Commonwealth of Virginia Department of Medical Assistance Services

Commonwealth of Virginia Department of Medical Assistance Services Eligible Professional (EP) Training Enrollment Year 1 Adopt, Implement, or Upgrade (AIU) September 14, 2015 Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 1 of 70 9/16/2015

Table of Contents 1 Purpose and Scope... 5 1.1 Purpose... 5 1.2 Scope... 5 1.3 Approach... 5 2 Eligible Professional User Accounts... 6 2.1 Getting Started... 6 2.1.1 Log In First Time... 6 2.1.2 Registration... 7 2.1.3 Welcome... 8 2.1.4 Change Password... 9 2.1.5 Reset Password... 10 2.1.6 Logout... 11 2.2 VMIP Home Page... 12 3 EP Enrollment Payment Year 1 for Adopt, Implement or Upgrade... 13 3.1 Enrollment Home... 13 3.1.1 Confirm Enrollment Action Pop-up Stay on Program Year 2014... 14 3.1.2 Confirm Payment Year 1 Attestation Selection Pop-up... 15 3.2 Enrollment Step 1 Provider Registration Verification... 16 3.2.1 Enrollment Step 1 National Provider Information Section... 16 3.2.2 Enrollment Step 1 State Provider Information Section... 17 3.2.3 Enrollment Step 1 Patient Volume Attestation Method Section... 18 3.2.4 Enrollment Step 1 Payment Assignment... 29 3.2.5 Enrollment Step 1 Point of Contact Section... 30 3.2.6 Complete Enrollment Step 1... 30 3.3 Enrollment Step 2 Medicaid Patient Volume Determination... 31 3.3.1 Enrollment Step 2 Medicaid Patient Volume Determination Overview... 31 3.3.2 Enrollment Step 2 Medicaid Patient Volume Determination... 32 3.3.3 Enrollment Step 2 Needy Patient Volume Determination... 34 3.4 Enrollment Step 3 Adopt, Implement Upgrade Certified EHR Software... 36 3.5 Enrollment Step 4 EHR Payment Determination... 37 3.6 Upload Supporting Documentation... 38 3.6.1 Supporting Documentation Upload Requirements Screen... 43 3.6.2 Upload Document Screen... 44 3.7 Enrollment Summary... 45 3.8 Legal Notice... 47 3.9 Submit Enrollment... 50 3.9.1 Submit Enrollment... 50 3.9.2 Enrollment Confirmation... 51 Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 2 of 70 9/16/2015

3.9.3 Enrollment Home Post Enrollment Submission... 52 4 Documents Tab... 53 4.1 Documents Home... 53 4.1.1 Manage Documents 2015 Program Year... 54 4.1.2 Documents Upload New Document... 55 5 Reconsiderations Tab... 56 5.1 Reconsiderations Home None Submitted... 56 5.1.1 Submit a New Reconsideration... 57 5.1.2 Reconsideration Status Not Yet Resolved... 58 5.1.3 Reconsideration - Upload Supporting Document... 59 5.1.4 Reconsideration Home Reconsideration Submitted... 60 6 Status Tab... 61 6.1 Status Summary Home Page... 61 6.1.1 Enrollment Summary... 62 7 Manage Account Tab... 64 7.1 Manage Account Update Contact Information... 64 7.2 Update Contact Information... 65 8 Contact Us Tab Secure Communications... 66 8.1 Contact Us Home... 66 8.1.1 Create Secure Communication... 67 8.1.2 Contact Us New Communications... 68 8.1.3 Secure Communications Response... 69 9 Conclusion... 70 Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 3 of 70 9/16/2015

Revision History Version Date Whom Contents 1.0 03/06/2013 CGI Technologies and Solutions, Inc., 2.0 03/19/2013 CGI Technologies and Solutions, Inc., Virginia DMAS Eligible Professional Training Enrollment Year 1 Adopt, Implement, or Upgrade. Minor edits to wording and screenshots. 3.0 09/14/2015 CGI Technologies and Solutions, Inc., Updates based on the latest changes and screenshots Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 4 of 70 9/16/2015

1 Purpose and Scope 1.1 Purpose The purpose of this document is to present Virginia-specific training materials for the Virginia Medicaid EHR Incentive Program (VMIP) for EP Payment Year 1 enrollment for Adopt, Implement or Upgrade (AIU). 1.2 Scope This training material only applies to Eligible Professionals (EPs) during VMIP enrollment year 1, for Adopt, Implement, or Upgrade (AIU). 1.3 Approach This training material presents and describes the majority of screenshots that an EP might encounter during VMIP enrollment year 1 for AIU. Also provided are screenshots for ancillary processes that the EP could encounter such as Documents, Reconsiderations, Status, Account Management and Secure Communications. The ancillary processes will not be repeated in the EP Meaningful Use training materials. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 5 of 70 9/16/2015

2 Eligible Professional User Accounts This document presents the training screenshots for the Eligible Professional (EP) during enrollment year 1 for Adopt, Implement or Upgrade (AIU) using the VMIP Provider Portal. 2.1 Getting Started The first time the EP launches the VMIP Provider Portal, the EP will land on the Log In page. The first time on the Portal, the provider will have to register. Once registered, the EP can then log in to the Portal. The very first time logging on, the EP will land on the Welcome page. This sequence is depicted in the following screenshots. 2.1.1 Log In First Time The EP has just launched the VMIP Provider Portal for the first time. Click Registration. Note the gray VMIP footer banner at the bottom of the above screenshot. To save space, it will be trimmed from the remaining screenshots Note also that all screenshots in this document contain fictitious provider data. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 6 of 70 9/16/2015

2.1.2 Registration Enter the required information on the Registration page and click Register. The EP will be automatically logged into the Provider Portal after successfully registering. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 7 of 70 9/16/2015

2.1.3 Welcome The first time the EP successfully registers for the VMIP Provider Portal, he/she will be greeted by the Welcome page. After reading, click Continue, to proceed to the VMIP Provider Portal Home page, which is presented below in Section 2.2. Before leaving this Getting Started section, we will present the Change Password, Reset Password screenshots along with the Logout process. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 8 of 70 9/16/2015

2.1.4 Change Password At any time the EP lands on the VMIP Provider Portal Log In page, he/she can elect to change the password. Click Change Password and land on this page. Enter the User ID (NPI), current and new password (twice), and click Save. If successful, the EP will automatically be logged into VMIP using the new password. Note the password requirements are explained in the lower half of this screenshot. Note: The EP may also receive this page if the password is expired forcing a new password to be created for the account. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 9 of 70 9/16/2015

2.1.5 Reset Password At any time the EP forgets his/her password they can choose to reset the password from the Login page. Click Reset Password and land on this page. Enter the User ID (NPI), last four digits of the TIN (SSN), current email address, new password (twice), and click Reset Password. If successful, the EP will automatically be logged into VMIP using the new password. Note the password requirements are explained in the lower half of this screenshot. This process can be utilized instead of calling the CGI BSC Helpdesk for a password reset. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 10 of 70 9/16/2015

2.1.6 Logout At any time in the VMIP Provider Portal experience, the EP can click the Logout command located in the upper right banner. The EP will then again land on the Log In page where he/she can conveniently login again, or close the VMIP Provider Portal window entirely. Also, if the EP leaves his/her computer idle for an extended period (30 minutes), it will time out, and the next step attempted in the Portal will result in a display of the Log In page. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 11 of 70 9/16/2015

2.2 VMIP Home Page After every successful login, the EP will land on the VMIP Home page, from where he/she can access all of the VMIP Provider Portal functions. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 12 of 70 9/16/2015

3 EP Enrollment Payment Year 1 for Adopt, Implement or Upgrade The following sections will present the screenshots the provider will see when progressing through the various VMIP Provider Portal sections and functions. We will present the enrollment process first, followed by the ancillary functions left-to-right according to the tabs across the top of the page: Documents, Reconsiderations, Status, Manage Account, and Contact Us. 3.1 Enrollment Home When the provider clicks the Enrollment tab (or the Enrollment link on the Home page), the Enrollment Home page is typically displayed. The following screenshot is an example, showing that the provider is ready to commence payment year 1 enrollment in program year 2015 by simply clicking Enroll. Note: The EP enrollments from previous years were expired due to no enrollment activity. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 13 of 70 9/16/2015

3.1.1 Confirm Enrollment Action Pop-up Stay on Program Year 2014 Note that when the EP is within the Virginia enrollment grace period, the EP will indicate that he/she wants to continue enrollment in program year 2014 or would want to advance to program year 2015. Once selected, the EP will click the Confirm button to continue back to the Enrollment Home Page. Note: Once the enrollment is rolled over the system closes out the program year and will not allow attestation for 2014. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 14 of 70 9/16/2015

3.1.2 Confirm Payment Year 1 Attestation Selection Pop-up The EP will have the option to attest for Adopt, Implement or Upgrade (AIU) or Meaningful Use (MU) for payment year 1. For purposes of this User Guide the EP will select the AIU option. The EP can click the Confirm button to continue. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 15 of 70 9/16/2015

3.2 Enrollment Step 1 Provider Registration Verification The following sections outline the steps necessary to complete the Step 1 Provider Registration Verification process. The EP will need to confirm and/or designate enrollment information to continue. 3.2.1 Enrollment Step 1 National Provider Information Section The EP has clicked Enroll on the Enrollment Home page, and the Enrollment Step 1 page is displayed, presented on this and the following screenshot. We will display only sections of the page for greater clarity over the next few sections. During enrollment, the EP can view the status through each of the four enrollment steps. In the National Provider Information section the EP should verify all the information received from CMS to ensure accuracy. If a correction is necessary, the EP must contact CMS to update the information. See the next sections for the continuation of the Enrollment Step 1 Provider Registration Verification page. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 16 of 70 9/16/2015

3.2.2 Enrollment Step 1 State Provider Information Section If the EP attests to being hospital-based, then he/she must also attest if they are using their own HER system or the hospital s. If the EP attests to using the hospital s EHR system they will be declared ineligible to receive Medicaid EHR Incentive Payments simply because the hospital itself will be receiving the incentive payments. The EP will be asked to confirm the hospital-based selection (but note, the EP will not confirm this selection until clicking Save & Continue on the bottom of the page). The EP can also attest as a Pediatrician in this section. If the patient volume of the EP is greater than or equal 20% and less than 30%, then he/she would qualify for Medicaid EHR Incentive payment at reduced amount. If the EP patient volume level is greater than 30%, he/she qualified for the full incentive payment, whether Pediatrician or not. See the Enrollment Step 4 Payment Calculation section for payment details. The screen below outlines the Hospital Based selection as No. The screen below outlines the Hospital Based selection as Yes. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 17 of 70 9/16/2015

3.2.3 Enrollment Step 1 Patient Volume Attestation Method Section The EP must attest to the patient volume attestation method to be used for the enrollment. He/she will be able to select from the following methods as outlined below: Individual Patient Volume Individual Patient Volume while practicing predominantly in an FQHC/RHC Group/Clinic Patient Volume Group/Clinic Patient Volume while practicing predominantly in an FQHC/RHC Once the EP has selected the patient volume attention method he/she will be required to select all practice locations for which patient volume will be provided. The following pages outline each of the four patient volume attestation methods. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 18 of 70 9/16/2015

3.2.3.1 Patient Volume Attestation Method Individual If the EP elects to attest to patient volume individually he/she can select the Individual Attestation option and choose No for practicing predominantly in an FQHC/RHC. Once the selections are made the EP can click the Select Practice Location(s) button to select all locations for which individual patient volume will be provided. The screen below outlines selections needed for individual attestation. The screen below presents the Select Practice Location(s) screen. Note that the Individual method is listed and the practice locations are denoted with a type of Individual. If the location is not listed the EP may perform an advanced search. The initial lists of locations are linked based on information received from the DMAS MMIS System. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 19 of 70 9/16/2015

3.2.3.2 Patient Volume Attestation Method Individual FQHC/RHC If the EP elects to attest to patient volume individually while practicing predominantly in an FQHC or RHC he/she can select the Individual Attestation option and choose Yes for practicing predominantly in an FQHC/RHC. The EP will also need to attest by confirming that they practice predominantly in an FQHC or RHC. Once the selections are made the EP can click the Select Practice Location(s) button to select all FQHC/RHC locations for which patient volume will be provided. The screen below outlines selections needed for individual attestation while practicing predominantly in an FQHC or RHC. The screen below presents the Select Practice Location(s) screen. Note that the Individual FQHC/RHC method is listed and the practice locations are denoted with a type of FQHC/RHC. If the location is not listed the EP may perform an advanced search. The initial lists of locations are linked based on information received from the DMAS MMIS System. If the FQHC/RHC location cannot be found please contact the help desk. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 20 of 70 9/16/2015

3.2.3.3 Patient Volume Attestation Method Group/Clinic Practice Enrollment Step 1 includes the ability for the EP attest to practicing within a Group/Clinic for purposes of patient volume. The EP may establish a new group or join an existing group. The EP must complete the following items to create/join a group for the Group/Clinic Attestation Select the attestation method for Group/Clinic Attestation Select the group practice locations Either join the existing group or complete the Group Setup page To begin the group selection process, the EP clicks the Yes radio button in the Group/Clinic Attestation selection. The EP must then select No for practicing predominantly in an FQHC/RHC. He/she will then need to enter the Group/Clinics NPI into the field to begin the process. Note: To create or join a group the EP must be linked to the group as identified in the Virginia State MMIS and then that group data must have been updated in VMIP. In certain circumstances DMAS may need to manually update this for your group. If you have issues creating or joining your group please contact the help desk. Once the selections are made the EP can click the Select Practice Location(s) button to select all Group/Clinic locations for which patient volume will be provided. The screen both outlines selections needed for Group/Clinic Attestation (new or existing). Continued on next page. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 21 of 70 9/16/2015

The screen below presents the Select Practice Location(s) screen. Note that the Group method is listed and the practice locations are denoted with a type of Group. If the proper location(s) are not listed the EP may perform an advanced search. The initial lists of location(s) are linked based on information received from the DMAS MMIS System. If the Group location(s) cannot be found please contact the help desk. Continued on next page. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 22 of 70 9/16/2015

The screen below presents the Group Setup screen. The first EP in the group must establish the Patient Volume for the group by establishing the Reporting Period, electing Out-of-state Encounters, naming the group/clinic, electing if it is a Pediatric Group, and entering the patient volume details for the group/clinic. Once complete, the EP will be returned the Step 1 page to continue the attestation. Continued on next page. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 23 of 70 9/16/2015

The screen below presents the user retuned to Step 1 after the group was created (or joined if existing). The group NPI will be listed along with the Medicaid Group Name. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 24 of 70 9/16/2015

3.2.3.4 Patient Volume Attestation Method FQHC/RHC Group/Clinic Practice Enrollment Step 1 includes the ability for the EP attest to practicing within an FQHC/RHC Group or Clinic for purposes of patient volume. The EP may establish a new group or join an existing group. The EP must complete the following items to create/join a group for the FQHC/RHC Group/Clinic Attestation Select the attestation method for Group/Clinic Attestation Select Yes for practice predominantly in an FQHC/RHC Select the group practice locations Either join the existing group or complete the Group Setup page To begin the group selection process, the EP clicks the Yes radio button in the Group/Clinic Attestation selection. The EP must then select Yes for practicing predominantly in an FQHC/RHC. The EP will also need to attest by confirming that they practice predominantly in an FQHC or RHC via the screen-pop. Note: To create or join a group the EP must be linked to the group as identified in the Virginia State MMIS and then that group data must have been updated in VMIP. In certain circumstances DMAS may need to manually update this for your group. If you have issues creating or joining your group please contact the help desk. Once the selections are made the EP can click the Select Practice Location(s) button to select all FQHC/RCH Group/Clinic locations for which patient volume will be provided. The screen both outlines selections needed for FQHC/RHC Group/Clinic Attestation (new or existing). Continued on next page. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 25 of 70 9/16/2015

The screen below presents the Select Practice Location(s) screen. Note that the Group FQHC/RHC method is listed and the practice locations are denoted with a type of FQHC/RHC. If the proper location(s) are not listed the EP may perform an advanced search. The initial lists of locations are linked based on information received from the DMAS MMIS System. If the FQHC/RHC Group location cannot be found please contact the help desk. Continued on next page. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 26 of 70 9/16/2015

The screen below presents the FQHC/RHC Group/Clinic Setup screen. The first EP in the group must establish the Patient Volume for the group by establishing the Reporting Period, electing Out-of-state Encounters, naming the group/clinic, and entering the patient volume details for the FQHC/RCH Group/Clinic. Once complete, the EP will be returned the Step 1 page to continue the attestation. Continued on next page. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 27 of 70 9/16/2015

The screen below presents the EP returning to Step 1 after the FQHC/RHC group was created (or joined if existing). The group NPI will be listed along with the Medicaid Group Name. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 28 of 70 9/16/2015

3.2.4 Enrollment Step 1 Payment Assignment The EP must attest to the entity receiving the incentive payment. The EP establishes the payee first by entering the appropriate NPI and TIN into the CMS registration system. This information is sent to DMAS and matched with records in the VA MMIS. The EP can select the payee by clicking the Select Payee button. 3.2.4.1 Payee Selector The EP selects the payee on this page and then clicks Select & Continue. The VMIP system will verify that the payees listed are included in the MMIS system as payable. The system will match based upon Payee TIN + Payee NPI, then by Payee TIN only. If your payee is not listed her please contact the help desk for assistance. If the EP is assigning the payment to a third party he/she must also acknowledge this via the screen-pop confirmation. Once complete, the EP will be returned to the Step 1 page. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 29 of 70 9/16/2015

3.2.5 Enrollment Step 1 Point of Contact Section The EP must verify the current contact Email Address and Phone Number on file. If updates are required, he/she can update the appropriate information prior to completing Step 1. 3.2.6 Complete Enrollment Step 1 The EP has reviewed and completed all the sections on Enrollment Step 1. With this, Enrollment Step 1 is now complete, and the EP clicks Save & Continue to progress to Enrollment Step 2. The system will verify all the attested information and issues are found the system will present the EP with the appropriate errors. If you receive errors and need assistance please contact the help desk. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 30 of 70 9/16/2015

3.3 Enrollment Step 2 Medicaid Patient Volume Determination The following sections outline the steps necessary to complete the Step 2 Medicaid Patient Volume Determination process. 3.3.1 Enrollment Step 2 Medicaid Patient Volume Determination Overview There are three paths through Enrollment Step 2, depending on the EP selections on Enrollment Step 1. If the EP indicated in Enrollment Step 1 that he/she participates in a Group/Clinic (with or without FQHC/RHC), then the Medicaid Patient Volume Determination for the Group was previously completely established in Enrollment Step 1 during Group Setup, and the data displayed during Enrollment Step 2 Medicaid Patient Volume Determination page is for review only and is displayed read-only (cannot be edited). Screenshots are not presented for these options. If the EP indicated in Enrollment Step 1 that he/she does not practice predominantly in an FQHC or RHC, then Enrollment Step 2 is the standard Medicaid Patient Volume Determination. If the EP indicated that he/she practices predominantly in an FQHC or RHC (cannot also participate in a Group), then Enrollment Step 2 is the Needy Patient Volume Determination. The following sections and screenshots will first describe the Enrollment Step 2 processes for Medicaid Patient Volume Determination and then describe for Enrollment Step 2 Needy Patient Volume Determination. Out-ofstate encounter processing, applicable to all three of the above-listed paths, is described once below under Medicaid Patient Volume Determination Out-of-State Encounter. The screenshots will present each section of the Enrollment Step 2 page, scrolling down from top to bottom. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 31 of 70 9/16/2015

3.3.2 Enrollment Step 2 Medicaid Patient Volume Determination The following screen is displayed if the EP elected in Step 1 to attest to individual patient volume (not practicing predominantly in an FQHC/RHC). Here the EP has progressed to program year 2015 when starting enrollment. The Patient Volume Reporting Period would have two date options, as shown. The EP must select to report 3- month patient volume from dates in the previous calendar year OR within the previous 12-months. The EP must also specify if out-of-state encounters are utilized in the patient volume calculation. If so, he/she can click the Select States/Territories button to select the appropriate locations. Continued on next page. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 32 of 70 9/16/2015

The following screen is displays all individual location(s) selected during Step 1 for patient volume. The EP will be required to enter the Medicaid and total Encounters for each location selected. The enrollment also requires that the EP attest if CEHRT technology is utilized in each location. The system will automatically calculate the total patient volume and display at the bottom. Once all of the information is entered he/she can click the Save & Continue button. The system will perform a quick analysis and alert the provider if the patient volume is outside of expected values based on claims during the patient volume reporting period. The EP can return to the Step 2 page to correct, or accept the values as entered to continue to Step 3. This warning is displayed when the reported volume is outside of the expected values based on claims. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 33 of 70 9/16/2015

3.3.3 Enrollment Step 2 Needy Patient Volume Determination The following screen is displayed if the EP elected in Step 1 to attest to individual patient volume and practicing predominantly in an FQHC/RHC. Here the EP has progressed to program year 2015 when starting enrollment. The Patient Volume Reporting Period would have two date options, as shown. The EP must select to report 3- month patient volume from dates in the previous calendar year OR within the previous 12-months. The EP must also specify if out-of-state encounters are utilized in the patient volume calculation. If so, he/she can click the Select States/Territories button to select the appropriate locations. Continued on next page. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 34 of 70 9/16/2015

The following screen is displays all FQHC/RHC location(s) selected during Step 1 for patient volume. The EP will be required to enter the Medicaid, Uncompensated Charity Care and total Encounters for each location selected. The enrollment also requires that the EP attest if CEHRT technology is utilized in each location. The system will automatically calculate the total patient volume and display at the bottom. Once all of the information is entered he/she can click the Save & Continue button to proceed with the attestation. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 35 of 70 9/16/2015

3.4 Enrollment Step 3 Adopt, Implement Upgrade Certified EHR Software Enrollment Step 3 for EPs requires the following information to be attested to: AIU Designation CMS EHR Certification ID Financially and Legally Binding Supporting Documentation The EP will be presented an opportunity to upload supporting documentation later in the enrollment process. He/she can click the Save & Continue button to proceed to Step 4. The system will complete a verification of the entered CMS EHR Certification ID. If the system rejects the ID an error message will be displayed and the EP will have the opportunity to correct. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 36 of 70 9/16/2015

3.5 Enrollment Step 4 EHR Payment Determination Enrollment Step 4 presents the Medicaid EHR Incentive Program payment amounts, showing the amount paid per year for a non-pediatrician provider and a pediatrician. After reviewing, the EP clicks Save & Continue. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 37 of 70 9/16/2015

3.6 Upload Supporting Documentation The following screens outline the process to upload required supporting documentation. When completing Step 4 the system will evaluate the enrollment and determine the minimum required documentation for payment. The system will display each of the required documents in a table on the page below and the EP is required to upload each document prior to continuing the enrollment. The following table lists all of the potential payment year 1 required documents based the enrollment information entered: Document Title AIU Supporting Documentation Freeware Group Consent Letter Document Description Providers are required to upload at least one form of AIU documentation. This documentation must clearly show the relationship between the certified EHR vendor, the entity that adopted, implemented or upgraded to the system, and the licensed user. Acceptable AIU documentation will include the following elements: proof of relationship between vendor, purchaser, and user, date of purchase, CMS certification number, and signatures that link the parties involved. Any combination of the following documents may be used to meet the AIU documentation requirement: Signed contract listing the provider and the vendor Signed purchase order listing the provider and the vendor Invoice listing the provider and the vendor Memorandum of understanding listing the provider and the vendor Email from certified EHR vendor listing the provider and vendor Providers are required to upload at least one form of certified electronic health record technology (CEHRT) documentation. CEHRT documentation for EHR software that was a FREE purchase must include, at a minimum, all of the following: Formal user agreement SIGNED by the EHR vendor/software and the provider Any third party/reseller agreement and/or invoice, if applicable Screen capture by the provider showing the landing page after log-on into the EHR system. The provider must demonstrate access to/acquisition of the system. The screen capture must show the provider s name, software name and date. The screen capture could be something other than the landing page as long as it shows the required information. Providers attesting using group Medicaid Patient Volume, are required to upload documentation listing the EPs in the group, whether they intend to attest as part of the group, and documenting their consent to include their patient volume included in the group. For group attestations, please upload a group consent form that includes the following information: Patient Volume Reporting Period begin and end dates Patient Volume Numerator Patient Volume Denominator Medicaid Provider Names and NPIs Group NPI Total Medicaid EP Encounters listed for each group member Total Encounters Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 38 of 70 9/16/2015

An indicator stating whether or not the provider consents to include his/her patient volume in the group Signature by each EP Facility Consent Letter Hospital Based Encounters Facility So-Led by a Physician's Assistant Individual Provider Out of State Encounters Providers who are part of an FQHC and attesting to clinic patient volume are required to upload documentation listing the EPs, whether they intend to attest as part of the FQHC, and documenting their consent to include their patient volume included in the clinic volume. For FQHC clinic patient volume attestations please upload a consent form that includes the following information: Patient Volume Reporting Period begin and end dates Patient Volume Numerator Patient Volume Denominator Medicaid Provider Names and NPIs Group NPI Total Medicaid EP Encounters listed for each FQHC member Total Encounters An indicator stating whether or not the provider consents to include his/her patient volume in the clinic volume Signature by each EP Providers servicing Medicaid clients in hospital and non-hospital based settings are required to have no more than 90% of their patient encounters in a Hospital Based setting (place of service code 21 and 23). Please upload a document which breaks out the attested patient volume by Place of Service code. Acceptable patient volume documentation will include the following elements: Report begin and end dates NPI Date of Service Patient Medicaid Number Claim status Place of Service Source of the data Physician Assistants leading an FQHC/RHC are required to upload supporting documentation at the time of attestation. The PA So-Led form can be downloaded from the States Medicaid website. Acceptable PA So-Led forms will include the following information: The FQHC/RHC Clinic name/npi/address/phone A separate sheet that states any additional service location addresses where soled requirements are met Printed name and signature of provider agreeing to the PAs eligibility requirements and understanding that funds are contingent on continued compliance, along with providers title and date Providers who include out-of-state (OOS) encounters in their individual Medicaid patient volume attestation are required to upload additional documentation that Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 39 of 70 9/16/2015

summarizes OOS encounters by state. Acceptable out-of-state encounter documentation will include the following elements: NPI Provider name The state in which the encounters occurred Specify the number of encounters for each state Additional detailed documentation to support attested patient volume may be requested during pre-payment review. FQHC/RHC Individual Provider Out of State Encounters Group Out of State Encounters FQHC/RHC Facility Out of State Encounters Providers who include out-of-state (OOS) encounters in their individual Medicaid patient volume attestation are required to upload additional documentation that summarizes OOS encounters by state. Acceptable out-of-state encounter documentation will include the following elements: NPI Provider name The state in which the encounters occurred Specify the number of encounters for each state Additional detailed documentation to support attested patient volume may be requested during pre-payment review. Providers who include out-of-state (OOS) encounters in their group Medicaid patient volume attestation are required to upload additional documentation that summarizes OOS encounters by state. Acceptable out-of-state encounter documentation will include the following elements: NPI Provider name The state in which the encounters occurred Specify the number of encounters for each state Additional detailed documentation to support attested patient volume may be requested during pre-payment review. Providers who include out-of-state (OOS) encounters in their Medicaid patient volume attestation are required to upload additional documentation that summarizes OOS encounters by state. Acceptable out-of-state encounter documentation will include the following elements: NPI Provider name The state in which the encounters occurred Specify the number of encounters for each state Additional detailed documentation to support attested patient volume may be requested during pre-payment review. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 40 of 70 9/16/2015

Less than 30% Medicaid Patient Volume - Pediatric Board Certification Attested PV exceeds Medicaid Threshold Attested Needy PV exceeds Medicaid Threshold Attested Group PV exceeds Medicaid Threshold Providers who attest as a Pediatrician and report patient volume less than 30% are required to upload documentation in support of their pediatrician attestation. 'Pediatrician' means a physician or Pediatric Dentist who is board certified in pediatrics or has completed a pediatric residency. Acceptable supporting documentation includes: A screen shot from the American Board of Pediatrics or the American Board of Pediatric Dentistry showing the providers status as a pediatrician. Other auditable document verifying providers pediatric credentials. Individual NON FQHC providers are required to upload documentation that supports the patient volume attestation. Supporting documentation for patient volume must come from the providers EHR system or another auditable data source such as a Practice Management System. Acceptable patient volume documentation will include the following elements: Performing Provider NPI Date of Service Patient Medicaid Number Claim Status Source of the data Billing NPI and TIN - can be uploaded as a separate document or in the volume document Individual FQHC providers with are required to upload documentation that supports the attestation. Supporting documentation for patient volume must come from the providers EHR system or another auditable data source such as a Practice Management System. Acceptable patient volume documentation will include the following elements: Performing Provider NPI Date of Service Patient Medicaid Number Claim Status Needy Patient encounters Provider should indicate total patient encounters Source of the data Billing NPI and TIN - can be uploaded as a separate document or in the volume document Group providers with attested volume are required to upload documentation that supports the attestation. Supporting documentation for patient volume must come from the provider s EHR system or another auditable data source such as a Practice Management System. Acceptable patient volume documentation will include the following elements: Performing Provider NPI Date of Service Patient Medicaid Number Claim Status Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 41 of 70 9/16/2015

Source of the data Billing NPI and TIN - can be uploaded as a separate document or in the volume document Attested Group Needy PV exceeds Medicaid Threshold Providers attesting to FQHC clinic volume are required to upload documentation that supports the attestation. Supporting documentation for patient volume must come from the providers EHR system or another auditable data source such as a Practice Management System. Acceptable patient volume documentation will include the following elements: Performing Provider NPI Date of Service Patient Medicaid Number Claim Status Needy Patient encounters Provider should indicate total patient encounters Source of the data Billing NPI and TIN - can be uploaded as a separate document or in the volume document The Supporting Documentation Upload screens are continued on the next page. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 42 of 70 9/16/2015

3.6.1 Supporting Documentation Upload Requirements Screen After enrollment Step 4 the system will evaluate all of the attested information and determine which required documents must be uploaded to complete the attestation. The EP may print out the documentation requirements by clicking the Download Document Requirements to PDF button. To upload a required document, he/she can click the Upload Document button to select the appropriate local file (as seen in the next section.) The EP may also elect to upload optional documentation by opening the Additional Documentation Optional section and uploading. Once complete, he/she can click the Save & Continue button to proceed. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 43 of 70 9/16/2015

3.6.2 Upload Document Screen When the EP clicks the Upload Document button the system will present the Document Upload screen-pop. He/she can click the Browse button to local the file to upload. The EP will also be required to check the box indicating he/she understands that the document being uploaded cannot contain PHI. Once complete, the EP will click the Upload button to transfer the file where the document status will change to Complete Pending Review. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 44 of 70 9/16/2015

3.7 Enrollment Summary Once the EP completes the Required Document uploads then the system will present the Enrollment Summary page. The EP carefully reviews all the selections, attested information, and calculations; clicks Continue; and will then be presented the Legal Notice. If the EP finds a discrepancy they can click the Previous button to go back to the appropriate step to update the attested information. The EP may also download a copy of the enrollment information by clicking the Download Enrollment Date to PDF button in the top right-hand corner of the page. Note: The next two screenshots present the top and bottom halves of the Enrollment Summary. Continued on next page. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 45 of 70 9/16/2015

Enrollment Summary continued: Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 46 of 70 9/16/2015

3.8 Legal Notice The EP Legal Notice will be presented over the next three screenshots due to length. The Legal Notice outlines the disclosures of the program and he/she must sign to complete the enrollment process. The EP is required to add an appropriate electronic signature and the CMS Registration ID (located in the CMS RNA system) and clicks Agree & Continue. Once the Legal Notice is completed, a PDF copy of the Legal Notice will be automatically uploaded to the provider s Documents tab, where it can be reviewed and/or downloaded for printing. If the EP disagrees with the Legal Notice a message is prompted to the screen and enrollment cannot continue. Continued on next page. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 47 of 70 9/16/2015

Legal Notice part 2 of 3: Continued on next page. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 48 of 70 9/16/2015

Legal Notice part 3 of 3: Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 49 of 70 9/16/2015

3.9 Submit Enrollment After completing the Legal Notice, the EP has completed Medicaid EHR Incentive Program enrollment and is ready to submit enrollment. The EP reviews this page and clicks Confirm & Submit. Once submitted, the system will validate all attested information and present any errors if any updates are required. The EP cannot use any browser navigation features during this validation process and the system will present a timing hourglass as an indication that it is processing the enrollment. If no errors are found, the system will present the congratulations screen. 3.9.1 Submit Enrollment After reviewing the attested information the EP can click the Confirm & Submit button to submit the enrollment for verification. If successful, the system will present the Enrollment Confirmation screen (next page.) Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 50 of 70 9/16/2015

3.9.2 Enrollment Confirmation Congratulations! The EP has successfully completed enrollment for this program year in the Medicaid EHR Incentive Program! Review this page; print for file; click Enrollment Home. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 51 of 70 9/16/2015

3.9.3 Enrollment Home Post Enrollment Submission Back on the Enrollment Home page, the EP can see that enrollment is complete and the enrollment status is now showing as Submitted for Review. Once the EP is paid, the Status will update to Paid. He/she may also view the Enrollment Summary by clicking the View Status button. See the section above for the screenshots of the Enrollment Summary page. We will now review each of the tabs, from left-to-right, starting with Documents. Click the Documents tab. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 52 of 70 9/16/2015

4 Documents Tab When the provider clicks the Documents tab, the Documents Home page is displayed. The EP has the ability to view previously uploaded documents (for all enrollments) as well as the ability to upload any additional required documents to support the attestation. The following screens outline the functionality within the Documents tab. 4.1 Documents Home After the EP clicks the Documents tab at the top he/she is presented with the Documents Home page. This is the launch point to view any historically uploaded documents or to upload new documents based on the program year. The EP can click the Manage Documents button to navigate to the Documents page for the specific program year. In the following pages the screens are shown for the 2015 program year. In the following screenshot, there are presently 3 documents uploaded for this EP. Click Manage Documents to see the documents uploaded for the 2015 program year. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 53 of 70 9/16/2015

4.1.1 Manage Documents 2015 Program Year The screen below displays all of the documents that the EP uploaded for the 2015 program year. He/she will be able to view the document by clicking the View Document button. To upload a required or optional document the EP can click the Upload New Document button (as displayed in the next section.) Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 54 of 70 9/16/2015

4.1.2 Documents Upload New Document As a result of clicking the Upload New Document button, the Document Upload screen-pop is displayed. The EP must select the Type of document to be uploaded and can select the local file by clicking the Browse button. The EP will also be required to check the box indicating he/she understands that the document being uploaded cannot contain PHI. Once complete, the EP will click the Upload button to transfer the file where the document status will change to Complete Pending Review. Note: Once uploaded, the EP cannot delete a document; the provider can only upload a new document to replace or update an existing document. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 55 of 70 9/16/2015

5 Reconsiderations Tab The EP will always have the opportunity to submit Reconsideration for the VMIP team s consideration. The following screens outline the reconsideration submission and status process. 5.1 Reconsiderations Home None Submitted The following screenshot depicts the Reconsiderations Home page with no reconsiderations submitted. The EP can click the Request Reconsideration to submit a new reconsideration to the VMIP team. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 56 of 70 9/16/2015

5.1.1 Submit a New Reconsideration To submit a new reconsideration the EP must enter the Category, Type, Program Year, and brief description (less than 2000 characters.) Once complete he/she can click the Submit button to proceed. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 57 of 70 9/16/2015

5.1.2 Reconsideration Status Not Yet Resolved After clicking Submit, the EP will be navigated to the Reconsideration Status page. From here, he/she can upload supporting documentation or click Previous to return to the Reconsiderations Home page. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 58 of 70 9/16/2015

5.1.3 Reconsideration - Upload Supporting Document As a result of clicking the Upload New Document button, the Document Upload screen-pop is displayed. The EP must select the Type of document to be uploaded and can select the local file by clicking the Browse button. The EP will also be required to check the box indicating he/she understands that the document being uploaded cannot contain PHI. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 59 of 70 9/16/2015

5.1.4 Reconsideration Home Reconsideration Submitted After uploading the document, the EP will click Previous to return to the Reconsiderations Home page, which now shows a reconsideration Status of Unassigned (that is, it has been submitted, but is not yet assigned, worked, or resolved by the VMIP team.) If you have questions about the status of your reconsideration please contact the help desk. The EP may elect to withdraw the reconsideration by clicking the Withdraw button or view the status of the reconsideration by clicking the View Details button. After the reconsideration has been resolved, it would appear as follows. Notice that, once the reconsideration is being worked by a Business Services Program Specialist (Status = In Progress), the EP can no longer withdraw the request for reconsideration, and the Withdraw command button will no longer be visible on the Reconsiderations home page. Here the reconsideration has been favorably reviewed and completed, and has been approved. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 60 of 70 9/16/2015

6 Status Tab Clicking on the Status tab will display the Status Summary Home page. The EP can come back to the Status tab to review the enrollment status of any previously submitted enrollment. The following screens outline the process for reviewing historical enrollment information and status of payment. 6.1 Status Summary Home Page The Status Summary Home Page lists all of the enrollments and status for each program year. The view more details, the EP can click the View Details button. If the EP clicks View Details, the Enrollment Summary page will be displayed, as shown in the next two screenshots. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 61 of 70 9/16/2015

6.1.1 Enrollment Summary The EP can carefully review all the selections, attested information, and calculations for the enrollment. Once paid, the EP can view payment details in the EHR Incentive Payment Details section. The EP may also download a copy of the enrollment information by clicking the Download Enrollment Date to PDF button in the top right-hand corner of the page. Note: The next two screenshots present the top and bottom halves of the Enrollment Summary. Virginia VMIP EP Year 1 AIU v3 2015.09.14.docx Page 62 of 70 9/16/2015

Enrollment Summary page 2 of 2: Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 63 of 70 9/16/2015

7 Manage Account Tab Clicking on the Manage Account tab allows the EP to view and to keep updated contact information specifically for the provider s VMIP-related communications. 7.1 Manage Account Update Contact Information After review, the EP can click the Update button to change the Email or Phone number on file. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 64 of 70 9/16/2015

7.2 Update Contact Information After clicking Update, the Update Contact Information section is displayed ready for new data entry. Once entered, he/she will click the Save button to complete the change(s). Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 65 of 70 9/16/2015

8 Contact Us Tab Secure Communications The Contact Us tab provides the tools to support secure communications between the provider and the VMIP team. 8.1 Contact Us Home On the Contact Us Home page, the EP can initiate a new secure communication by clicking Create New Message or view previously submitted secure communications. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 66 of 70 9/16/2015

8.1.1 Create Secure Communication Here the provider has clicked Create New Message, and is required to enter a Type, Subject and Message (less than 2000 characters) and the name of the sender. Once entered, the EP can click the Submit button to transmit the message to the Help Desk. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 67 of 70 9/16/2015

8.1.2 Contact Us New Communications On the Contact Us Home page, the new secure communications is shown collapsed. The EP will click the expand + icon to view all responses to the communication. The EP can initiate a response by clicking the Respond button. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 68 of 70 9/16/2015

8.1.3 Secure Communications Response The EP can respond to any Help Desk comments by completing message and name of sender fields. The EP can click the Submit button to send the response to the help desk. Virginia VMIP EP Year 1 AIU v2 2013.03.14.docx Page 69 of 70 9/16/2015