medicaid Share from Step 6 of the worksheet Both are required Molina X L A Connect Louisiana Medicaid EHR Incentive Payment Program EH Payment Calculation Please provide the following information to calculate the hospital incentive payment from the EH Incentive Payment worksheet Overall EHR amount from Step 5 Medicaid Share from Step 6 4 Upload the following documentation EH Incentive Payment Worksheet Document Title Attachments 1 ID Dare Added Document Tithe 224 04 24 2013 title txt Submit Disregands required ee Back Save and Continue gt gt For help with managing your documentation uploads please refer to section 4 5 After you have entered the data from the worksheet and uploaded the supporting documentation see section 4 5 click on the Save and Continue button to proceed Alternatively click on the Back button to return to the Patient Encounter Volume page Date Revised 9 08 2015 25 EHR Provider Application User Manual 4 7 Eligible Hospital Review and Attestation The Eligible Hospital Review and Attestation screen allows the user to review the data curren
41. d April 1 for EP the Provider will see a link entitled New Enrollment for Payment Year X where X is the next or current year of program participation Molina L Connect CERES Louisiana Medicaid EHR Incentive Payment Program Menu Enrollment New Enrollment for Payment Year 2 Latest Registration Application Report View Attachments View Notes and Emails Payments Remittance Reports Copyright 2013 Molina Medicaid Solutions All Rights Reserved If the Provider s latest case has been paid prior to January 1 for EH and April 1 for EP neither the Update Enrollment Information nor the New Enrollment for Payment Year X link will be displayed In the last condition the View Attachments page and the Notes page will be read only when they are visited Molina LAConnect Home Menu UserManual Logout Louisiana Medicaid EHR Incentive Payment Program Menu Enrollment Latest Registration Application Report View Attachments View Notes and Emails Payments Remittance Reports Copyright 2013 Molina Medicaid Solutions All Rights Reserved Date Revised 9 08 2015 60 EHR Provider Application User Manual 7 1 Update Enrollment Information If Displayed After clicking the Update Enrollment Information link an updated welcome screen is displayed It enables the user to view add to and correct all of the information previously entered as described in section 6 0 UJ
42. d technology You can proceed only if you have successfully registered with the Centers for Medicare and Medicaid Services CMS If you have not registered click here to register with CMS During the state level attestation process you will be required to complete and submit certain documentation See below the documentation you must upload for your type of attestation Eligible Professional Meaningful Use Patient Volume Worksheet 3 1 Navigating through the Application The four basic navigation tools are available in the upper right corner Home Menu User Manual Logout Home Returns the user to the Provider Applications Area home page of www lamedicaid com see 2 1 above Menu Routes the user to the main EHR Application menu unless you have never performed an enrollment in the past in which case a message similar to the one shown below is displayed Message from webpage Click on the OK button to proceed Date Revised 9 08 2015 6 EHR Provider Application User Manual User Manual Displays this document Logout Returns the user to the main Home Page of www lamedicaid com Date Revised 9 08 2015 EHR Provider Application User Manual 3 1 1 Continue Button Click on the Continue button on the welcome screen to use the application Chck Continue to begin attestation process _ Continue gt gt Copyright 032 Molina Medicated Solutigo
43. d to Molina If the provider specified payment will be delayed and a paper check will be mailed to the payee address provided If you wish to receive a paper that the check be sent to another party the address fields will be check do not enter information in the routing and account number fields 3 Payee Information Help Windows Internet Explorer nj xj updatable and the revised address information saved for future reference Payee Name Payee Street Payee City Payee State Payee Zip Payee Tax ID Payee Routing Number Payee Account Number Required Please use the tab key to navigate between fields tota Click the Continue button If the Provider wants to assign the payments to another entity they will receive this screen E ass Clicking on the red link provides the Melina A Li Connect bois pop up reminder Louisiana Medicaid EHR Incentive Payment Program Payee Information Help Windows Internet Explorer loj x Payee Information E s aan c NN NE RE RN E RR RN This screen displays where the incentive payment will be sent If the Enter payee information below Payee is the individual or entity to whom the incentive payment will be made payable provider specified the payment be sent to them all the fields on this and issued You must upload a completed Form W 9 for the payee Make sure the information you enter below matches screen will be read only and will include t
44. document upload a table of all file attachments associated with the attestation case is displayed at the bottom An option to indicate to DHH any uploaded attachments that should be disregarded is available E Boe PP FP M a K Once all mandatory fields are filled click on the Add button to add this vendor record to your list The record has been added successfully After receiving the above message users are able to continue adding vendor records as necessary Date Revised 9 08 2015 EHR Provider Application User Manual 4 3 1 CMS EHR Certification ID If needed enter the CMS EHR Certification ID in the text box If you click on the CMS EHR Certification ID link a message similar to the one shown below is displayed The CMS EHR Certification ID can be found by visiting http onc chpl force com ehrcert This certification ID is NOT the product number It will consist of a 15 digit alphanumeric code with no dashes or spaces 4 3 2 Disregards Once you have specified a vendor the record for the vendor is displayed in a manner similar to that shown below You are enabled to remove the vendor by clicking on the Disregard check box and then on the Submit Disregards button Products 1 Date Added Vendor Product Product Number Version Disregard 03 21 2012 Acurus Solutions Inc Capella IG 2524 11 0076 1 E Submit Disregards 4 3 3 Certified Health IT Product List A convenient link to the Office of
45. e Payment Year 2 Meaningful Use Attestation Period Please enter your MU attestation period begin and end dates The MU attestation period is a consecutive 90 day period for Payment Year 2 and a 365 day period for Payment Year 3 The 90 day period for Payment Year 2 must fall within the current calendar year The 365 day period for Payment Year 3 must be January 1 to December 31 of the current calendar year Begin Date 1 1 2013 Ea mm dd ccyy End Date 5 1 2013 Fs mm dd ccyy Upload the following documentation MU Attestation Worksheet Document Title Browse Attachments 3 ID Date Added Document Title View Disregard 401 05 06 2013 large doc docx View E 403 05 06 2013 test zip View G 404 05 06 2013 test again zip View Z Submit Disregards Sort By iD Ascending Sort Required Please use the tab key to navigate between fields lt lt Back Save and Continue gt gt Copyright 2013 Molina Medicaid Solutions All Rights Reserved Note If an invalid date range other 90 days for payment year 2 or 1 1 xx 12 31 xx for payment year 3 is entered the following error message appears Please populate all required fields dates cannot be in the future the Begin Date must be before the End Date and ensure the date range is at least 90 days for payment year 2 or a calendar year of January 1st to December 31st for payment year 3 Date Revised 9 08 2015 62 E
46. e 30 of the patient volume is 3 Are you a Physician Assistant who practices in an FQHC RHC led by a Physician Assistant Molina Louisiana Medicaid EHR Incentive Payment Program Practice Characteristics upload supporting documentation Please indicate Yes or No to the following requestions regarding your practice Do you provide more than 90 of your services in an Inpatient Hospital or ER Are you a Physician Assistant who practices in an FOHC RHC led by a Physician Assistant Required Please use the tab key to navigate between fields Copyright 2013 Molina Medicaid Solutions All Rights Reserved UJ AConnect Home Menu UserManual Logout en nce ive Di JEN 3 1 Eligible Professionals must answer the following questions regarding their practice characteristics You must input and Do you practice predominantly in an FOHC or RHC where 30 of the patient volume is derived from needy individuals C Yes No C Yes No C Yes No Save and Continue gt gt When completed clicking on the Save and Continue button takes the user to the Eligible Professional Screen Date Revised 9 08 2015 45 EHR Provider Application User Manual Clicking on the red link provides the following pop up reminder Practice Characteristics Help Windows Internet Explorer This screen exclusive to eligible professionals EP and the first screen of attestation for them requires the pro
47. e Update FOE ainiin 12 4 2 Payeelntormalloni susciter eger Oc deban tees ee Deeper DUM cis DOMS pass uem 13 4 3 Eligible Hospital Participation sess 15 43 1 CMS EHR Certification ID uoti c sites c mt cxi uxo adie 17 4 9 2 DISTOOAIGS NAS 17 4 3 3 Certified Health IT Product List 2 ee ceres esee nee 17 44 Documentation UDIOGAQO s iiec ose cen sees 18 4 5 Patient Encounter Volume 1 eeceeseeseeeere enne nnne nnn nenne nnn 23 4 6 EH Payment Calculation 11eeeeeeeeeeeeeeee eene nnn 25 4 7 Eligible Hospital Review and Attestation 26 4 8 Application Certification eeseeeeeeee eere nennen nnn 26 4 9 Confirmation of Submission 1 eeeeeeeeeen eene nennen nnn 27 5 0 ELIGIBLE HOSPITAL EH USERS SUBSEQUENT LOGONS 28 5 1 Update Enrollment Information If Displayed 30 5 2 New Enrollment for Year X If Displayed 32 5 2 1 Meaningful Use Attestation Period ee esee sene 32 5 3 Latest Registration Application Report 35 5 4 Add View Attachments
48. e of this website may result in administrative disciplinary action and civil and criminal penalties By continuing to access this website you indicate your awareness of and consent to these terms and conditions of use LOG OFF IMMEDIATELY if you do not agree to the conditions stated in this warning Document Provider Login Date Modified 1 24 03 Read the NPI Implementation Reminder and click on the Continue to Login Page link NPI Implementation Reminder Document NPI Implementation Reminder Date Modified 4 04 08 Our records indicate y u have registered your NPI with LMMIS This is a reminder hat you should be billingQyyour electronic claims with your registered NPI to ensure claims will be proc amp ssed correctly If you are an individual provider and have an individual NP and ay organizational NPI please ensure both numbers are registered with Louisiana Medicaid Please download the NP registration form by clicking on the link below c mplete the form and fax it to 225 216 6495 or call 225 216 6400 to register your organization number Continue to Loain Pal Date Revised 9 08 2015 EHR Provider Application User Manual Enter your Login ID and Password in the text boxes and then click on the Login button Provider Applications Area Please enter your Login ID and Passwopet Remember the Login ID and Pesswefd are case sensitive LoginID Password Forgot Your Login ID Forgot Your Password Forgot
49. een Molina X L Connect uu Louisiana Medicaid EHR Incentive Payment Program CMS Registration EFT Displayed below is information contained in Louisiana Medicaid s Provider Enrollment file Molina and information you provided to the NLR during your registration Review the following information carefully Discrepancies between the information received from the NLR and that contained in the Medicaid Provider Enrollment file will be marked with an asterisk Please note that for text based fields such as Provider Type and Provider Specialty a difference in wording between the two files will induce an asterisk but doesn t necessarily indicate a discrepancy If information from the NLR is incorrect you must return to the NLR site and make necessary corrections One to two business days are needed before Louisiana Medicaid receives an updated file from the NLR and you can continue with this application If there is incorrect information regarding your Medicaid Provider Enrollment file displayed in the Molina section the attached File Update Form will aid you in determining if the incorrect information can be updated with these forms or if a complete enrollment packet Is required Once the determination is made complete the necessary forms and submit to Molina Provider Enrollment Unit PO Box 80159 Baton Rouge LA 70898 0159 All Provider change requests must be received hardcopy with original signatures Processing may take up to three
50. enshots based 9005 Jody upon LIFT 9005 and review Lavigne Jody Lavigne By Randy Sheehan 03 10 2011 04 12 2012 05 14 2013 Updated screenshots in 4 0 amp 6 0 CMS EFT Screen 4 5 amp 6 6 Upload ToolTip and 5 4 amp 7 4 9005 Attachments Screen and added verbiage in section 4 2 amp 6 2 for Payee Screen 06 14 2013 Hevised document based on comments from DHH 9005 Jody Lavigne Jody Lavigne 10 22 2013 Updated screenshots as per programmer 9192 01 27 2015 Updated screenshots in 5 1 and 7 0 9873 Randy 09 08 2015 Updated screenshots in sections 3 0 4 2 4 4 and 4 6 9652 Sheehan Tracie Tate Date Revised 09 08 2015 i EHR Provider Application User Manual TABLE OF CONTENTS FO OVERVIEW 1 NE een 2 1 2 Further Reading eiie etae reo ree aaa uu o a Sat REePraEi E E Ede 2 20 lt ACCESSING THE APPLICATION ido FEN EYNA VORNE VES YEY E VESEYFUxVE En E Era REDI Yr PEE Fen VE Ew E 3 2 1 Provider Applications Area eeseeeee eren e nnne nnn nnn 5 30 A VELGOMESOHEEDN auds isi asian iue passt esses as Cro ee pell aei u eaae i6 o suona i re EE oe ges CERE saa 6 3 1 Navigating through the Application 6 3 1 1 CORUANUC BUN ON t M 8 35 24 Welcome EMaANN sie a Ea 9 4 0 ELIGIBLE HOSPITAL EH USERS INITIAL LOGIN 10 4 1 Fil
51. ents for receiving such a grant including requirements of the Secretary that an entity may not be owned controlled or operated by another entity or iv was treated by the Secretary for purposes of Part B of title XVIII as a comprehensive Federally funded health center as of January 1 1990 and includes an outpatient health program or facility operated by a tribe or tribal organization under the Indian Self Determination Act or by an urban Indian organization receiving funds under Title V of the Indian Health Care Improvement Act for the provision of primary health services RHCs are defined as clinics that are certified under section 1861 aa 2 of the Social Security Act to provide care in underserved areas and therefore to receive cost based Medicare and Medicaid reimbursements In considering these definitions it should be noted that programs meeting the FQHC requirements commonly include the following but must be certified and meet all requirements stated above Community Health Centers Migrant Health Centers Healthcare for the Homeless Programs Public Housing Primary Care Programs Federally Qualified Health Center Look Alikes and Tribal Health Centers Physician Assistant PA led Federally Qualified Health Clinic FQHC or Rural Health Clinic RHC means So led by a Physician Assistant APA is the primary provider in a clinic e g when there is a part time physician and full time PA we would consider the PA as the primary pro
52. ew the data currently entered Use the Back button to return to any of the previous data input pages to make corrections L Molina LAConnect Home Menu UserManual Logout Louisiana Medicaid EHR Incentive Payment Program Eligible Professionals Review and Attestation Review the summary report below detailing your entries for accuracy Use the back button to make changes to incorrect entries Practice Characteristics Do you provide more than 90 of your services in an Inpatient Hospital or ER No Do you practice predominantly in an FQHC or RHC where 30 of the patient volume is derived from needy individuals No Are you a Physician Assistant who practices in an FQHC RHC led by a Physician Assistant No AIU Product s 1 Date Added Vendor Product Product Number Version Disregard 10 16 2013 V p n 1 D Submit Disregards CMS EHR Certification ID ww invalid Patient Encounter Volume Begin Date 1 1 2013 End Date 3 31 2013 Total Medicaid Needy Encounters 25 Total Patient Encounters 50 Please indicate whether the patient encounters volume calculation was based on individual provider or Group Practice Clinic Level methodology Individual Provider Attachments 1 ID Date Added Document Title View Disregard 690 10 16 2013 test txt View E Submit Disregards Sort By iD Ascending Sort _ lt lt Back Save and Continue gt gt Copyright 2013 Molina Medicaid Solutions All Rights Reserved If all of the da
53. he Routing and Account the information on the completed Form W 9 The information entered will be used for the issuance of the EHR incentive numbers if previously provided to Molina If the provider specified payment and associated 1099 only It will not affect the routing of Medicaid reimbursements that the check be sent to another party the address fields will be You have the option of receiving the incentive payment via Electronic Funds Transfer EFT or paper check If you wish to updatable and the revised address information saved for future receive the payment via EFT enter your routing and account numbers in the appropriate fields below Louisiana Medicaid reference is not responsible for a lost payment if you enter incorrect account information If incorrect information is entered payment will be delayed and a paper check will be mailed to the payee address provided If you wish to receive a paper check do not enter information in the routing and account number fields Payee Name Payee Street Payee City Payee State Payee Zip Click the Continue button Payee Tax ID Payee Routing Number Payee Account Number Required Please use the tab key to navigate between fields Continue gt gt Date Revised 9 08 2015 13 EHR Provider Application User Manual Contact Person The Contact Person page enables you to verify and or update the contact information Click on any of the text boxes to type in the update
54. heet The begin and end dates represent the start and end of the 90 day period from which your encounters were obtained You have the option of obtaining your consecutive 90 day period from the previous calendar year OR from the previous 12 months The point of reference for the 90 day period is your attestation date men dazre End Dates 11 2013 KJ immj dd eeny 7 Total Patient Encounters Begin Date 500 Upload the following d cumentation Patient Volume Worksheet 7 500 Document Title Browse ead Attachments 3 iD Date Added Document Tithe View Disregard 20 04242013 tes S 271 04 24 2013 test 222 04212013 test Submit Disregards Required Please uas the tab key lon gate Irctvreen Fields lt lt Back yigi 2213 Moling Medicaid Eolytgeg AH Righi agar If you click on the 90 day period link a message similar to the one shown below is displayed gt 90 Day Reporting Period Windows Internet Explorer To attest for the Medicaid EHR Incentive Program you will need to have met eligibility requirements for a consecutive 90 day reporting period Providers have the option of choosing a consecutive 90 day period within the previous calendar year OR a consecutive 90 day period within the preceding 12 month period The point of reference for the 90 day period is date of attestation Date Revised 9 08 2015 EHR Provider Application User
55. ialty a difference in wording between the two files will induce an asterisk but doesn t necessarily indicate a discrepancy If information from the NLR is incorrect you must return to the NLR site and make necessary corrections One to two business days are needed before Louisiana Medicaid receives an updated file from the NLR and you can continue with this application If there is incorrect information regarding your Medicaid Provider Enrollment file displayed in the Molina section the attached File Update Form will aid you in determining if the incorrect information can be updated with these forms or if a complete enrollment packet Is required Once the determination is made complete the necessary forms and submit to Molina Provider Enrollment Unit PO Box 80159 Baton Rouge LA 70898 0159 All Provider change requests must be received hardcopy with original signatures Processing may take up to three 3 weeks Note Change in direct deposit information for this initiative also changes the direct deposit for ALL Medicaid payments CMS Registration Site Molina Last Name e Provider ID See First Name Provider Name Middle Name E Provider Type Suffix L Provider Specialty Address P Pay To Name Provider Type OS Pay To Address Provider Specialty Y RouingNumberendingin CMS CCN Account Number ending In _i O O S SC COCOCO
56. ian Providers 12 23 10 CommunityCARE Quality Profiles 12 23 10 Anesthesia Providers Recycle of Specified OB Claims 12 20 10 Date Revised 9 08 2015 EHR Provider Application User Manual Enter your 10 digit National Provider Identifier NPI or 7 Digit Medicaid Provider ID in the box and then click on the Enter button NOTE EPs must use their individual login credentials to access LAConnect EPs must not login using the group s or practice s login credentials Louisiana i ad For Technical Support call oll free 1 877 598 8753 Provider Login Please enter your 10 digit National Provider Identifier NPI or 7 Digit Medicaid Provider ID NOTICE TO USERS This is Louisiana s Medicaid information and is the property of Molina and Department of Health and Hospitals It is for authorized use only Users authorized or unauthorized have no explicit or implicit expectation of privacy Any or all uses of this website and all files on this system may be intercepted monitored recorded copied audited inspected and disclosed to authorized site Department of Health and Hospitals and law enforcement personnel as well as authorized officials of other agencies both domestic and foreign By using this system the user consents to such interception monitoring recording copying auditing inspection and disclosure at the discretion of authorized site or Department of Health and Hospitals Unauthorized or improper us
57. iously Also accessible from the menu is a link to the case s latest summary report as well as links to standalone screens for the Provider to view or add attachments and notes associated with the case All system generated emails will be automatically added as a note for the case Finally the menu will also have a link to a Remittance Report screen where the Provider can download any remittance reports on file for them Once DHH determines that a case can be paid a status of Approved is assigned and the case is scheduled to be included in the next payment cycle At the time their case is given an Approved status the Provider will see a limited version of the menu screen upon visiting the EHR Provider application Specifically the link to update their case will no longer be displayed and the standalone attachments and notes screen will be read only that is the Provider will be able to view all the attachments and notes associated with the case but will not be able to add additional notes or attachments From the second payment year onward Providers will be required to demonstrate Meaningful Use as an additional qualification for payment A link that reads New Enrollment for Payment Year X X denoting the Provider s current payment year will be available on the menu on January 1 20xx for EHs and April 1 20xx for EPs thus allowing the Provider to create a new attestation case Date Revised 9 08 2015 1 EHR Provider Applicatio
58. ised 9 08 2015 21 EHR Provider Application User Manual If you upload a file by mistake you can request that the file be disregarded by clicking on the check box in the Disregard column to the right Attachments 3 ID Date Added Document Title View Disregard 218 04 23 2013 second bmp g 219 04 23 2013 second test jpg View r 220 04 23 2013 still testing jpg P Submit Disregards lt Sort By ID Ascending ss Sot Click on the Submit Disregards button to confirm that you want the specified file to be disregarded Note Ihe file will continue to be displayed on the grid but with the Disregard check box checked This alerts DHH to disregard the specified documentation Only files uploaded in the current day can be marked as disregarded You can view the contents of any of the uploaded documentation at any point by clicking on the View button Once you have input all of the required fields and uploaded the required documentation click on the Save and Continue button Date Revised 9 08 2015 22 EHR Provider Application User Manual 4 5 Patient Encounter Volume Enter the appropriate response in the text boxes for Begin Date End Date Total Medicaid Needy Encounters and Total Patient Encounters All are required Molina 9 Connect ee Louisiana Medicaid EHR Incentive Payment Program Patient Encounter Volume T Please complete the fields with information from your completed Patient Volume Works
59. itial Logon When an Eligible Professional EP user logs in for the first time after having registered with CMS the Eligible Professional welcome screen is displayed L Molina AConnect Home Menu User Manual Logout eni Mcentive DI 2am Louisiana Medicaid EHR Incentive Payment Program Welcome to LAConnect Louisiana Medicaid s Electronic Health Record EHR Incentive Payment Program You have entered the site where Eligible Professionals EPs and Eligible Hospitals EHs can complete their state level attestations to receive incentive payments for adoption implementation and upgrade of meaningful use of certified electronic health record technology You can proceed only if you have successfully registered with the Centers for Medicare and Medicaid Services CMS If you have not registered click here to register with CMS During the state level attestation process you will be required to complete and submit certain documentation See below the documentation you must upload for your type of attestation Eligible Professional Adoption Implementation Upgrade Patient Volume Worksheet e Proof of Purchase Back Click Continue to begin attestation process Continue gt gt Copyright 2013 Molina Medicaid Solutions All Rights Reserved To begin the attestation process click the Continue button Date Revised 9 08 2015 40 EHR Provider Application User Manual Below is the CMS Registration EFT scr
60. ive incentive payments for adoption implementation and upgrade of meaningful use of certified electronic health record technology You can proceed only if you have successfully registered with the Centers for Medicare and Medicaid Services CMS If you have not registered click here to register with CMS During the state level attestation process you will be required to complete and submit certain documentation See below the documentation you must upload for your type of attestation Eligible Hospital Adoption Implementation Upgrade s Proof of Purchase c Cost Reports and Supporting Docs Chck Continue to begin attestation process _ Continue gt gt Copyright 2013 Molina Medicaid Solutions All Rights Reserved To begin the attestation process click the Continue button Date Revised 9 08 2015 EHR Provider Application User Manual Below is the CMS Registration EFT screen Molina X L Connect uu Louisiana Medicaid EHR Incentive Payment Program CMS Registration EFT Displayed below is information contained in Louisiana Medicaid s Provider Enrollment file Molina and information you provided to the NLR during your registration Review the following information carefully Discrepancies between the information received from the NLR and that contained in the Medicaid Provider Enrollment file will be marked with an asterisk Please note that for text based fields such as Provider Type and Provider Spec
61. le must describe the document you are uploading See the appropriate table belpw for document requirements Failure to upload all necessary documents will result in your application being rejected Required Documents for Upload Eligible Professional Adoption Implementation Upgrade Meaningful Use e Patient Volume Worksheet e Patient Volume Worksheet e Form W 9 NEW e Form W 9 NEW e Proof of Purchase e MU Application Stage 1 or Stage 2 e MU Report from EHR System NEW Document Title Browse Date Revised 9 08 2015 51 EHR Provider Application User Manual A dialogue box will open which enables you to navigate to the file you want to upload SS 05 of Ev 01 2011_Molina_phonelist pdf 4JAMB_Billing_Ins doc Waleed Z Annual Review Form Template MMS jrs pdf EEN bookmark htm 6 Cisco IP Phone Instructions pdf Desktop Contact List from Old Cell Phone docx lt Idrive mapping info doc PE Employee Self Evaluation Form MMS jrs docx Uis IENROLLMENT_GENERIC_FORM_2011 doc ENROLLMENT GENERIC FORM 2011 pdf uu ExcelFL xls r TIR SILIFT doc aces E inl File name Y Files of type fan Files v Cancel fa Note You may upload any file of the following types doc docx txt rtf xls xlsx Zip wpd pdf ppt pptx html htm msg csv bmp jpg If you attempt to upload
62. lified EHR Amount From Step 5 Medicaid Share from Step 6 CMS EHR Certification ID Vendors Date Added Vendor Product Product Number Version Disregard Uploaded Documents File Name Upload Date Disregard Meaningful Use Digital Signature Preparer s Name Preparer s Initials Relationship to Applicant Logon ID Date Revised 9 08 2015 35 EHR Provider Application User Manual 5 4 Add View Attachments Clicking on the Add View Attachments links displays the Upload Documents page similar to the one shown below refer to section 4 5 Molina _AConnec papa Louisiana Medicaid EHR Incentive Payment Program Document Upload Depending on your attestation type and payment year certain documents must be uploaded See the table below for the documents that are required for your type of attestation Upload Instructions s Use the browse button to select the file to be uploaded s The maximum document size is 7MB s You must enter text in the Document Title box It is important that the Document Title be in the following format DOCUMENT TYPE 7 Digit INDIVIDUAL Provider ID YYYYMMDD s See the table below for document requirements and acceptable Document Title formats Failure to upload all necessary documents and failure to use the correct Document Title format will result in your application being rejected The maximum document size is 7 MB DOCUMENT UPLOAD REQUIREMENTS Cost Report Patient Volume Worksheet AI
63. login ID and Password Document Provider Applications Area Date Modified 1 24 03 2 1 Provider Applications Area All EH and EP Providers will automatically be granted access to the LAConnect EHR link on the list of applications Click on the link to proceed Restricted Provider Applications Administrative Tools Provider Locator Information TPL Provider Notice to Pursue Difference Electronic Prior Authorization Medicaid Eligibility Verification System Weekly Remittance Advices Immunization Pay Far Perftormance P4P Precert Inquiry Uncompensated Care Costs CC 2 0 PAP Remittance Advice Statements Note Depending upon the Provider s requirements more or fewer applications will be displayed in the list The list shown above is just a sample Date Revised 9 08 2015 EHR Provider Application User Manual 3 0 Welcome Screen When a user launches the application for the first time a welcome screen similar to the one shown below is displayed Molina X LAConnect ehr incentive program Louisiana Medicaid EHR Incentive Payment Program Welcome to LAConnect Louisiana Medicaid s Electronic Health Record EHR Incentive Payment Program You have entered the site where Eligible Professionals EPs and Eligible Hospitals EHs can complete their state level attestations to receive incentive payments for adoption implementation and upgrade of meaningful use of certified electronic health recor
64. lume calculation was based on Individual Provider or Group Practice Clinic Level meth Individual Provider Group Practice Clinic Level Upload the following documentation Patient Volume Worksheet Document Title Browne T Attachments 3 if Date Added 04 24 2013 Save and Continue gt gt If you click on the 90 day period link a message similar to the one shown below is displayed gt 90 Day Reporting Period Windows Internet Explorer l ml x To attest for the Medicaid EHR Incentive Program you will need to have met eligibility requirements for a consecutive 90 day reporting period Providers have the option of choosing a consecutive 90 day period within the previous calendar year OR a consecutive 90 day period within the preceding 12 month period The point of reference for the 90 day period is date of attestation Click on a radio button to indicate whether the patient encounter volume calculation was based on Individual Provider or Group Practice Clinic Level methodology For help with managing your documentation uploads please refer to section 6 6 Once you have input all of the required fields and uploaded the required documentation click on the Save and Continue button Date Revised 9 08 2015 DD EHR Provider Application User Manual 6 8 Eligible Professionals Review and Attestation The Eligible Professionals Review and Attestation screen allows the user to revi
65. ly in accordance with all of the following limitations 1 The clinic or group practice s patient volume is appropriate as a patient volume methodology calculation for the EP 2 There is an auditable data source to support the clinic s or group practice s patient volume determination 3 All EPs in the group practice or clinic must use the same methodology for the payment year 4 The clinic or group practice uses the entire practice or clinic s patient volume and does not limit patient volume in any way and 5 If an EP works inside and outside of the clinic or practice then the patient volume calculation includes only those encounters associated with the clinic or group practice and not the EP s outside encounters The information entered on this screen will be used to calculate a Medicaid Patient Encounter Volume percentage which will then be determined as valid or invalid based on the following rules Eligible Professionals EP Scenario Minimum Non Hospital Based and Non Pediatric 3U Non Hospital Based and Pediatric 20 Eligible Hospitals EH Scenario Minimum Acute Care Hospital 10 Children s Hospital No minimum If the provider is updating an existing case and has already completed this screen the fields will be pre populated with the information found in our records The provider can then update or simply review the information before pressing the Save and Continue button If the provider is co
66. mpleting a new attestation case all required fields must be populated before proceeding Dates must be in mm dd yyyy format and encounter values must be integers Due to the fact that this screen requires a document upload a table of all file attachments associated with the attestation case is displayed at the bottom An option to indicate to DHH any uploaded attachments that should be disregarded is available Payment schedule for EHs Payment Year Percentage of Overall Amount Year 1 50 Year 2 30 Year 3 10 Year 4 10 Payment schedule for EPs Provider EP EP Pediatrician Patient Volume 30 20 29 Year 1 21 250 14 167 Year 2 8 500 5 667 Year 3 8 500 5 667 Year 4 8 500 5 666 Year 3 8 500 5 666 Year 6 8 500 5 666 Pediatrician means a Medical doctor who diagnoses treats examines and prevents diseases and injuries in children A pediatrician must Hold a four year Doctor of Medicine M D or Doctor of Osteopathy D O degree Have at least three years of residency training Hold a valid unrestricted medical license and Hold a board certification in Pediatrics ou snm Date Revised 9 08 2015 EHR Provider Application User Manual For help with managing your documentation uploads please refer to section 4 5 Once you have input all of the required fields and uploaded the required documentation click on the Save and Continue button Alternatively cli
67. n User Manual Cyclical enrollments will be permitted in this way until the Provider is paid in full after which the application will be locked from further updates In the year 2022 the system will be shut off entirely and the site will no longer be accessible 1 1 Objectives The program objectives are as follows e Front end registration and attestation capabilities for eligible professionals and eligible hospitals participating in Medicaid programs who are requesting to participate and can demonstrate that they meet the criteria to receive incentive payments e Back end Provider reimbursement capabilities to be performed at a DHH specified frequency e Administrative reporting capabilities for tracking assessment and forecasting 1 2 Further Reading Before attempting to use the EHR application Providers should familiarize themselves with the various aspects of the EHR program at www lamedicaid com then click on EHR Incentive Program Date Revised 9 08 2015 EHR Provider Application User Manual 2 0 ACCESSING THE APPLICATION If you are not already registered as a Provider at www lamedicaid com please refer to http www lamedicaid com provweb1 Provweb Enroll website enrollment htm for assistance with enrollment Once enrolled users can access the application by navigating to the www lamedicaid com web site and selecting the Provider Login button Louisi iaid AP For Technical Support Welcome to the Louisiana Medi
68. n and 2014 Edition CEHRT who choose to attest to the 2014 Stage 1 meaningful use objectives and measures will report on only those objectives and measures and submit the 2014 CQMs Using 2014 Edition CEHRT for 2014 Stage 1 Objectives and Measures for Providers Scheduled to begin Stage 2 2 Final Rule Flexibility Update issued September 4 2014 page 52914 states that providers scheduled to begin Stage 2 for the EHR reporting period in 2014 who cannot fully implement all the functions of their 2014 Edition CEHRT required for Stage 2 objectives and measures due to issues related to 2014 Edition CEHRT availability delays could use 2014 Edition CEHRT to attest to the 2014 Stage 1 objectives and measures for the EHR reporting period in 2014 Providers scheduled to begin Stage 2 in 2014 who choose this option must attest that they are unable to fully implement 2014 Edition CEHRT because of issues related to 2014 Edition CEHRT availability Clinical Quality Measures N Final Rule Flexibility Update issued September 4 2014 page 52928 states that if a provider elects to use only 2011 Edition CEHRT for the EHR reporting period in 2014 the provider would be required to report CQMs by attestation as follows Eligible hospitals and CAHs would report all 15 measures finalized in the Stage 1 final rule 75 FR 44411 through 44422 If a provider elects to use a combination of 2011 Edition and 2014 Edition CEHRT and chooses to attest to the the 2013 Stage
69. n the Payment side Remittance Reports The screen shot below showing the Update Enrollment Information link is displayed if the Provider has submitted a case but it has not yet been approved ehr incentive program Louisiana Medicaid EHR Incentive Payment Program Welcome to LAConnect Louisiana Medicaid s Electronic Health Record EHR Incentive Payment Program You have entered the site where Eligible Professionals EPs and Eligible Hospitals EHs can complete their state level attestations to receive incentive payments for adoption implementation and upgrade of meaningful use of certified electronic health record technology You can proceed only if you have successfully registered with the Centers for Medicare and Medicaid Services CMS If you have not registered click here to register with CMS During the state level attestation process you will be required to complete and submit certain documentation See below the documentation you must upload for your type of attestation Eligible Professional Meaningful Use e Patient Volume Worksheet e Form W 9 e Meaningful Use 2014 Edition Stage 1 e Meaningful Use 2011 Edition e Meaningful Use Report from EHR System Click Continue to begin attestation process _ Continue gt gt Copyright 2015 Molina Medicaid Solutions All Rights Reserve Date Revised 9 08 2015 59 EHR Provider Application User Manual If the Provider s latest case was prior to January 1 for EH an
70. n your attestation type and payment year certain documents must be uploaded See the table below for the documents that are required for your type of attestation Upload Instructions e Use the browse button to select the file to be uploaded s The maximum document size is 7MB s You must enter text in the Document Title box It is important that the Document Title be in the following format DOCUMENT TYPE 7 Digit INDIVIDUAL Provider ID YYYYMMDD s See the table below for document requirements and acceptable Document Title formats Failure to upload all necessary documents and failure to use the correct Document Title format will result in your application being rejected The maximum document size is 7 MB DOCUMENT UPLOAD REQUIREMENTS Document for Upload Attestation Type Provider Type Document Title Format EH Payment Calculator EHCalculator 1234567 20121015 EHR Proof of Purchase EP EH POP 1234567 20121015 Patient Volume Worksheet AIU and MU EP EH PVW 1234567 20121015 s An uploaded document can be deleted during the business day that it was uploaded by using the Submit Deletes button However if you must delete a document that was uploaded on a previous business day contact EHR staff at ehrincentives la gov Document Title Browse Attachment s 4 ID Date Added Document Title View Delete 579 05 30 2013 test docx View r 584 05 31 2013 test JPG View E 585 05 31 2013 large doc docx View E 586 05 31 20
71. nding Sort Click on the Submit Disregards button to confirm that you want the specified file to be disregarded Note The file will continue to be displayed on the grid but with the Disregard check box checked This alerts DHH to disregard the specified documentation You can view the contents of any of the uploaded documentation at any point by clicking on the View button Once you have input all of the required fields and uploaded the required documentation click on the Save and Continue bution Date Revised 9 08 2015 54 EHR Provider Application User Manual 6 7 Patient Encounter Volume Enter the appropriate response in the text boxes for Begin Date End Date Total Medicaid Needy Encounters and Total Patient Encounters Molina AConnect Home Mens UserManual Logout Louisiana Medicaid EHR Incentive Payment Program Patient Encounter Volume Please complete the fields with information from your completed Patient Volume Worksheet The begin and end dates represent the start and end of the 90 day period from which your encounters were obtained You have the option of obtaining your consecutive 90 day period from the previous calendar year OR from the previous 12 months The point of referen for the 90 day period is your attestation date Begin Date 1 1 2013 CS mm dd ccyy End Date Total Medicaid Needy Encounters Total Patient Encounters 90 100 Indicate whether the patient encounters vo
72. ng AN Rights Bagerced Note If you have not yet registered with CMS a message similar to the one shown below is displayed Prior to registering with the State EPs and EHs must first register with CMS Registration and Attestation site Please allow two business days for the state to receive and process your registration from CMS before returning to this site You will receive an email from Molina Healthcare providing further instruction regarding our process and the documentation necessary to complete this registration ox Pe Ome a A 7 You must register with the CMS Registration and Attestation Site in order to proceed Later when you log in again you may receive messages similar to the ones shown below https 192 60 37 68 sprovyweb1 EHR B6NoB htm Windows loj x https 192 60 37 68 sprovweb1 EHR B6NoB7 htm ef Certificate Error https 192 50 37 58 sprovwebl EHR UnapprovedBz hEm Win B x a je https 192 60 37 68 sprovwebi EHR LInapprovedB hkm https 192 60 37 68 Based on information received from CMS we are unable to process your application at this time Refer to the email you received from Molina Healthcare for further instruction You must allow two business days for the State to receive and process your registration from CMS Once this registration is processed you will receive an email from Molina Healthcare providing further instruction ok ok
73. nnect Louisiana Medicaid s Electronic Health Record EHR Incentive Payment Program You have entered the site where Eligible Professionals EPs and Eligible Hospitals EHs can complete their state level attestations to receive incentive payments for adoption implementation and upgrade of meaningful use of certified electronic health record technology You can proceed only if you have successfully registered with the Centers for Medicare and Medicaid Services CMS If you have not registered click here to register with CMS During the state level attestation process you will be required to complete and submit certain documentation See below the documentation you must upload for your type of attestation Eligible Hospital Meaningful Use e Patient Volume Worksheet Important Message Regarding CEHRT Flexibility Rule If you took advantage of the 2014 CEHRT Flexibility Rule when attesting with CMS for the Medicare EHR Incentive Program please click here and complete the CEHRT Flexibility Rule Eligibility Form Click Continue to begin attestation process _ Continue gt gt Copyright 2015 Molina Medicaid Solutions All Rights Reserved 5 2 1 Meaningful Use Attestation Period The Meaningful Use Attestation screen is added to the end of the attestation process for New Enrollment for Year X users It enables them to enter their Meaningful Use Attestation Period begin and end dates Both dates are mandatory fields Date
74. ntinue gt gt Copyright 2013 Molina Medicaid Solutie All Rights Reserved Click the Save and Continue button Clicking on the red link provides the following pop up reminder F Contact Person Help Windows Internet Explorer l E mi x le http 192 60 37 68 5ProvWebl EHRhelp cenback help hkm ba This screen requires a provider to enter a primary contact with the option of specifying a secondary contact Contacts will receive notifications related to the provider s attestation case If a provider already has a contact associated the fields will be pre populated with the information as 1t appears in our records after which the provider can update or simply review it as needed before clicking the Save and Continue button If the provider is found to not yet have a primary contact associated contact information for a primary contact must be entered all fields are required Entering a secondary contact 1s not required however if you enter any information in any field all fields must then be completed E pre 5 f terete Rm 7 Date Revised 9 08 2015 44 EHR Provider Application User Manual 6 4 Practice Characteristics Use the Yes No radio buttons to answer the three questions on the Practice Characteristics page 1 Do you provide more than 90 of your services in an Inpatient Hospital or ER 2 derived from needy individuals Do you practice predominantly in an FQHC or RHC wher
75. on the summary report in parenthesis as valid the code was found to be certified invalid the code was not found to be certified or unable to verify there was a problem connecting to the CHPL web service that performs the validation For the EHR Vendor field a list of approved vendors can be found at the following web site http onc chpl force com ehrcert The CMS EHR Certification ID can be found at this web site as well This certification ID is NOT the product number It will consist of a 15 digit alphanumeric code with no dashes or spaces Due to the fact that this screen requires a document upload a table of all file attachments associated with the attestation case is displayed at the bottom An option to indicate to DHH any uploaded attachments that should be disregarded is available E Boe PP FP M a K Once all mandatory fields are filled click on the Add button to add this vendor record to your list The record has been added successfully After receiving the above message users are able to continue adding vendor records as necessary Date Revised 9 08 2015 EHR Provider Application User Manual 6 5 1 CMS EHR Certification ID If needed enter the CMS EHR Certification ID in the text box If you click on the CMS EHR Certification ID link a message similar to the one shown below is displayed The CMS EHR Certification ID can be found by visiting http onc chpl force com ehrcert This certifi
76. ovider Application User Manual Users may click the Upload link for a tool tip as seen below e Upload Documents ony gt E e Page lt Safety lt Tools Molina LAConnect Home Menu UserManual Logo Louisiana Medicaid EHR Incentive Payment Program Document Upload Depending on your attestation type and payment year certain documents must be uploaded Upload Instructions Use the browse button to select the file to be uploaded The maximum document size is 7MB You must enter text in the Document Title box The Document Title must describe the document you are uploading See the appropriate table below for document requirements Failure to upload all necessary documents will result in your application being rejected Required Documents for Upload Eligible Hospital Adoption Implementation Upgrade Meaningful Use e Patient Volume Worksheet e Patient Volume Worksheet e EH Payment Calculator e Cost Reports e Proof of Purchase Document Title Browse Once you have uploaded documentation each time you return to the Eligible Hospital page the uploaded documentation is displayed in a grid at the bottom of the page Attachments 3 ID Date Added Document Title View Disregard 218 04 23 2013 second bmp View E 219 04 23 2013 second test jpg e 220 04 23 2013 still testing jpg View a Submit Disregards Sort By ID Ascending Sort Date Rev
77. p 192 60 37 68 5ProvWebl EHRJhelp aiu help htm ka This screen requires the provider to enter information regarding their certified EHR system For an eligible professional EP this is the second screen of attestation for an eligible hospital EH it is the first If the provider is updating an existing case and has already completed this screen of attestation the fields will be pre populated with the information found in our records The provider may then update or simply review the information before clicking the Save and Continue button If this is a new attestation case the provider must fill out all required fields before proceeding Note that dates must be entered in proper mm dd yyyy format A validation will also be performed to check whether or not the EHR code entered is CMS certified the result of this validation will appear on the summary report in parenthesis as valid the code was found to be certified invalid the code was not found to be certified or unable to verify there was a problem connecting to the CHPL web service that performs the validation For the EHR Vendor field a list of approved vendors can be found at the following web site http onc chpl force com ehrcert The CMS EHR Certification ID can be found at this web site as well This certification ID is NOT the product number It will consist of a 15 digit alphanumeric code with no dashes or spaces Due to the fact that this screen requires a
78. section 1905 1 2 defines an FQHC as an entity which i is receiving a grant under section 330 of the Public Health Service Act or ii I is receiving funding from such a grant under a contract with the recipient of such a grant and II meets the requirements to receive a grant under section 330 of the Public Health Service Act iii based on the recommendation of the Health Resources and Services Administration within the Public Health Service and is determined by the Secretary to meet the requirements for receiving such a grant including requirements of the Secretary that an entity may not be owned controlled or operated by another entity or iv was treated by the Secretary for purposes of Part B of title XVIII as a comprehensive Federally funded health center as of January 1 1990 and includes an outpatient health program or facility operated by a tribe or tribal organization under the Indian Self Determination Act or by an urban Indian organization receiving funds under Title V of the Indian Health Care Improvement Act for the provision of primary health services RHCs are defined as clinics that are certified under section 1861 aa 2 of the Social Security Act to provide care in underserved areas and therefore to receive cost based Medicare and Medicaid reimbursements In considering these definitions it should be noted that programs meeting the FQHC requirements commonly include the following but must be certified and meet all req
79. t contains the list of Remittance Dates click on the specified Download link to view the report as Date The specified Remittance Report similar to the one shown below will be displayed in the Adobe Reader Date Revised 9 08 2015 67
80. ta are correct and if you have successfully uploaded the required documentation click on the Save and Continue button Date Revised 9 08 2015 56 EHR Provider Application User Manual 6 9 A Application Certification Enter the appropriate response in the text boxes for Preparer Name Preparer Initials and Relationship to Applicant Logon User ID is auto populated All are required Molina Louisiana Medicaid EHR Incentive Payment Program Application Certification I understand that all information submitted to DHH for participation in the EHR Incentive Payment Program is subject to audit I grant to the Office of Legislative Auditor Office of Inspector General the Federal Government and any other duly authorized agencies of the State the right to inspect and review all records pertaining to participation in the EHR Incentive Payment Program Upon request by the Louisiana Department of Health and Hospitals DHH I agree to provide additional supportive documentation to ensure that the requirements of the program have been met I understand that in all instances of improper or duplicate payments DHH will pursue repayment This attestation serves to certify that the foregoing information is true accurate and complete I understand that Medicaid EHR incentive payments submitted under this provider number will be from Federal funds and that any falsification or concealment of material fact may be prosecuted under Federal and State la
81. tly entered Home Hama Lua Marma Lzcak Louisiana Medicaid EHR Incentive Payment Program Eligible Hospital Review and Attestation Review the summary report below detailing your entries for accuracy Use the back button to make changes to mcorrect entries ATL Products 1 CMS EHR Certification 10 55555 invalid Patent Encounter Velum Begin Gate 2 1 2012 End Date 3 30 2012 Total Mecdicaid Needy Encounters Tw Total Patient Encounters 4 EH Payment Calculation Overall EHR amount from Step 5 LODODOO 00 Medicaid Share fram Step 25 00 ia AttBehments There ane po attachments wesocimEed with this case Users are enabled to have products disregarded from the review process by clicking on the Disregard check box and then on the Submit Disregards button If all of the data are correct and if you have successfully uploaded the required documentation click on the Save and Continue button Clicking on the Back button returns to the EH Payment Calculation page 4 8 X Application Certification Enter the appropriate response in the text boxes for Preparer Name Preparer Initials and Relationship to Applicant Logon User ID is auto populated All are required Molina Louisiana Medicaid EHR Incentive Payment Program Application Certification I understand that all information submitted to DHH for participation in the EHR Incentive Payment Program is subject to audit I grant to the Office of Legislative Auditor
82. tware Print out the form complete it and mail it to MOLINA PROVIDER ENROLLMENT UNIT P O BOX 80159 BATON ROUGE LA 70898 0159 Your updated provider data will be matched against information on file at the National Level Repository Click the Continue button on the CMS Registration EFT page Date Revised 9 08 2015 42 EHR Provider Application User Manual 6 2 Payee Information The Payee Information page enables you to verify and or update the payee information If the Payee TIN from CMS does not match the Payee TIN from the Molina Provider File the CMS Payee NPI and TIN will be pre populated and you will be able to enter other payee info name and address A paper check will be created If the Provider wants to be the recipient of the payment he she will receive this screen Clicking on the red link provides the A Lh Connect cmm cum following pop up reminder Louisiana Medicaid EHR Incentive Payment Program Payee Information Help Windows Internet Explorer Payee Information This screen displays where the incentive payment will be sent If the M provider specified the payment be sent to them all the fields on this screen will be read only and will include the Routing and Account Your CMS registration indicated that you want your incentive payment to be paid to you If the below NPI numbers if previously provided to Molina If the provider specified and or TIN is incorrect DO NOT PROCEED click the
83. uirements stated above Community Health Centers Migrant Health Centers Healthcare for the Homeless Programs Public Housing Primary Care Programs Federally Qualified Health Center Look Alikes and Tribal Health Centers Eie rrr PCs Tan If you click on the Physician Assistant link a message similar to the one shown below is displayed Definition of Physician Assistant Windows Internet Explorer So led by a Physician Assistant A PA is the primary provider in a clinic e g when there is a part time physician and full time PA we would consider the PA as the primary provider APA is a clinical or medical director at a clinic site or practice or APA is an owner of an RHC Date Revised 9 08 2015 47 EHR Provider Application User Manual 6 5 Eligible Professional Participation Enter the appropriate response in the text boxes for EHR Vendor EHR Product EHR Product Number EHR Version Number and CMS EHR Certification ID All fields are required L Molina LAConnect S enr incentive progran Louisiana Medicaid EHR Incentive Payment Program Eligible Professionals Provide the following information regarding your certified EHR system If you have an EHR Module provide information on all modules that make up the certified bundle Enter the vendor product name number and version and click ADD after each entry EHR Vendor EHR Product EHR Product Number EHR Version Number 0p 2p
84. vel attestations to receive incentive payments for adoption implementation and upgrade of meaningful use of certified electronic health record technology You can proceed only if you have successfully registered with the Centers for Medicare and Medicaid Services CMS If you have not registered click here to register with CMS During the state level attestation process you will be required to complete and submit certain documentation See below the documentation you must upload for your type of attestation Eligible Hospital Meaningful Use e Patient Volume Worksheet Important Message Regarding CEHRT Flexibility Rule If you took advantage of the 2014 CEHRT Flexibility Rule when attesting with CMS for the Medicare EHR Incentive Program please click here and complete the CEHRT Flexibility Rule Eligibility Form Click Continue to begin attestation process _ Continue gt gt Copyright 2015 Molina Medicaid Solutions All Rights Reserved Click on the here link to view and complete the CEHRT Flexibility Rule Eligibility Form in Excel format Louisiana Department of Health and Hospitals Medicaid Incentive Program for Meaningful Use of EHR Program Year 2014 Eligible Hospral Contact informazon enes rese L jt Section 2 inszructions This form is to be completed by eligible hospitais or CAHs who were unable to fully Implement 2014 Certified EHR Technology for an EHR Bare larar ar practice action I KENN teams
85. vider APA is a clinical or medical director at a clinic site or practice or APA is an owner of an RHC Hospital Based means a professional furnished ninety percent 9096 or more of their Louisiana Medicaid covered professional services during the relevant EHR reporting period in a hospital setting whether inpatient or Emergency Room through the use of the facilities and equipment of the hospital If a hospital based EP can demonstrate that he she funds the acquisition implementation and maintenance of certified EHR technology without reimbursement from an EH and uses the technology the EP is eligible for an incentive payment E pee ee ie Date Revised 9 08 2015 46 EHR Provider Application User Manual If you click on the practice predominantly link a message similar to the one shown below is displayed Definition of Practices Predominantely Windows Internet Explorer Practices Predominantly an EP for whom more than fifty percent 50 of his or her total patient encounters occur at a federally qualified health center FQHC or rural health clinic RHC The calculation is based on a period of six 6 months within the prior calendar year or preceding 12 month period from the date of attestation E prs eet C O oe If you click on the FQHC or RHC link a message similar to the one shown below is displayed Definitions of FQHC and RHC Windows Internet Explorer The Social Security Act at
86. vider to answer questions regarding their practice 90 Hospital Based means a professional furnished ninety percent 90 or more of their Louisiana Medicaid covered professional services during the relevant EHR reporting period in a hospital setting whether inpatient or Emergency Room through the use of the facilities and equipment of the hospital If a hospital based EP can demonstrate that he she funds the acquisition implementation and maintenance of certified EHR technology without reimbursement from an EH and uses the technology the EP is eligible for an incentive payment Practice Predominantly an EP for whom more than fifty percent 5096 of his or her total patient encounters occur at a federally qualified health center FQHC or rural health clinic RHC The calculation is based on a period of six 6 months within the prior calendar year or preceding 12 month period from the date of attestation FQHC RHC The Social Security Act at section 1905 D 2 defines an FQHC as an entity which 1 is receiving a grant under section 330 of the Public Health Service Act or ILL is receiving funding from such a grant under a contract with the recipient of such a grant and II meets the requirements to receive a grant under section 330 of the Public Health Service Act ii based on the recommendation of the Health Resources and Services Administration within the Public Health Service and is determined by the Secretary to meet the requirem
87. w is a table of any remittance reports on file for this provider To view a remittance report click the Download link that appears beside it Provider Id Provider Name Total Records Page 1 of 1 First Previous Next Last Copyrnighk 2020 Moline Megiqgid amp olukigng 65 Rights Fgpaneard In instances in which you have a large number of Remittance Reports you can control the number of pages displayed by using the drop down list function Page F of 1 Click on the down arrow to show the possible number of pages to display at once if available On the table that contains the list of Remittance Dates click on the specified Download link to view the report uw ES Date The specified Remittance Report similar to the one shown below will be displayed in the Adobe Reader Report EHR A 101 State of Louisiana Page 1 Run Date 01 20 2011 Department of Health and Hospitals Bureau of Health Services Financing Electronic Health Records Incentive Payment System Report EH mitt IR A 101 Provider Remittance Advice Statement 5 nas Payment Approved Date 20110125 Provider Provid Address Processing Cycle 2011 EHR Incentive Payment for Payment Year 1 Total payments on this remittance 21 250 00 Total invoice line items 1 Date Revised 9 08 2015 39 EHR Provider Application User Manual 6 0 Eligible Professional EP Users In
88. ws Digital Signature of Applicant Preparer Name Preparer Initials D 1 Relationship to Applicant Logon User ID m Save and Submit gt gt Click on the Save and Submit button Date Revised 9 08 2015 57 EHR Provider Application User Manual 6 10 Confirmation of Submission Molina LAConnec ee eg ee ee Louisiana Medicaid EHR Incentive Payment Program Confirmation of Submission Thank you for applying to the Louisiana Medicaid EHR Incentive Payment Program Please allow 3 to 6 weeks for payment Email communication will be sent to the Primary Contact if additional information is needed and when your attestation is approved for payment Registration Application Report Copyright 2013 Molina Medicaid Solutions All Rights Reserved The Confirmation of Submission page enables you to review your input data by clicking on the Registration Application Report link An Adobe pdf file similar to the one shown below will be displayed which you can print for your records Electronic Health Records Incentive Payment System Attestation Registration Application Report for Payment Year 1 ree Begin End 5 7 2013 Total Medicaid Patient Encounters Total Patient Encounters Please indicate whether the patient encounters volume calculation was based on individual Individual Provider CMS Registration Site Molina mede Ceding PRIMORUM nantes denl Medicaid Patient Volume Siete Do
89. y if the Provider has a valid B6 record on file and a corresponding B7 record has been processed As part of the enrollment process the Provider will be able to review the information on file with CMS as well as add or update their primary and secondary contact information The Provider will then proceed through a series of attestation screens entering data into all required fields and attaching all required documentation Upon submitting or updating an attestation case to DHH for review a confirmation email will be dispatched to the contacts entered into the system and a summary report will be made available for view download The review by DHH is performed via a separate admin application where a DHH reviewer will assign the attestation case and ultimately give it a status When denying a case the reviewer will provide the Provider with a reason and if applicable further instructions In a situation where the Provider s supporting documentation was found to be insufficient for example DHH will request that the Provider attach a missing worksheet and resubmit In the EHR Provider application a link for updating a submitted attestation case is accessible via a main menu that will become the application s default screen after the Provider enrolls for the first time The process of updating a case is similar to creating a new one except that the fields on the attestation screens will be pre populated with the data the Provider had entered prev
90. you provide more than 90 of your services in an inpatient hbspital or ER Address Pay To Address Do you practice predominantly in an FQHC or RHC where 30 percent of the patient volume is derived from needy individuals Provider Type Provider Type Are you a Physician Assistant who practices in an FQHC RHC led by a physician assistant Provider Specialty Provider Specialty NPI NPI CMS EHR Certification ID TIN TIN Email Address Tiebreaker Taxonomy Vendors Date Added Vendor Product Product Number Version Disregard Tiebreaker Zip 4 Routing Number Uploaded Documents File Name Upload Date Disregard Eligibility End Date Cancel Reason Code Payee Information Payee TIN matches Molina file Digital Signature P NPI ae Preparers Name Payee TIN Preparer s Initials Payee Address Relationship to Applicant Logon ID Contacts Primary Secondary Name Name Phone Phone Email Email Job Title Job Title Click the End button to return to the initial application screen Date Revised 9 08 2015 58 EHR Provider Application User Manual 7 0 Eligible Professional EP Users Subsequent Logons After the initial logon subsequent logons to the EHR application provide a menu screen with a variable number of main links On the Enrollment side Update Enrollment Information on a pending application New Enrollment for Payment Year X Latest Registration Application Report View Attachments View Notes and Emails O

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