West Virginia Trading Partner Account Patient Roster User Guide. Date of Publication: 01/19/2016 Document Version: 1.0

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1 West Virginia Trading Partner Account Date of Publication: 01/19/2016 Document Version: 1.0

2 Privacy and Security Rules WV MMIS Trading Partner Account The Health Insurance Portability and Accountability Act of 1996 (HIPAA Public Law ) and the HIPAA Privacy Final Rule 1 and the American Recovery and Reinvestment Act (ARRA) of 2009 provides protection for personal health information. Protected Health Information (PHI) includes any health information and confidential information, whether verbal, written or electronic, created, received, or maintained by Molina Healthcare. It is healthcare data plus identifying information that allows the data to tie the medical information to a particular person. PHI relates to the past, present and future physical or mental health of any individual or member; the provision of healthcare to an individual; or the past, present or future payment for the provision of healthcare to an individual. All member information including but not limited to claims data, prior authorization information, and attachments such as medical records and consent forms are all PHI CFR Parts 160 and 164, Standards for Privacy of Individually Identifiable Health Information; Final Rule Proprietary and Confidential Molina Medicaid Solutions Page ii

3 Disclaimer WV MMIS Trading Partner Account This document and information it contains is proprietary information. Authorization is hereby provided to you to copy documents published by Molina Medicaid Solutions on the Health PAS-OnLine portal provided such copies are used for non-commercial purposes and solely for use within your organization. This authorization is specifically conditioned upon including all legends, copyright, proprietary, and other notices that appear herein on all copies you make of such documents whether they pertain to Molina Medicaid Solutions or another party. No license is granted herein expressly, impliedly, by estoppel or otherwise under any patent or to use any trademark of any party. No other rights under any copyrights are granted herein, except as expressly stated above. The documents herein may refer to products and/or services that are neither available nor planned for availability in your particular locality. In referring to such products and/or services, Molina Medicaid Solutions incurs no obligation to subsequently make them available in your locality. DOCUMENTS PUBLISHED HEREIN ARE FURNISHED TO YOU "AS IS." THERE ARE NO WARRANTIES, EXPRESS, OR IMPLIED, BY OPERATION OF LAW OR OTHERWISE. MOLINA MEDICAID SOLUTIONS DISCLAIMS THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NON- INFRINGEMENT AS TO BOTH MOLINA MEDICAID SOLUTIONS AND NON-MOLINA DOCUMENTS FURNISHED HEREIN. Some states or territories do not allow the exclusion of implied warranties and the foregoing exclusions may not be applicable to you. Any communication provided by you to Molina Medicaid Solutions relating to the documents furnished herein by Molina Medicaid Solutions will be received only on a non-confidential basis. There shall be no obligation on the part of Molina Medicaid Solutions with respect to use or disclosure of any information in such communication. Molina Medicaid Solutions shall have the unrestricted right to copy, use, and distribute any information you communicate including, but not limited to any ideas, concepts, know-how, techniques, software, documentation, diagrams, schematics, or blueprints. Additionally, Molina Medicaid Solutions may use all such information in any manner or for any purpose including, but not limited to developing products or providing services. The documents furnished herein by Molina Medicaid Solutions are subject to change without notice. All brand names and product names are acknowledged to be the trademarks or registered trademarks of their respective owners. Proprietary and Confidential Molina Medicaid Solutions Page iii

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5 1. Introduction WV MMIS Trading Partner Account This user guide is provided for all trading partners with a patient roster, who use the West Virginia (WV) Healthcare Payer Administration Solution (Health PAS)-OnLine Web portal. The Patient Roster is a tool that will help the user manage the patient s Medicaid Account electronically. The web portal system permits real-time completion of healthcare transactions over the Internet. To create a patient roster, providers must be signed into their trading partner account (provider portal) at 2. Patient Roster The patient roster, or list of Medicaid members, can be customized to individual billing providers. Two advantages of creating a Patient Roster are to submit a claim directly from the Patient Roster screen or verify a member s eligibility. To create a Patient Roster, follow these steps: 1. In the Form Entry section of the navigation pane, click the View Patient Roster link to go to the Patient Roster screen. Refer to Figure 2-1. Figure 2-1: Accessing the Patient Roster Proprietary and Confidential Molina Medicaid Solutions Page 1 of 16

6 2. In the Billing Provider drop-down list, click the name of the Billing Provider. Refer to Figure 2-2. Figure 2-2: Patient Roster 3. The Patient Roster displays a list of participants sorted alphabetically by last name. Refer to Figure 2-3. The roster lists the following information: Last Name First Name Date of Birth Member (Participant) ID 4. To view the member s information, click the Last Name hyperlink or click one of the highlighted letters to view details for the specified member. Proprietary and Confidential Molina Medicaid Solutions Page 2 of 16

7 Figure 2-3: Search Member Proprietary and Confidential Molina Medicaid Solutions Page 3 of 16

8 5. View the selected Member Details. Refer to Figure 2-4. Figure 2-4: Viewing Member Details Proprietary and Confidential Molina Medicaid Solutions Page 4 of 16

9 6. To search for a specific member, click the Search hyperlink to begin entering data for the search. Refer to Figure 2-5. Figure 2-5: Search Hyperlink 7. In the Find field, located within the Search function, type the full or partial name. Refer to Figure Click OK to display a list of potential matches. Figure 2-6: Find Member 9. Review the search results by clicking the radio button or the last name hyperlink. Refer to Figure 2-7. Figure 2-7: Search Results The Member Details page will display. Refer to Figure 2-4. Proprietary and Confidential Molina Medicaid Solutions Page 5 of 16

10 2.1 Add Member to the Patient Roster 1. To add a member to the Patient Roster, click Add Member to Roster. Refer to Figure 2-8. Figure 2-8: Add Member to Roster Proprietary and Confidential Molina Medicaid Solutions Page 6 of 16

11 2. Search for the member by entering the member s information. Refer to Figure 2-9. You have to use two of the following items to search; click SUBMIT. Member ID Name (Last and First) Date of Birth Social Security Number Figure 2-9: Find Member 3. Click the check box in front of the member's name, and then click ADD TO ROSTER. Refer to Figure Figure 2-10: Add to Roster Proprietary and Confidential Molina Medicaid Solutions Page 7 of 16

12 4. To delete a participant from the roster, click the trash can icon next to the last name of the participant. Refer to Figure Figure 2-11: Trash Can Icon 5. The user will be prompted with a message from the webpage confirming that the patient s record will be deleted. Click OK to delete or click Cancel to cancel the request. Refer to Figure Figure 2-12: Message from Webpage Proprietary and Confidential Molina Medicaid Solutions Page 8 of 16

13 2.2 Patient Roster Activities WV MMIS Trading Partner Account Users can either submit a claim from the patient roster section or verify member eligibility. The following section describes how each of these can be performed. To create one of the forms for submission, click the option in front of the patient s name, and then click one of the buttons at the bottom of the screen to initiate the form. Refer to Figure Figure 2-13: Submit Claim or Verify Eligibility Proprietary and Confidential Molina Medicaid Solutions Page 9 of 16

14 2.2.1 Submitting a Claim WV MMIS Trading Partner Account 1. Submit Claim Refer to the West Virginia Trading Partner Account Claim Submission User Guide for detailed entry information. Refer to Figure Figure 2-14: Submit Claim Proprietary and Confidential Molina Medicaid Solutions Page 10 of 16

15 2.2.2 Verifying Member Eligibility WV MMIS Trading Partner Account 1. Verify Eligibility Refer to the West Virginia Trading Partner Account Eligibility Verification User Guide for detailed entry information. Refer to Figure Print Patient Roster Figure 2-15: Verify Eligibility 1. Click Print List to print all current members associated to the billing provider who are effective at the time of the search. Refer to Figure Figure 2-16: Print Patient Roster Options Proprietary and Confidential Molina Medicaid Solutions Page 11 of 16

16 2. The Patient Roster List will display in a Portable Document Format (PDF). Refer to Figure Figure 2-17: Patient Roster List 3. Click the Print icon in the top left corner of the Patient Roster to select the Printer Options. Once the user has selected the preferred printer options, click the OK button. Refer to Figure Figure 2-18: Selecting Printer Options Proprietary and Confidential Molina Medicaid Solutions Page 12 of 16

17 2.4 Export to Excel WV MMIS Trading Partner Account 1. Click Export to Excel to create a Microsoft Excel spreadsheet with the members information. Refer to Figure Figure 2-19: Export to Excel 2. The user will be prompted to either Open, Save, or Cancel the File Download. Click Open to open the roster in Excel. Refer to Figure Figure 2-20: File Download Options Proprietary and Confidential Molina Medicaid Solutions Page 13 of 16

18 3. View the Patient Roster in Excel. Refer to Figure Figure 2-21: Patient Roster in Excel Proprietary and Confidential Molina Medicaid Solutions Page 14 of 16

19 Appendix A Acronyms and Abbreviations Acronym Definition ARRA American Recovery and Reinvestment Act 2009 CFR Code Federal Regulations EDI Electronic Data Interchange HIPAA Health Insurance Portability and Accountability Act (1996) ID Identifier/Identification MMIS Medicaid Management Information System PDF Portable Document Format PHI Protected Health Information Proprietary and Confidential Molina Medicaid Solutions Page 15 of 16

20 End of Documentation Proprietary and Confidential Molina Medicaid Solutions Page 16 of 16