West Virginia EHR Incentive Program Attestation Application User Manual For Eligible Hospitals 2015 Stage 1 & 2 Attestations

West Virginia EHR Incentive Program Attestation Application User Manual For Eligible Hospitals 2015 Stage 1 & 2 Attestations Date of Publication: 12/2015 Document Version: 1.1

Provider Incentive Program Hospitals EH 2015 Stage 1 & 2 Attestations Privacy Rules The Health Insurance Portability and Accountability Act of 1996 (HIPAA Public Law 104-191) 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 would allow 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 recipient; the provision of healthcare to an individual; or the past, present, or future payment for the provision of health care to an individual. Claims data, prior authorization information, and attachments such as medical records and consent forms are all PHI. 1 45 CFR Parts 160 and 164, Standards for Privacy of Individually Identifiable Health Information; Final Rule Confidential and Proprietary Page 2

Provider Incentive Program Hospitals EH 2015 Stage 1 & 2 Attestations Revision History Version Date Author Action/Summary of Changes Status 1.0 12/2013 Karla Battle First Draft Completed 1.1 10/2015 Karla Battle Modified for 2015 Stage 1 and Stage 2 changes outlined by CMS In Review with State Confidential and Proprietary Page 3

Provider Incentive Program Hospitals EH 2015 Stage 1 & 2 Attestations Table of Contents Privacy Rules... 2 Revision History... 3 Table of Contents... 4 Table of Figures and Tables... 6 1. Introduction... 10 1.1 Eligible Hospitals... 12 1.2 Registering with CMS... 12 2. Information Needed... 13 2.1 Eligible Hospital Attestation Workbook - Overview... 14 3. Required Supporting Documentation... 15 4. Finding EHR Certification Number... 16 5. Selecting Cost Reports... 17 6. System Requirements... 18 7. Navigation... 19 7.1 Breadcrumbs... 19 7.2 Use of the Navigation Features... 19 7.2.1 Help Hyperlink... 20 7.2.2 West Virginia EHR Incentive Program Account Hyperlink... 20 7.2.3 Back to WV MMIS Portal link... 20 7.2.4 Home Tab... 21 7.2.5 Registration Tab... 22 7.2.6 Attestation Tab... 23 7.2.7 The Standard Buttons.... 24 8. Using the West Virginia EHR Incentive Program Attestation Application... 25 8.1 Login to the West Virginia EHR Incentive Program Attestation Application... 25 8.1.1 Starting the West Virginia EHR Incentive Program Attestation Application... 26 8.2 Registering a Hospital within the West Virginia EHR Incentive Program Attestation Application... 31 8.2.1 Add Registration... 33 8.2.2 Select Registration... 35 8.2.3 Remove Registration... 36 8.3 Pre-Attestation Eligibility Checks... 36 8.4 Attestation... 37 8.4.1 Attestation Eligibility... 42 8.4.2 Attestation Payment Schedule... 47 8.4.3 Certified EHR Technology... 48 8.4.4 Dually-eligible hospitals ONLY... 50 8.5 Meaningful Use (MU) Core Questions... 51 Confidential and Proprietary Page 4

Provider Incentive Program Hospitals EH 2015 Stage 1 & 2 Attestations 8.5.1 Meaningful Use Core Question General Workflow Functionality... 52 8.6 Public Health Reporting Measures... 53 8.6.1 Public Health Reporting Question General Workflow Functionality... 55 8.7 Clinical Quality Measures (CQMs)... 56 8.7.1 Clinical Quality Measures Question General Workflow Functionality... 57 8.8 Supporting Documentation... 58 8.9 Submit Attestation and Payment Status... 61 9. Status Grid... 65 10. Successful Registration with CMS Email... 66 11. Submitted Attestation Email... 67 12. Error Occurred When Processing Registration Email... 68 13. Attestation Accepted Email... 69 14. Error Occurred While Processing Registration Medicaid Enrollment Failed Email 70 15. Attestation Error Medicaid Claims Count Failed Email... 71 16. Attestation Paid Email... 73 17. Attestation Payment Denied Email... 74 18. Attestation Payment Denied Pay Hold Found... 75 19. Attestation Excluded from Payment Email... 76 20. Attestation Rejected Email... 77 21. Attestation Pended for Out-of-State Entries... 78 22. Attestation Failed Meaningful Use... 79 23. Stage 1 and Stage 2 Core Menu Measures... 80 24. Public Health Reporting Measures... 100 25. Stage 1 and Stage 2 Clinical Quality Measures Screenshots... 104 Confidential and Proprietary Page 5

Provider Incentive Program Hospitals EH 2015 Stage 1 & 2 Attestations Table of Figures and Tables Figure 1 - Example Workbook Page... 14 Figure 2 - CMS ONC Certified EHR Product Screen... 16 Figure 3 - Breadcrumbs... 19 Figure 4 - Feature Description... 19 Figure 5 - Update Account Screen Example... 20 Figure 6 - Home Page... 21 Figure 7 - Registration Tab... 22 Figure 8 - Attestation Selection Example... 23 Figure 9 - Registration Tab... 24 Figure 10 Provider Web Portal... 26 Figure 11: Trading Parnter Sign In... 27 Figure 12 - WV Welcome Page Example... 28 Figure 13 - Provider Incentive About This Site Page... 29 Figure 14 - Home Page... 30 Figure 15 - Registration Tab... 31 Figure 16 - Registration Tab Registration Home Page... 32 Figure 17 - Registration Tab No Records to Display... 33 Figure 18 - Registration Tab - Add Registration... 33 Figure 19 - Registration Tab - Registration Information Window... 34 Figure 20 - Add Registration Error Message... 35 Figure 21 - Registration Tab - Registration Information... 35 Figure 22 - Registration Tab Remove Option... 36 Figure 23 - Attestation Selection Example... 39 Figure 24 - Reason for Attestation Example... 40 Figure 25 - Verify Registration Information Example... 41 Figure 26 - Medicaid Volume Example... 44 Figure 27 - Out-of-State Entry Screen... 45 Figure 28 - Out-of-State Add Entries screen... 46 Confidential and Proprietary Page 6

Provider Incentive Program Hospitals EH 2015 Stage 1 & 2 Attestations Figure 29 - Payment Schedule Example... 47 Figure 30 - CMS EHR Buttons Example... 48 Figure 31 Certified HER Technology... 49 Figure 32 Error message... 50 Figure 33 - Meaningful Use Core Questions List... 51 Figure 34 - Meaningful Use Menu Measures Question List... 53 Figure 35 - Menu Measure Error Message example... 54 Figure 36 Menu Measure Error if registry used more than once... 54 Figure 37 - Clinical Quality Measure Question Example... 56 Figure 38 Uploading Supporting Documents Page... 58 Figure 39- Supporting Documentation - Add Screen... 59 Figure 40 Topics Page... 61 Figure 41 - Attestation Tab Attestation Reasons for Submission Page... 62 Figure 42 - Attestation Tab - Submission Receipt Window... 63 Figure 43 - Attestation Status... 65 Figure 44 - Successful CMS registration email... 66 Figure 45 Submitted Attestation email... 67 Figure 46 Registration failed email... 68 Figure 47 Attestation Accepted email... 69 Figure 48 Medicaid Enrollment failed email... 70 Figure 49 Medicaid claims count failed email... 71 Figure 50 Encounter count failed email... 72 Figure 51 Attestation Paid email... 73 Figure 52 Payment Denied email... 74 Figure 53 Pay Hold email... 75 Figure 54 Duplicate Payment Error email... 76 Figure 55 Attestation rejected email... 77 Figure 56 Pended for OOS entries email... 78 Figure 57- Failed MU email... 79 Confidential and Proprietary Page 7

Provider Incentive Program Hospitals EH 2015 Stage 1 & 2 Attestations Table 1 Stage 1 and 2 Core Menu Measures... 80 Figure 58 PH Immunization Registry Reporting... 100 Figure 59 PH Syndromic Surveillance Reporting... 101 Figure 60 PH Specialized Registry Reporting... 102 Figure 61 PH Electronic Reportable Lab Results Reporting... 103 Figure 62 CQM 1 - ED-1 Emergency Dept Throughput... 104 Figure 63 CQM 2 ED-2 Emergency Dept Throughput... 104 Figure 64 CQM 3 Stroke-2-Discharged on Anti-thrombotic Therapy... 104 Figure 65 CQM 4 Stroke 3 Anticoagulation Therapy for Atrial Fibrillation/Flutter... 105 Figure 66 CQM 5 Stroke 4 Thrombolytic Therapy... 105 Figure 67 CQM 6 Stroke 5 Antithrombotic Therapy by end of Hospital Day Two... 105 Figure 68 CQM 7 Stroke 6 Discharged on Statin Medication... 106 Figure 69 CQM 8 Stroke 6 Stroke Education... 106 Figure 70 CQM 9 Stroke 10 Assessed for Rehabilitation... 106 Figure 71 CQM 10 VTE Prophylaxis... 107 Figure 72 CQM 11 VTE-2 ICU VTE Prophylaxis... 107 Figure 73 CQM 12 VTE-3 Patients with Anticoagulation Overlap Therapy... 108 Figure 74 CQM 13 VTE-4 IV UFH therapy... 108 Figure 75 CQM 14 VTE-5 VTE Discharge Instructions... 109 Figure 76 CQM 15 VTE-6 Incidence of potentially preventable VTE... 109 Figure 77 CQM 16 VTE 16 AMI-2 Aspirin Prescribed at Discharge for AMI... 109 Figure 78 CQM 17 PC-01 Elective Delivery Prior to 39 Completed Weeks Gestation... 110 Figure 79 CQM 18 AMI-7a Fibrinolytic Therapy Received within 30 minutes of Hospital Arrival... 110 Figure 80 CQM 19 AMI-8a Primary PCI Received Within 90 Minutes of Hospital Arrival... 110 Figure 81 CQM 20 AMI-10 Statin Prescribed at Discharge... 111 Figure 82 CQM 21 PN-6 Immunocompetent patients with CAP... 111 Confidential and Proprietary Page 8

Provider Incentive Program Hospitals EH 2015 Stage 1 & 2 Attestations Figure 83 CQM 22 SCIP-INF-1 Prophylactic Antibiotic Received within 1 hour Prior to Surgical Incision... 111 Figure 84 CQM 23 SCIP-INF-2 Prophylactic Antibiotic Selection for Surgical Patients... 112 Figure 85 CQM 24 SCIP-INF-9 Urinary Catheter Removed... 112 Figure 86 CQM 25 ED-3 Median Time from ED Arrival to ED Departure for Discharged ED Patients... 112 Figure 87- CQM 26 HMPC Document Given to Patient/Caregiver... 113 Figure 88 CQM 27 Exclusion Breast Milk Feeding... 113 Figure 89 CQM 28 Healthy Term Newborn... 113 Figure 90 CQM 29 EDHI-1a Hearing Screening Before Hospital Discharge... 114 Confidential and Proprietary Page 9

1. Introduction The document provides instructions for Eligible Hospitals (EH) who are attesting for Adopt, Implement or Upgrade (AIU) or Meaningful Use (MU) Stage 1 and Stage 2 for calendar year (CY) 2015. The instructions will provide designation between Stage 1 and Stage 2 attestation rules. Stage 1 Attestation definition: An EH that is demonstrating MU for the first time. An EH that is completing the second year of attestation after demonstrating AIU. Stage 2 Attestation definition: An EH that has successfully completed two attestations and received two payment for MU Stage 1. CMS defines the stages as: Stage 1 sets the baseline for electronic data capture and information sharing. Eligible hospitals (EHs) must receive two EHR Incentive Program payments for meeting these requirements before moving on to Stage 2. Stage 2 meaningful use requirements were formalized in federal regulations in September of 2012, focuses on advanced clinical procedures, including: Measures focused on more rigorous health information exchange (HIE); Additional requirements for e-prescribing and incorporating lab results; Electronic transmission of patient care summaries across multiple settings; and Increased patient and family engagement. Stage 3 meaningful use requirements were formalized in federal regulations effective in December 2015, focused on the following goals: Provide a flexible, clear framework to simplify the meaningful use program and reduce provider burden; Ensure future sustainability of Medicare and Medicaid EHR Incentive Programs; Advance the use of health IT to promote health information exchange and improved outcomes for patients Meaningful use attestations are not evaluated solely for meeting meaningful use objectives and reporting clinical quality measure information. A hospital must also be either actively enrolled with Medicaid as an acute care hospital (including critical access hospitals or cancer hospitals) and meet a 10% Medicaid patient volume threshold or be a children s hospital to be eligible for Medicaid EHR Incentive Program payments. The Stage 1 and Stage 2 meaningful use requirements were modified in the federal regulations that were released in effective December 2015, for Stage 3. The changes are summarized as follows: Confidential and Proprietary Page 10

EHR Reporting Period For 2015 EHs will attest using the calendar year rather than fiscal year for the Certified Electronic Health Record Technology (CEHRT) reporting period. The EHR reporting period is any continuous 90-day period within the calendar year. For 2016 and beyond, For first time participants or first year of demonstrating Meaningful Use, the reporting period would be any continuous 90-day period within the calendar year. Returning participants that have successfully demonstrated meaningful use in a prior year, the reporting period would be a full calendar year. Last Year for Eligible Hospitals to Begin Participation and Receive Payments in the Medicaid and Medicare EHR Incentive Program. CMS released an announcement on February 11, 2015 for eligible hospitals who have not started participation in the EHR Incentive Programs. For the Medicare EHR Incentive Program, the last year to begin and still earn incentive payments is FY2015. For the Medicaid EHR Incentive Program, the last year to begin and still earn incentive payments is FY2016. Medicaid eligible hospitals must receive an incentive in FY2016 to receive an incentive in FY2017 and later years. Starting in FY2016, incentive payments must be made every year in order to continue participation in the program. Dual-Eligible Hospital Attestations For EH that are attesting as dual-eligible hospital, meaningful use information from Medicare will be exchanged between CMS Medicare attestation process and the West Virginia EHR Incentive program application. The West Virginia EHR Incentive program will insert the meaningful use information into the meaningful use screens. The application user will be able to review and modified as needed. The attestation process is halted until the Medicare MU information is received from CMS Medicare attestation process. 2015 EH Meaningful Use Requirement There are a total of 9 meaningful use objectives. The following requirements must be met to qualify for the incentive payment. Core Objectives EP must complete 8 core objectives Public Health Reporting Objectives (multiple options) EP must attest to two Public Health question Clinical Quality Measures EP must report on 16 of 29 CQM Confidential and Proprietary Page 11

1.1 Eligible Hospitals To be eligible for the West Virginia EHR Incentive Program, a hospital must be actively enrolled with West Virginia Medicaid and fall into one of the following categories: Acute Care Hospitals Includes general hospitals, cancer hospitals and critical access hospitals; Must have a CMS Certification Number (CCN) with the last four digits in the series 0001 0879 and 1300-1399; Must have an average length of patient stay of 25 days or fewer; Must have 10% Medicaid patient volume based on encounters. Children s Hospitals Must have a CMS Certification Number (CCN) with the last four digits in the series 3300-3399; No average length of stay or patient volume requirements 1.2 Registering with CMS If you have submitted an attestation, you do not need to register with CMS. Your attestation will be ready when WV EHR Incentive Program Attestation Application opens up the attestation period. If you are a new user and have not submitted an attestation, prior to participating in the Medicaid EHR Incentive program, an eligible hospital first must be registered for the EHR Incentive Program within the CMS National Level Repository (NLR) system to sign up for the program at the national level and must select either Medicaid or dual-eligible. This will enable the CMS NLR solution to notify the Medicaid EHR Incentive Payment application of the hospital s intent to attest for incentive payment. Visit the National Level Repository (NLR) solution at https://ehrincentives.cms.gov/hitech/login.action to register. Once the hospital has successfully registered with the CMS NLR for the Medicaid EHR Incentive Program, the hospital must complete the attestation for the year with the Medicaid EHR Incentive Payment solution available by logging into the secure Medicaid Provider web portal www.wvmmis.com after waiting at minimum 48 hours for incentive registration to be processed and be received by Medicaid EHR Incentive program application from the NLR. Hospitals who do not have access to the web portal can request access via an online form at www.wvmmis.com Confidential and Proprietary Page 12

2. Information Needed Before a hospital can begin to complete a West Virginia EHR Incentive Program attestation, the hospital will need to gather all of the information necessary to complete the attestation correctly. The West Virginia EHR Incentive Program has created a workbook to guide the hospital user through the data needed to complete an attestation successfully. The workbook is available in Excel format within the WVMMIS Provider Portal at www.wvmmis.com. The Eligible Hospital Workbook provides the questions CMS requires for their registration process and that the EHR Incentive Program Attestation Application requires for West Virginia s attestation process. The Workbook can be used to gather answers before logging in to the EHR Incentive Program Attestation Application. Confidential and Proprietary Page 13

2.1 Eligible Hospital Attestation Workbook - Overview The Workbook describes the eligibility requirements, the meaningful use core and menu measures, and the clinical quality measures for eligible hospitals and web requirements for utilizing the West Virginia EHR Incentive Program Attestation Application. It can also hold your responses before accessing the application. A sample page from the workbook is below; the full version is available at the West Virginia Medicaid EHR Incentive Program website (http://www.state.wv.us/health/wvhit/ehr/). Figure 1 - Example Workbook Page Confidential and Proprietary Page 14

3. Required Supporting Documentation CMS and BMS recommend documentation supporting hospital attestations be retained in case of audit. Hospitals must maintain records in accordance with Federal regulations for a period of 5 years, or 3 years after audits. The hospital must make all records and documentation available upon request to West Virginia BMS, the United States Department of Health and Human Services, or contracted entities acting on their behalf. Such records and documentation should include, but not be limited to, the following: Hospital Information (credentials) Identification of Service Sites Supporting material used to measure Medicaid patient volume (including Excel spreadsheets or any other report identifying discharge dates and emergency department information used to count patient encounters.) Invoices, lease agreements, contract or other documentation supporting adoption, implementation, or upgrading of ONC-certified EHR technology EHR reports supporting meaningful use objective and clinical quality measure information. Please review BMS requirements and applicable provider manuals for the specific service requirements, retention periods, and lists. Out of State Documentation If the hospital plans to include encounter counts from another state (this is optional), the following documentation is required in an electronic format (pdf, Microsoft Word or Excel, or jpeg) and will need to be included with the electronic attestation: Certification on official letterhead from the other state Medicaid agency or agencies declaring the numbers obtained were derived from the State s MMIS and are accurate. Report generated by the other state Medicaid agency or agencies with the total fee-forservice and managed care encounter count and reporting period. Confidential and Proprietary Page 15

4. Finding EHR Certification Number The Office of the National Coordinator Authorized Testing and Certification Body (ONC- ATCB) tests and certifies electronic health record (EHR) systems. If the EHR system is approved ONC-ATCB, it is assigned a certification number. The website below is the Certified Health IT Product List website that can be used to find an EHR certification number or even to register an EHR system. http://onc-chpl.force.com/ehrcert Figure 2 - CMS ONC Certified EHR Product Screen Confidential and Proprietary Page 16

5. Selecting Cost Reports If your hospital is choosing to use its Medicare cost reports to complete its West Virginia EHR Incentive Program overall payment calculation, it is imperative that the appropriate cost reports are selected. The Eligible Hospital Attestation Workbook provides the location of the Medicare cost report data elements that are needed to complete a payment calculation. Please be aware that 42 CFR 495.31 (g)(1)(i) (B) states that the discharge-related data amount must be calculated using a twelve month period that ends in the hospital s fiscal year before the federal fiscal year that serves as the first payment year. To assist hospitals in determining the correct cost reporting period(s) to utilize in entering discharge and Medicaid share data used in calculating the facility s overall Medicaid EHR Incentive Program payment, the following reference is provided. STEP 1: Enter the current federal fiscal year in which you are applying (If applying prior to 9/30/11 enter FY2011: if applying on or after 10/1/11 enter FY2012.) STEP 2: Subtract from the date entered in Step 1, one fiscal year (Assuming FFY 2011 is entered, the date entered would be FFY 2010) STEP 3: Select the year end cost report that falls within the FFY identified in Step 2 a. If Hospital A YE = 12/31; Hospital A must report discharge and Medicaid share data using the cost report ending 12/31/2009 b. If Hospital B YE = 6/30; Hospital B must report discharge and Medicaid share data using the cost report ending 6/30/2010 c. If Hospital C YE = 9/30; Hospital C must report discharge and Medicaid share data using the cost report ending 9/30/2010 Confidential and Proprietary Page 17

6. System Requirements To successfully use all features of the West Virginia Medicaid EHR Incentive Program Attestation Application, ensure that the computer system meets the following minimum requirements: PC with a reliable internet connection Web browser The latest version of Microsoft Internet Explorer is recommended (IE8.0 and higher). As new versions of Internet Explorer become available it is recommended that these versions are used Adobe Acrobat Reader Confidential and Proprietary Page 18

7. Navigation This section describes all of the different navigation options that are available throughout the application. 7.1 Breadcrumbs When a hyperlink is clicked, the appropriate web page is displayed to the right of the navigation bar. The breadcrumbs indicate the current position within the site. Breadcrumbs are a visual representation of pages and sub-pages followed to reach this page. Select the underlined name to return to the specific page. For the example screen, the breadcrumb translates to the following The gray text that is not underlined in the breadcrumb indicates the current section. In this case it is the Meaningful Core Measures section. The underlined text will display the page that it is assigned. For example: o o displays the Reason for Attestation page. displays the Attestation Instructions page. Breadcrumbs 7.2 Use of the Navigation Features Figure 3 - Breadcrumbs Every screen of EHR Incentive Program Attestation Application has a set of standard navigation features. These are found on the upper right had corner of the application screens as shown in Figure 4 below. Figure 4 - Feature Description Confidential and Proprietary Page 19

7.2.1 Help Hyperlink Each meaningful use question and clinical quality measure screen includes a Help link. When selected, the CMS specifications for the meaningful use question or clinical quality measure display in a separate Internet Explorer window. An example of the link is below: 7.2.2 West Virginia EHR Incentive Program Account Hyperlink Choosing this link will display a screen with an e-mail address field. The West Virginia EHR Incentive Program Attestation Application will send attestation status updates and other system notifications to the e-mail address listed. The user may enter a new address or update an existing one. Save changes by selecting the Update button. Press the Cancel button and changes will not be saved. 7.2.3 Back to WV MMIS Portal link Figure 5 - Update Account Screen Example Displays the WV MMIS Portal Welcome screen. Refer to Figure 12 - WV Welcome Screen. Confidential and Proprietary Page 20

7.2.4 Home Tab The Home tab displays the Home Page as shown in Figure 6. Figure 6 - Home Page Confidential and Proprietary Page 21

7.2.5 Registration Tab The Registration tab displays the Registration Instructions window as shown in Figure 7 below. Figure 7 - Registration Tab Confidential and Proprietary Page 22

7.2.6 Attestation Tab The Attestation tab displays the Attestation Home Page as shown in Figure 8. Figure 8 - Attestation Selection Example Confidential and Proprietary Page 23

7.2.7 The Standard Buttons. There are buttons found below the fields of each functional window that enable certain actions. The available actions depend on the purpose of the window. The most common buttons are the Previous Page and Save and Continue buttons. The Previous Page button displays the previous page in the current page sequence. The Save and Continue button must be selected to retain information entered in any screen. If it is not selected, any entries in the screen are lost and must be re-entered. At the last attestation screen, the Submit button is also an option and is used when the user is ready to submit an attestation for processing and possible payment. Figure 9 - Registration Tab Confidential and Proprietary Page 24

8. Using the West Virginia EHR Incentive Program Attestation Application The West Virginia EHR Incentive Program Attestation Application guides the user through the CMS required questions to determine if a provider is eligible to receive EHR Incentive Program payments. A workbook that contains the questions and the rules outlined by CMS is available and provides areas where answers may be recorded. A hospital may enter the information or assign someone to enter the information on their behalf. The list below contains the different sections of the application. Each section is discussed in detail. Pre-eligibility checks Login instructions How to register a hospital Entry of eligibility responses Respond with Medicaid volume and determine if the amount is accurate. If not, then determine if certain criteria are met. Payment schedule Entry of CMS EHR information, including meaningful use objectives and clinical quality measures Submit attestation 8.1 Login to the West Virginia EHR Incentive Program Attestation Application This section provides instructions on how to start the West Virginia EHR Incentive Program Attestation Application and log into the system to use the application. The user should be authorized by their facility to enter information on their behalf. Confidential and Proprietary Page 25

8.1.1 Starting the West Virginia EHR Incentive Program Attestation Application The application runs on the Internet. Execute the following steps to start the application. Access the wvmmis.com main page, as shown in the figure below. Either sign in or register for a Trading Partner Accout to get started. Figure 10 Provider Web Portal Confidential and Proprietary Page 26

Log on by entering in the Username and Password in the appropriate entry boxes and select Submit. Enter web portal user ID. Enter web portal password. Check the I have read and accept the HIPAA PHI proviacy policy box. Select SIGN IN button. Figure 11: Trading Parnter Sign In Confidential and Proprietary Page 27

On the Form Entry window, select the Provider Incentive Program option. Figure 12 - WV Welcome Page Example Confidential and Proprietary Page 28

The Provider Incentive Program About This Site window diplays as shown in Figure 13. Figure 13 - Provider Incentive About This Site Page Confidential and Proprietary Page 29

Select the Continue button to display the West Virginia EHR Incentive Program Home Page. Refer to Figure 14. Figure 14 - Home Page Confidential and Proprietary Page 30

8.2 Registering a Hospital within the West Virginia EHR Incentive Program Attestation Application The West Virginia EHR Incentive Program application s registration process is used to associate the CMS registration with the West Virginia EHR Incentive Program attestation. The following bulleted items are different scenarios and indicate if the registration process is executed. If you have submitted a prior attestation, you do not need to register. Your attestation will be ready when the attestation year is opened in the WV EHR Incentive Program Attestation Application. Use the Attestation tab. If you are a new user to submit on behalf of an EP who is eligible for Stage 1, you will need to register and follow the Add Registration instructions. Please ensure that you have the EH s permission to attest on his or her behalf. If the EH s information has changed, you may need to update their CMS registration information on the CMS registration page at https://ehrincentives.cms.gov/. Be sure to submit or complete the action on the CMS page. This includes the action of reviewing the information on the CMS page. If you do not submit or complete, this will stop your attestation from processing. The Register tab associates one or more EH registrations to a user ID, allows the user to view registration IDs that are attached to their user ID, and allows the user to remove any EP registrations. Please obtain authorization from the EH to enter the data on their behalf. To view, add, and remove registrations, select the Registration tab on the navigation bar. Figure 15 - Registration Tab Confidential and Proprietary Page 31

On selection, the Registration Home Screen displays as shown in Figure 16 below. Figure 16 - Registration Tab Registration Home Page Confidential and Proprietary Page 32

The Registration Home Page lists all registrations that you have added. If you have not added any, the Registration Selection section will display No records to display as shown in the figure below. Figure 17 - Registration Tab No Records to Display The sections below explain the options that are available on the Registration Home Page, which are Add Registration, Select, and Remove. 8.2.1 Add Registration Figure 18 - Registration Tab - Add Registration Confidential and Proprietary Page 33

The following describes the steps required to add a CMS registration to the West Virginia EHR Incentive Program Attestation Application. 1. Click the Add Registration button on the Registration Home Page. 2. Enter the registration ID from the CMS website 3. Enter the provider s NPI. 4. Click the Add button. The system validates that the registration ID is a valid ID assigned by CMS and that the correct NPI was entered. If valid, the registration ID and NPI is associated with the user ID. The Registration Information window displays with the registration information that was entered. Refer to Figure 19. 5. The Previous Page button returns to the Registration Home page. Figure 19 - Registration Tab - Registration Information Window Confidential and Proprietary Page 34

If invalid, an error message displays. The Add Registration page continues to display until the information is entered correctly or a navigation option is selected. Error Msg. The most common reasons why an error occurs: Figure 20 - Add Registration Error Message Information entered incorrectly - if necessary, access the CMS NLR website at ehrincentives.cms.gov to check the information or add a new registration. The registration ID will not be found if 48 hours have not expired since completing and submitting the registration on the CMS NLR website. The Cancel button is an additional option that is available. Clicking the Cancel button does not add the registration ID and the Registration Home Page displays. No additional registration IDs is displayed. 8.2.2 Select Registration Click the Select hyperlink and the registration details displays for the registration ID selected. Refer to Figure 21. Figure 21 - Registration Tab - Registration Information Confidential and Proprietary Page 35

8.2.3 Remove Registration The Remove hyperlink next to a registration ID removes the Registration ID from the user ID. The registration ID no longer displays in the registration and in the Attestation window. Refer to Figure 22. The registration ID is still available for the user to reassign by executing the add registration steps described in section 8.2.1. The data that was entered is saved. NOTE: If someone else also registered the provider, the data that was entered by this user will display. 8.3 Pre-Attestation Eligibility Checks Figure 22 - Registration Tab Remove Option Pre-attestation eligibility checks are executed by the application prior to starting a new attestation year. These pre-attestation eligibility checks will verify that the hospital is still eligible to attest. Enrollment Check West Virginia Medicaid for both the 90 day period used to establish the facility s Medicaid patient volume and for the certified EHR technology attestation period - the date of adoption, implementation, or upgrade for year 1 payments, the 90 day meaningful use period for year 2 payments, and the entire federal fiscal year for year 3 payments. Provider Type Specialty Check the application will verify that the EP is enrolled with West Virginia Medicaid as an Acute Care, Critical Access, or Children s Hospital. The hospital must meet the system s preliminary eligibility checks in order to continue on to the attestation screens. If these checks are not met, the hospital is considered ineligible for West Virginia EHR Incentive program payments. The EHR Incentive Program Attestation Application will send the CMS NLR the hospital s preliminary eligibility status and will also send an e-mail to the address entered into the NLR indicating the status of the hospital s Confidential and Proprietary Page 36

registration and whether the hospital can begin the attestation process. If the hospital is determined to be ineligible for the West Virginia EHR Incentive Program, the e-mail will contain the eligibility checks that were not met and information on contacting the Medicaid Provider Services Help Desk if there are questions or concerns about this determination. If the EHR Incentive Program Attestation Application finds the hospital ineligible, the user will not be able to add the registration for the ineligible hospital to the application or proceed to the attestation screens. At this point, West Virginia Provider Services representatives will have the ability to review and determine if the eligibility determination for the hospital is valid; these representatives may be contacted at (888) 483-0793 between the hours of 7:00 AM and 7:00 PM. The hospital will then work with the representative via phone/e-mail regarding the registration s eligibility status and the provider may be asked to resubmit the registration with the NLR in order to begin the attestation process. Depending on the situation, the Provider Services representative may also be able to override the system and manually approve the provider s eligibility, allowing it to move on to the attestation process. 8.4 Attestation The provider will select the registration and continue with populating the provider s attestation for that year. The Attestation Application will walk the eligible hospital through a series of screens with a questionnaire on Medicaid population, and meaningful use and clinical quality measure questions. The provider must complete these questions in order to proceed with submitting an attestation and potentially receiving payment. The attestation workflow consists of the following topics. The application will guide the user through the topics. Therefore, topics do not become active until the prerequisite topic is completed. Each topic will be addressed. Verify Registration Information Verify that the provider information is accurate and not from another provider Ability to indicate proxy usage Eligibility Screens These screens walk the provider through the attestation specific eligibility questions that must be completed to be validated as an eligible provider for the Incentive Program These screens include: Questions on hospital Medicaid volume Payment Screen Displays the payment amounts calculated during year 1 attestation. Confidential and Proprietary Page 37

Certified EHR Technology This screen validates that the provider is indeed using a valid EHR solution for the purposes of supporting meaningful use in attestation Meaningful Use Core Objectives For 2015 There are 8 required core objectives the eligible hospital is required to answer. Public Health Measures For 2015 A minimum of two out of five public health measures must be selected. A specialized registry reporting measures may be counted more than once if more than one specialized registry is available. If an exclusion is taken for one public health measure, then a qualified exclusion must be claimed for all or the remaining measures to meet this objective. Clinical Quality Measures For 2015 A minimum of 16 out of 29 clinical quality measures must be selected. The attestation process is accessible by selecting the Attestation tab. When selected, the Attestation Instructions page displays. This page indicates the registration IDs that are assigned to the user. The user does not need to complete the attestation process in one sitting. Each screen in the attestation workflow has a Save and Continue button. This will save changes and allow the user to stop at any time without the loss of data that has been entered on that page. The attestation process does not allow the user to skip forward to screens or jump past a screen without entering data. The user may edit answers until the attestation is submitted. Confidential and Proprietary Page 38

To start the attestation process Select the Attest option on the row for the hospital s registration information. Figure 23 - Attestation Selection Example Confidential and Proprietary Page 39

Review the attestation status displayed on the Attestation Topics page. If the hospital is not listed, please select the Status tab. The Status tab will display the current attestation. Locate the hospital in the list to see the error that prevented the provider from executing the attestation process. The topics available on this page are as follows: Topic listing Figure 24 - Reason for Attestation Example The topic listing identifies the completed topic by placing a check mark next to the topic. A topic is completed when the required answers are entered and saved. Topics become available as previous topics are completed. 4. Select the Start Attestation button to start the attestation process or to continue to add and modify data already entered. Confidential and Proprietary Page 40

5. Select the Submit & Attest button when all data is entered and verified. This submits the responses to determine eligibility for payment processing. The responses are also available to be reviewed by the State. The Submit & Attest button is disabled on the initial selection of a registration ID. The Submit & Attest button is disabled if the eligibility check was set to Ineligible. 6. Select the Previous Page button to display the Attestation Instructions page. 7. On selection of the Start Attestation button, the Registration Information page will display. Figure 25 - Verify Registration Information Example Select the appropriate Medicaid ID using the dropdown box Select the Medicaid ID to be associated with this attestation. A hospital can have one-to-many Medicaid IDs on file matching to the facility s single NPI. The designated NPI for institutional providers should match Medicaid ID Confidential and Proprietary Page 41

the facility wishes to have the payment sent to in order to ensure an appropriate match to the local Medicaid payee records. Select Continue button if after selecting the correct registration ID. Select Previous Page if an incorrect registration ID was selected or if the user needs to return to the Attestations Instructions page or select the Attestation tab. 8.4.1 Attestation Eligibility When the facility representative selects the organization s registration number and continues with the attestation portion of the West Virginia EHR Incentive Program attestation process, the Attestation Application presents the user with a series of screens to complete the hospital s eligibility check and gather the appropriate data needed to calculate the hospital's overall West Virginia EHR Incentive Program payment. 8.4.1.1 Eligibility Screen 1 Volume Check The purpose of this screen is to determine if facility's Medicaid patient volume meets the threshold necessary to be eligible for a West Virginia EHR Incentive Program payment. In order to be eligible for the West Virginia EHR Incentive Program the hospital must meet one of the following: CAH or Acute Care Hospitals with at least 10% Medicaid (Title XIX only) patient volume Children s hospitals regardless of Medicaid patient volume The West Virginia EHR Incentive Program defines a hospital encounter as: An unduplicated count of Medicaid (Title XIX only) encounters for the provider in a selected 90 day period from the federal fiscal year (calendar year in 2015) preceding the attestation year. An encounter for a hospital is defined as services rendered to an individual per inpatient discharge AND services rendered to an individual in an emergency department on any one day where the individual receiving services was Medicaid-eligible on the date the service was rendered. In the Stage 2 Final Rule, the Medicaid encounter definition was expanded to include unpaid encounters or any service rendered on any one day to an individual enrolled in a Medicaid program. It also includes encounters for individuals enrolled in Medicaid and the provider either did not bill or did not receive payment from Medicaid for the services provided. For example, encounters with Medicare/Medicaid dual eligibles where Medicare paid for the entire cost of the service provided or the service was not covered under Medicaid. Confidential and Proprietary Page 42

In other words, an eligible hospital should count the following as a patient encounter: One to many claims for the same patient where the claim has the same date of service and the same rendering/attending provider. All claims related to the actual encounter with the patient for the same date and same provider. The West Virginia EHR Incentive Program Attestation Application includes a calculation to derive the number of unduplicated encounters for a provider by reviewing all Medicaid paid and reversed claims for the provider within the WVMMIS for the selected 90 day patient volume period. The West Virginia EHR Incentive Program Attestation Application will run a report from the MMIS to validate the fee-for-service claim and managed care encounter count entered by the facility. If the hospital has significant Medicaid encounters from other state Medicaid agencies, then it may optionally add these to its in-state encounter count to meet the required encounter volume. The Volume page provides functionality to add and maintain out-of-state (OOS) volume counts. When an attestation with OOS entries is submitted, the attestation will be placed in a Pend status once the in-state volume counts are validated. West Virginia EHR Incentive Program staff will review the attestation to ensure the appropriate documentation was provided and also to review the documentation to determine if the attestation will be accepted or rejected. The hospital must obtain their encounter counts from the other state(s) MMIS and be prepared to submit the following documentation: Certification on official letterhead from the other state Medicaid agency declaring the numbers obtained were derived from the state s MMIS and are accurate. Report generated by the state Medicaid agency with the total fee-for-service and managed care encounter count and reporting period. Confidential and Proprietary Page 43

Figure 26 - Medicaid Volume Example NOTE: An encounter for hospitals is defined as the number of inpatient discharges and the number of emergency room encounters over a 90 day period in the federal fiscal year proceeding the attestation federal fiscal year (calendar year in 2015). Enter start date by typing in the date or selecting the calendar icon. The system will automatically calculate the 90 day patient volume period end date. Enter the numerator. Do not add commas. System will format with commas after entry. Enter the denominator. Do not add commas. System will format with commas after entry. Confidential and Proprietary Page 44

Enter in MCO amount Do not add commas. System will format with commas after entry. Enter out-of-state counts (optional) The screen allows for entry of out-of-state entries. The following is a sample of a screen to display the different options available to the user. Each option s instructions are bulleted sections following this screen shot. To Add To Delete To Modify Figure 27 - Out-of-State Entry Screen To add an out-of-state entry: 1. Select Add State to display the screen above. 2. Select a state from the drop down list. 3. Enter the Medicaid encounter counts for the selected state 4. Enter denominator, which is the total patient encounters for the selected state 5. Select the Add button To enter in patient volume information for additional states encounters, repeat Steps 1-5. To modify an out-of-state entry: 1. Select Edit 2. The screen will display the selected out-of-state entry 3. Select the Update button To delete an out-of-state entry: Confidential and Proprietary Page 45

1. Select Remove 2. Respond appropriately to the displayed question. Select Save and Continue button to save all entries and changes including any out-of-state entries. The system validates if all fields have data entered. If any errors occur, check the dates, numerator, and denominator. Please enter the appropriate data. If no errors occur, the Payment Calculation pages displays Figure 28 - Out-of-State Add Entries screen Confidential and Proprietary Page 46

8.4.2 Attestation Payment Schedule The payment amount was calculated during the eligible hospital s year 1 attestation. The Payment Schedule page displays the amount that was calculated at that time. West Virginia EHR Incentive Program payments are distributed according over three years as follows: 50% in the first year 40% in the second year 10% in the third year Figure 29 - Payment Schedule Example Select Continue button to display the Certified EHR Technology screen. Select Previous Page button to display the Eligibility screen. Confidential and Proprietary Page 47

8.4.3 Certified EHR Technology The Office of the National Coordinator Authorized Testing and Certification Body (ONC- ATCB) is the body that tests and certifies EHR systems. If the EHR system is approved, it is assigned a certification number. The web site below is the Certified Health IT Product List web site that can be used to look up an EHR certification number or register an EHR system. Please contact the help contacts listed on the Certified Health IT Product List web site if you have questions. http://onc-chpl.force.com/ehrcert Enter the EHR Certification Number Select the Meaningful Use option, which is the only option. Select the meaningful use period The date range displayed on the screen is controlled by the attestation payment year as outlined below: For 2015 The EHR reporting period is any continuous 90-day period within October 1, 2014 to December 31, 2015. Figure 30 - CMS EHR Buttons Example Confidential and Proprietary Page 48

If AIU is selected, you will not see the following screen and will go to the next step, Section 8.8. If Meaningful Use is selected, you will need to answer two additional questions regarding your CEHRT usage. Message displays your CEHRT edition. Required if MU selected on previous screen Figure 31 Certified HER Technology Confirm that 80% of patients records are in an certified EHR If this cannot be confirmed, attestation progress is not allowed. Select Save and Continue button. The system validates that all fields have data entered. Error message displays if you did not: supply EHR Certification number select an required option supply a start and end date If no errors occur on the Certified EHR Technology page, you will continue the attestation process based on the selection of AIU or Meaningful Use. If AIU is selected from the CEHRT option, then go to Section 8.8 to complete the attestations process. If Meaningful Use is selected from the CEHRT option, then continue to the next section. Confidential and Proprietary Page 49

8.4.4 Dually-eligible hospitals ONLY If you are attesting as a dual-eligible hospital, after selecting Save, the system will check for your Medicare attestations. If the system has not received your Medicare attestation, the attestation process halts and displays the message shown below. The system will request the information from CMS. When the Medicare attestation is received, the MU measures are systematically updated in your attestation. The EH resumes attesting for the Medicaid attestation after the Medicare incentive payment is received. Values may be modified if necessary. Figure 32 Error message Confidential and Proprietary Page 50

8.5 Meaningful Use (MU) Core Questions CMS requires that hospitals attest to meeting meaningful use core questions, when attesting to MU. The questions may change each year. The application will display the core measures in a list with a selection box to select the measures. The screen below is the 2015 Core Measures to show an example. The measures are available within the EH Stage 1 or 2 workbook for the 2015. Section 23 present Stage 1 and Stage 2 Core Measures in a table. Figure 33 - Meaningful Use Core Questions List Confidential and Proprietary Page 51

Please note that each MU core objective question is required. The application will validate that all questions are completed during attestation, but does not validate that the questions meet the threshold required for meaningful use of a certified EHR system until after the attestation is submitted. After submission, the system will reject any attestation that does not meet the required threshold for any MU core measures. 8.5.1 Meaningful Use Core Question General Workflow Functionality Link to CMS definition Each meaningful use measure screen has a link to the CMS definition for the applicable requirements and detail of each measure for the EP to access and review the specific requirements for completing the numerator/denominator for each measure and, if applicable, the criteria for being exempt from the particular meaningful use measure. Save and Continue Button When selected, a check is executed to determine if all required fields have been populated. If required fields are not completed, the page will continue to display until all required fields are completed. If required fields are completed, the next screen displays. Previous Button Displays the previous screen. Confidential and Proprietary Page 52

8.6 Public Health Reporting Measures CMS has defined a set of public health questions. Since the questions may change year after year, the application will present the questions in a list and provide a selection box for selection. The screen below is the list of public health reporting measures for Stage 1 and 2. The measures are available within the EH Stage 1 and 2 2015 workbook. Section 24 contains screenshots. Figure 34 - Meaningful Use Menu Measures Question List User must select the public health reporting set questions the EH wish to attest to by clicking in the box under the SELECT column for each question. A checkmark indicates that the EH has selected that question. The application will allow you to select more than the minimum 1 question. Confidential and Proprietary Page 53

The following are error message could be display on this screen. MESSAGE 1 - User receives the following error and cannot continue attestation process until error is fixed. If the user selects less than required minimum, the following error message displays: Figure 35 - Menu Measure Error Message example MESSAGE 2 - User receives the following error if the listed State Registry is used by another public health measure. Two Specialized Registry Reporting measures cannot specify the same registry name. User cannot continue attestation process until error is fixed. Figure 36 Menu Measure Error if registry used more than once The application will only display the questions that were selected. The navigation is the same as was outlined in the Meaningful Use Core Measures section, as shown again below. The application will not validate if the required score has been met at the time of entry, it will only tell the user if the appropriate questions have been completed or not. The Confidential and Proprietary Page 54

validation of EHR meaningful use thresholds is done after the attestation is submitted. 8.6.1 Public Health Reporting Question General Workflow Functionality Link to CMS definition Each public health reporting measure screen has a link to the CMS definition for the applicable requirements and detail of each measure for the EH to access and review the specific requirements for completing the numerator/denominator for each measure and, if applicable, the criteria for being exempt from the particular meaningful use measure. Save and Continue Button When selected, a check is executed to determine if all required fields have information entered. If required fields are not completed, the page will continue to display until required fields are corrected. If required fields are completed, the next screen displays Previous Button Displays the previous screen. Confidential and Proprietary Page 55

8.7 Clinical Quality Measures (CQMs) CMS requires hospitals to report on a minimum of CQMs as outlined for the year. For example, attestation year 2015, EH must report on 16 of the 29 total CQMs available for selection. The questions are presented in a list and provide a selection box to indicate which measure to report on. Below is the CQM listing as an example. The application will not validate values entered except to validate that the appropriate type of answers were supplied, i.e. digits were entered for numeric fields. The CQMs are available within the EH Stage 1 and Stage 2 2015 workbook. Section 25 provides screenshots of each question. Figure 37 - Clinical Quality Measure Question Example Confidential and Proprietary Page 56

8.7.1 Clinical Quality Measures Question General Workflow Functionality Link to CMS definition Each clinical quality measure screen has a link to the CMS definition for the applicable requirements and detail of each measure for the EH to access and review the specific requirements for completing the numerator/denominator for each measure and, if applicable, the criteria for being exempt from the particular meaningful use measure. Save and Continue Button When selected, a check is executed to determine if all required fields have information entered. If required fields are not completed, the page will continue to display until required fields are corrected. If required fields are completed, the next screen displays Previous Button Displays the previous screen. Confidential and Proprietary Page 57

8.8 Supporting Documentation Documents supporting any of the information entered into the Attestation Application may be uploaded here. Documents may be in the form of PDF, Jpeg, Microsoft Excel, and Microsoft Word files and must be 4 megabytes or smaller. Section 3 of this document lists required documentation. If you have entered out-of-state encounters, you are required to upload two documents, which are a certification letter that patient volumes entered are from the other state s MMIS and the report from the state s MMIS. If attesting to Meaningful Use, then you are required to include a Meaningful Use report or dashboard from the CEHRT. Figure 38 Uploading Supporting Documents Page Confidential and Proprietary Page 58

To add a document 1. Select Add Document to display the following screen: Figure 39- Supporting Documentation - Add Screen Select File to upload the supporting document from your computer Select the Select button On the Files window, navigate through your computer and select the file to upload, Select OK. Document name displays in the File Name box. 2. Select a Category from the dropdown. This identifies the document type, such as Patient Volume, MU (Other Documentation), and others. (required) 3. Enter a title for the document (required) 4. Enter a description of the file (required) 5. Select Add To add more files, repeat steps 1-4. To edit a document: 1. Select Edit next to the desired document 2. The Supporting Documentation Add screen displays with Update and Cancel buttons instead. 3. Modify the information Confidential and Proprietary Page 59

4. Select Update To delete a document: 1. Select Remove next to the desired document 2. Answer the Are you sure? question appropriately Select Continue button when all files have been uploaded or maintained. Confidential and Proprietary Page 60

8.9 Submit Attestation and Payment Status The Submit Attestation button remains disabled if the eligibility checks failed or not all required questions have been answered. If the eligibility checks passed and all required questions are answered, then the Submit Attestation button is available. Topics are based on AIU or Meaningful Use selection. Screen example of MU topics. Figure 40 Topics Page Confidential and Proprietary Page 61

On selection of the Submit Attestation button, the following screen displays. If needed, you may need an email address that is different than the email address that was used during the NLR registration. Notifications will be sent to this email address as well. Figure 41 - Attestation Tab Attestation Reasons for Submission Page Confidential and Proprietary Page 62

On selection of the Submit button, the following screen displays: Figure 42 - Attestation Tab - Submission Receipt Window Upon the successful submission of the uploaded documents, the attestation entry process is completed. The West Virginia EHR Incentive Program provides 72 hours to make changes. If changes are made during the initial 72 hour period, a new 72 hour period will begin. Once no changes are made to an attestation for 72 hours, the West Virginia Medicaid EHR Incentive Program Attestation Application will execute its final eligibility checks. These include validating that the Medicaid and CHIP patient encounter counts entered by the EP are within a reasonable range of the fee-for-service claim and managed care encounter volume stored in the WVMMIS and querying the CMS NLR to determine if the attesting EP has already received an EHR Incentive Program payment from the Medicare EHR Incentive Program or another state s Medicaid EHR Incentive Program. This processing will take some time to complete, and payments will not be sent immediately after submitting a completed attestation. Confidential and Proprietary Page 63

After the eligibility and payment checks are executed, the West Virginia Medicaid EHR Incentive Program will send the EP an e-mail with their current attestation status. If an eligibility or payment error has occurred during the initial data verification process and assistance is needed, please contact the West Virginia Medicaid Provider Services Help Desk at (888) 483-0793, option 8. The West Virginia Medicaid EHR Incentive Program Attestation Application will describe the attestation errors. Alternatively, EPs can log in to the application and select the Status tab to display their current attestation status. Confidential and Proprietary Page 64

9. Status Grid The table lists the attestation status that may occur. Figure 43 - Attestation Status Confidential and Proprietary Page 65

10. Successful Registration with CMS Email After registering with CMS, it may take 48 hours before this message is received. The delay is to allow CMS to process the registration and send it to the appropriate State. The Provider Portal will receive the registration for the State process it. The Provider Portal checks that the EP has a valid Medicaid EHR Incentive Program provider type on file and is actively enrolled with West Virginia Medicaid. When this message is received, log into the Provider Portal to register and attest for the EP. Figure 44 - Successful CMS registration email Confidential and Proprietary Page 66

11. Submitted Attestation Email This email is sent after submitting the attestation. The Attestation Application will allow EPs to make changes to a submitted attestation for 72 hours. After 72 hours have passed from the last attestation change, the system will execute its final edits. Figure 45 Submitted Attestation email Confidential and Proprietary Page 67

12. Error Occurred When Processing Registration Email When the Attestation Application receives a registration from the National Level Repository (NLR), it must validate the EP s Medicaid EHR Incentive Program eligibility. The email below is sent if the EP does not exist in the MMIS. Figure 46 Registration failed email Confidential and Proprietary Page 68

13. Attestation Accepted Email This email is sent when either one of the two scenarios occur: The 72 hours allowed for attestation changes has expired. The attestation is no longer accessible for changes within the application. The attestation details will be sent to the NLR to check if any other EHR Incentive Program payments have been made for the attesting EP for the given payment year. Figure 47 Attestation Accepted email Confidential and Proprietary Page 69

14. Error Occurred While Processing Registration Medicaid Enrollment Failed Email The following checks are made when an attestation is received from the NLR. The email below displays all the possible error messages for the following checks: Check if the EP was enrolled with Medicaid during the attestation period. Check if the provider type selected when registering with CMS matches the provider type on the EP s Medicaid enrollment record. Check if the payee NPI entered when registering with CMS is found when validating the attesting EP s payees on the Medicaid record. Figure 48 Medicaid Enrollment failed email Confidential and Proprietary Page 70

15. Attestation Error Medicaid Claims Count Failed Email The Attestation Application will check the EP s Medicaid fee-for-service claims and managed care encounters that were submitted for the selected 90 day patient volume period. If there was no activity found for the EP during their patient volume period, the following email will be sent. Figure 49 Medicaid claims count failed email Confidential and Proprietary Page 71

If the Attestation Application finds that the EP s entered patient encounter counts could not be validated, then the following email is sent. Figure 50 Encounter count failed email Confidential and Proprietary Page 72

16. Attestation Paid Email If final eligibility checks pass and no payment issues occurred, an email is sent indicating that payment is approved and being processed. The payment will continue with additional processing, so payment arrival will take a few days. Figure 51 Attestation Paid email Confidential and Proprietary Page 73

17. Attestation Payment Denied Email If final eligibility checks did not pass and payment issues occurred, an email indicating denial is sent. The West Virginia Medicaid Provider Services Help Desk at (888) 483-0793 may be able to address questions. Figure 52 Payment Denied email Confidential and Proprietary Page 74

18. Attestation Payment Denied Pay Hold Found Payment is denied if the EP is on pay hold and this email is sent if it is found. Figure 53 Pay Hold email Confidential and Proprietary Page 75

19. Attestation Excluded from Payment Email This email indicates that CMS already has a payment on record for this EP. Please contact the CMS NLR at (888) 734-6433 with any questions and concerns. Figure 54 Duplicate Payment Error email Confidential and Proprietary Page 76

20. Attestation Rejected Email West Virginia Medicaid Provider Services Help Desk staff has the ability to review attestations and reject a submitted attestation. When an attestation is rejected, an email is sent to notify the user of the status change. To find out more information, please contact the Medicaid Provider Services Help Desk at (888) 483-0793 and have your seven digit West Virginia Medicaid provider ID number available. Figure 55 Attestation rejected email Confidential and Proprietary Page 77

21. Attestation Pended for Out-of-State Entries If a submitted attestation has passed volume checks and has out-of-state entries, the attestation will be pended. The West Virginia Medicaid Provider Services Help Desk staff will review the required documentation and determine if the attestation is acceptable. The following email indicates that the attestation was pended. To find out more information, please contact the Medicaid Provider Services Help Desk at (888) 483-0793 and have your seven digit West Virginia Medicaid provider ID number available. Figure 56 Pended for OOS entries email Confidential and Proprietary Page 78

22. Attestation Failed Meaningful Use After the EP s attestation passes the volume check and payment checks, the application will validate that the meaningful use core and menu measure responses meet or exceed the required threshold. If the EP fails one or more questions, the following email will be sent to notify the EP that their attestation failed meaningful use. Figure 57- Failed MU email Confidential and Proprietary Page 79

23. Stage 1 and Stage 2 Core Menu Measures Table 1 Stage 1 and 2 Core Menu Measures Stage 1 Core Measures 2015 Stage 2 Core Measures 2015 Confidential and Proprietary Page 80

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24. Public Health Reporting Measures Figure 58 PH Immunization Registry Reporting Confidential and Proprietary Page 100

Figure 59 PH Syndromic Surveillance Reporting Confidential and Proprietary Page 101

Figure 60 PH Specialized Registry Reporting Confidential and Proprietary Page 102

Figure 61 PH Electronic Reportable Lab Results Reporting Confidential and Proprietary Page 103