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The Information Guidance for Old Louisiana Standardized Credentialing Application Form

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Tutorial as toOld Louisiana Standardized Credentialing Application Form

Music.Hello and welcome to one of our many PECOS.demonstrations..In this demonstration, we will be walking.you through the process of submitting an application.in PECOS if you were a practitioner providing.healthcare services and work in a group setting.like a private practice or a hospital..In order to begin this application, we'll.have to log in to the PECOS homepage..To obtain your login credentials and find.other helpful information regarding Medicare.and the application process, please visit.the PECOS homepage..Please note that if you are a practitioner.working in the setting other than what we've.just described or have some other business.arrangement, these steps for beginning your.application are identical to what we'll be.showing here, and the process of enrolling.will have many of the same screens shown in.this demonstration..After logging in, you'll need to select this.My Enrollments button here first..And because we're now creating a new application.for the practitioner Jenny Lewis you'll want.to select this New Application button here..After doing this, you will be prompted to.answer a series of questions to help personalize.the application to your specific scenario..You'll first need to indicate who the application.is being created for..So here you'll select yourself and select.the Next Page button to continue..On this screen, you're being prompted to enter.whether or not you, as the practitioner solely.order and refer services..So for the purpose of this demonstration,.I'm going to select no and continue..On this screen, you will be selecting the.business setting in which you work..Because this demonstration is for a provider.working in a group setting, we'll be selecting.the group member only field shown here..I'll go ahead and scroll down and select the.Next Page button to continue..Here, you're identifying information will.be displayed to you as a label so you can.go ahead and select the Next Page button now..You'll then need to indicate the state where.healthcare services are rendered..So for this example, the practitioner works.and provides services in Arizona so that's.what we'll select and then move on by clicking.the Next Page button at the bottom of the.screen..And here you'll indicate your physician or.non-physician specialty type..So in this example, Jenny Lewis practices.internal medicine so we'll select that from.the drop-down and then move forward with the.Next Page button at the bottom of the screen..You'll then be brought to a page which simply.serves to inform you that the provider group.you work for must already be enrolled in Medicare..So please ensure that this is the case before.continuing your application..And if you'd like to continue, you'll just.select this Yes option here and move forward..Finally, we've completed the initial set of.questions for this enrollment and you can.then verify at the top of the screen that.the information presented here is correct.for your situation..In this example, the practitioner is enrolling.indeed for the first time so you can scroll.down to the bottom of the page after verifying.and start this initial enrollment by selecting.that Start Application button shown here..At this point in time, we're now ready to.begin completing each of the sections needed.to submit the Medicare form..Before beginning the application, please note.some key features located at the top of the.page..First, there's a progress bar shown here which.indicates how close you are to completing.your enrollment application and being able.to scroll down to the bottom of the page and.selecting this Begin Submission button..Additionally, there are three tabs located.at the top of the page to help you in browsing..First is the Topic View page which is the.page we're on right now and conveniently gives.you high level view of what needs to be completed.in your enrollment application by showing.check marks next to sections that are already.done..The Fast Track View on the second tab here.shows all of these sections also within one.page including the information you've already.entered easily accessible simply by selecting.this Go to Topic button here..And then lastly, there's the Error/Warning.Check tab which shows you what is still outstanding.to be completed within your application and.any error the systems finds in what you've.entered..Note the red number shown here in the tab.and that that will decreases you address each.item that's listed here as an error..I'm now going to navigate by selecting this.Topic View tab here..There are number of sections that still need.to be addressed and completed before I can.move forward by selecting this Begin Submission.button..These sections can be done in any order..And so for the purpose of this demonstration,.I'll start by walking you through the first.section, the Personal Information section.and I'll do that by selecting this hyperlink.now..To complete this section, you'll need to start.by selecting the Add Information button here..You'll then see some personal identifying.information shown as labels and you'll need.to complete the rest of the remaining required.field shown here with the red asterisk..I'll then select the Next Page button to continue..Here, you'll be able to provide any additional.names to Medicare like a former maiden name.or professional name..For the purpose of this demonstration, I'm.going to select No, that there are no other.names that I'd like to report and click on.the Next Page button at the bottom of the.screen..You'll then be able to enter any drug enforcement.agency or DEA numbers..And if you do not have this information, you.can move forward because it is optional by.simply selecting the Next Page button..You'll then indicate birth location information.and I'll select Arizona and move forward..[Next Page] On this page, you'll then be able.to indicate the medical school or professional.school that you obtained your medical degree.and then also be able to indicate the year.of graduation..After entering this information, you can select.Next Page button to move forward..Finally, you'll be brought to the IRS Proprietary/Non-Profit.Status page where you can indicate how the.business is registered with the IRS..In this example since we're enrolling as a.group member, I'm not going to enter this.information as in here..I'll just instead select the Save button to.move forward..You'll then be brought to this Topic Summary.screen where you'll see all of the information.you entered here as a label, and if you need.to make any updates at this time, you can.do so by selecting this Edit button here..Since I'm satisfied with this information,.I'm going to return to my topics by selecting.this Return to Topics button at the bottom.of the screen..As you can see, the Personal Information section.now has a check mark next to it..For the purpose of this demonstration, I'm.going to go ahead and complete most of the.remaining sections missing in this enrollment.application in order to show you the submission.piece of your enrollment in PECOS..So now I've gone ahead and entered in almost.all of the missing information needed in order.to scroll down to the button of the page and.select this Begin Submission button shown.here..You'll see that if I scroll up here, there's.one section here that's still missing a check.mark, the Required and/or Supporting Documentation.section and all the way at the top of the.page, the Error/Warning Check tab still indicates.that there is one missing piece left to my.enrollment application that needs to be addressed..So I'll select this Error/Warning Check tab,.and you'll see here that the error is that.an indication on the Required and/or Supporting.Documentation needs to be made..So we'll navigate directly to that section.now by selecting this hyperlink here and you'll.then be pulled to enter this Required and/or.Supporting Documentation section where you.can indicate whether or not you as the applicant.wish to upload supporting documents to your.enrollment..So I'm going to select Yes that I want to.upload some documentation and I'll scroll.down to the bottom of the page and you'll.see additional helpful information on the.requirements for this documentation shown.here on the screen..And now, I'll go ahead and select one of these..So for the purpose of this demonstration,.I'll upload a Driver's License and then I'll.select the Upload button shown here..I'll then scroll down to the bottom of the.page and see that this document indeed has.been uploaded and has been assigned the unique.Document ID shown here..If you need to view that this information.indeed was uploaded accurately, you can do.so using the View button..And if you need to remove this document because.you accidentally uploaded the wrong one, simply.select this Remove button shown here..You can go back and repeat the steps just.shown to upload different documents instead.if you need to..Next, we'll navigate back to the error check.tab just to make sure that there are no errors.left that I need to address before I can continue.with the application..And as you can see, there are no errors or.warnings found for this enrollment so I'll.go ahead and select the Topic View button.now and I'll scroll down to the page and this.Begin Submission button is now enabled..So I'll go ahead and click on that now..The first page you are brought to in the submission.process is the Electronic Signature Option.page where you will be given the opportunity.to electronically sign for any documents listed.on the screen at this point in time..So in this example, that includes the Certification.Statement and Authorization Statement..I'm going to select, Yes, that I would like.to electronically sign these documents, and.what this means is that I would not then need.to mail them and submit a hard copy to my.Medicare administrative contractor as this.would be sufficient..So I'll go ahead and select the Next Page.button now..The next piece of your submission process.is the E-Signature Submission page where you'll.be prompted to review all documentation prior.to E signing and then you'll need to scroll.down through the page and read each of the.terms and conditions for all documents listed.here and agreed to accept them..And so in this example, I'll select Yes for.both the Certification Statement terms and.conditions and the Authorization Statement..If you continue to scroll down further to.the middle of the page, you'll see the Signatories.for accepting a Reassignment section..Here, you'll need to identify an authorized.signer for the group that is receiving your.reassignment of benefits..So I'll select Tony Smith here from this drop.down here as my authorized signer and I'll.enter Tony's e-mail address now..You're authorized signer will then receive.an e-mail suggesting that they need to go.ahead and electronically sign that they accept.the reassignment of benefits indicated in.this application before your Medicare administrative.contractor will be able to begin processing.your enrollment record in PECOS..And then if you scroll down further to the.bottom of the page, you'll see this Complete.Your E-Signature section where you will need.to indicate your identifying information and.this is what will validate and constitute.as your electronic signature for your application..And after entering this information here and.verifying it for correctness, I'll select.this Next Page button to continue..You'll then be brought to the Contact and.Processing page where we'll go over to this.drop down here and select your Medicare administrative.contractor and select the Apply button..And as you scroll down on this page, you'll.then see a reason for submission here as a.label..Other information on required and/or supporting.documentation and when you scroll all the.way down to the bottom of the page, you'll.also see the document that you've uploaded.to electronically submit with your application..If at any point in time in navigating to this.page there are any updates you need to make.to your application, you can still do so at.this time by selecting the Previous Page button.here or selecting this Upload New/Remove Documentation.hyperlink..If you simply just want to review your document.that you've uploaded and ensure that it is.indeed correct, you can do that without going.back into your enrollment by simply selecting.this View button here..Because all of the information on the screen.seems accurate and I'm ready to submit my.application to Medicare, I'll click on this.Complete Submission button now..A pop up will then appear on your screen to.notify you that any documentation that you've.not uploaded electronically with this application.at this time will need to be printed and mailed.to your Medicare administrative contractor..And any delay in doing this will mean that.your application will risk not being processed.in a timely manner by your contractor..So, after you acknowledged this fact, you.can select the OK button and then you'll be.brought to the Submission Confirmation page.where you can print this as a receipt for.your personal records..Congratulations..We've now just completed an initial submission.to Medicare using PECOS..And for any further information on the application.process and Medicare itself, please visit.the PECOS homepage..

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Old Louisiana Standardized Credentialing Application Form FAQs

Here are the answers to some common problems regarding Old Louisiana Standardized Credentialing Application Form. Let us know if you have any other problems.

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What service can I use to have a website visitor fill out a form, put the data in the form into a prewritten PDF, then charge the visitor to download the PDF with the data provided filled in?

You can use FormAPI to set up PDF templates, which can be filled out with an online form. FormAPI doesn’t support charging people to download the PDF, but you could use Stripe for this (would require some programming.)

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