eSigning Release of Medical Information Made Easy

Provider information update form

hello and welcome to Pecos in this demonstration we're going to show you how to log into Pecos and make an update to an enrollment that you've already submitted to start we're going to have to log in so go ahead and pull up and use your credentials that you already received when you first submitted the application if you have any questions about your login credentials or need further support go ahead and click on the forgot password button below or the manage slash update user profile link shown here AJ's user password field after logging in you'll go ahead and select the my enrollments button here to move forward on this page you'll see the view enrollments button and the new application button in order to make a change to an existing enrollment you'll need to select the view enrollments button here on this page you'll be able to scroll down to the bottom of the screen and see any existing enrollments you already have submitted to Medicare and any new ones you are aiming to submit soon we're going to select this existing enrollment shown here and select the more options button you'll then be brought to a screen that asks you to indicate what the applicant is trying to perform so in this case because you're trying to make an update to a current enrollment what you'll do is select the perform a change of information to current enrollment information option you'll then select the next page button for the purpose of this demonstration I'm not going to actually make any updates to the physical location I'm going to make updates to owner information so I'm going to select no and move forward on this screen you'll have the opportunity to confirm that the reason here shown above for what you are doing to this enrollment application is accurate as you can see it says here that the practitioner Jenny Lewis is adding deleting or changing Medicare enrollment information and since that is accurate I'm going to scroll down to the bottom of the page and select the start application button here after selecting the start application button you'll be navigated to the inside of your enrollment application where you can actually perform these updates so what you can do is navigate to the topic View page here and you'll see in scrolling down that all of these sections noted already have completed checkmarks next to them and the reason is that this information is already complete within your enrollment on this page you can select whichever section you need to make your updates and you can also navigate to the error slash warning check tab to see what else needs to be completed before you can submit because I'm going to be updating ownership information I'm going to go ahead and select the individual control section so here we're navigated to individual control section and you can select yes that there is an individual control to report on this application so now I'll select the add information button to begin adding this information into the enrollment and I'm going to say that Danielle Smith is the individual control needing to be added here so I'll add all of our identifying information before hitting the next page button at the bottom of presenter completes fields and on this page you'll need to indicate the country of birth and state of province of birth of this individual but you will you can note that this information actually is optional so if you don't have this information or don't want to enter it you can go ahead and select the next page button to move on and on this page you'll need to indicate if there are any final adverse actions associated with the individual that you're adding for the purpose of this demonstration I'm going to select know that Danielle Smith does not have any final adverse actions so now I'm going to scroll down to the bottom and select the Save button then you're navigated to the summary screen which shows you the information entered for that individual that you've reported and if you need to make any updates to this information you can use the edit and delete buttons shown on the screen here and if you do indeed it ultimately need to add a final adverse action for this individual you can do that by selecting the add button shown here I'm going to move forward by going to the error check tab to see what else is remaining in my enrollment before I can move forward a check tab at bottom of screen here so as you can see there is only one era left - that needs to be addressed before submitting this application to Medicare before I do that though I'm going to navigate back to the topic View presenter precious the topic view tab so as you can see here all of our sections have check marks next to them the contact person information still needs to be reviewed as we saw a contact person selected so as you can see that after reviewing and updating any necessary contact person information you'll be navigated to the contact person information summary page where you can view this information once you're done you can select the review complete button you can also select to go back to the error check tab or select this change of information hyperlink at the top of the screen to be navigated back to the topic view to see all of your information with checkmarks associated to that at this point in time after making several updates to the enrollment application I'm ready to submit that application to Medicare you can then select the begin submission button to initiate this on this page you'll be prompted whether or not you want to electronically sign your documents all documents that you electronically sign will therefore not need to be printed and mailed to your Medicare administrative contractor for the purpose of this demonstration I'm going to select yes that I would like to electronically sign the certification statement for this submission and select the next page button at the bottom of the screen on this page you will be prompted to review all documentation before you electronically sign and to accept the terms and conditions you'll need to read the information shown here on the screen before you select yes I agree to the certification statement terms and conditions note that if you are submitting a different type of application any associated documents that you will be assigning for will also appear on this same screen and you can select yes that you agree to the terms and conditions for all of those documents applicable when you scroll down on the page you'll see a subsection called complete your ecig mature here you can put your identifying information in in order to perform that you are actually going to e-sign your application before moving forward as Jenny Lewis the practitioner I'm going to put in my information now after making sure that I've entered accurate information I'm going to select the next page button to move forward with my e signature of the certification statement here you'll be navigated to the submission page where you'll see your Medicare contractor at the top of the screen shown as a label you'll be able to read all important pertinent information regarding required and supporting documents for your submission along with the reason for your submission as you can see you can scroll down to the bottom of the page and you'll see the document that you've previously uploaded for your your application that's on file as you can see when you scroll down to the bottom of the page you'll see any existing documents that are associated with your Medicare enrollment application this driver's license shown here was uploaded when I first submitted the enrollment application and is still here to be viewed when you are ready to move forward and complete this submission process hit the complete submission button below a pop-up will then appear on your screen to warn you that any uploaded documentation has been submitted but that any other required or supporting documentation will need to be mailed to your Medicare administrative contractor because otherwise your application will be delayed in processing once you've acknowledged this fact select ok to move forward you'll then be navigated to the submission confirmation page where you can print your receipt for your personal records congratulations you've performed a change of information to your enrollment application in Pecos