Project Access Dallas Patient Enrollment Process

Once eligibility for Project Access Dallas (PAD) is established, complete the following steps to enroll a patient.

1. Log on to https://www.projectaccess.info/projectaccess/enter.cfm
   Enter Username and Password and click Submit.
   
   
2. Click Patient Search link located on the left side bar. Enter the patient’s last name and date of birth (this eliminates duplicate enrollments). Once you determine the patient is not in the system, click Enroll A New Patient. It will take you to the Patient Profile Form. Complete the Patient Profile and click Submit, verify the information, and click Submit again. The system then produces a patient ID number.

Complete the following on-line with the patient

3. Enrollment Application (link to this survey is located on the left side toolbar under Patient Forms)
   
   
4. Patient Needs Assessment (also located on the left side toolbar under Patient Forms) These questions are used to evaluate the patient’s health care and social service needs.
   
   
5. Contact Log (link is located on the top toolbar on the patient profile page) The Contact Log records every interaction with the patient by all PAD team members. It’s helpful to document why the patient is being referred to PAD, where they were referred from, and what their medical issues are.
   
   
6. Select Medical Home (located on the patient profile page under Associated Providers). Click Select Medical Home, then Find a Medical Home, then Select next to your clinic name from the list that appears. If you are unsure of the patient’s medical home assignment, contact PAD staff for assistance.

Have the Patient sign the PAD consent forms.

The section labeled Authorization to Use and Disclose Confidential Health Information is a release of the patient’s medical record to be shared when necessary between PAD providers and/or PAD staff. The section labeled Program Information & Patient Consent for Services explains that PAD providers are volunteers. The Patient Responsibilities section describes how the PAD program works and what the patient can expect. The Question and Answers section is to be discussed and given to the patient.

Give the patient the following items:

1. Project Access Dallas ID card:

1. Print the patient’s name on the card
2. Print the Patient ID on the card. This number is generated by the website.
3. The expiration date is always the last day of the month, one year after the patient enrolls. Example: Patient is activated on 6/1/2010, expiration date is 6/30/2011.
4. Advise the patient to contact the Patient Help Line number for any concerns regarding their enrollment or services.
   
   
2. PAD Brochure
   
   
3. Copy of signed consent forms

Upload the following forms to the Project Access Dallas website:

1. Signed Patient Consent Forms
   
   
2. Patient’s Financial Information One of the following must be provided for any household member with income:

• Paycheck within last 30 days
• IRS Form W-2
• Complete previous year’s tax return
• Letter from employer stating number of hours worked, pay rate, pay frequency, employer name and phone number, and employer signature
• Social Security Income
• Unemployment Compensation
• Proof of benefits received from Food Stamps, Public Housing, AFDC, TANF
• Complete bank statements
• Child Support documentation from the Texas Attorney General’s office, or a court order showing amount to be paid
• Letter from patient/spouse stating their own income is accepted ONLY if there is no steady employer to provide employment documentation. MUST BE NOTARIZED.
  
  If no household member has income:
• A letter of support is required from individual(s) financially assisting the patient, providing food and housing, and/or providing resources to meet basic needs. Letter must include:
  • Patient’s name
  • Current date
  • Description of assistance being provided
  • Name, signature, and phone number of the individual assisting the patient.

3. Copy of the patient’s picture ID, which could verify their Dallas County residency
   
   
4. Proof of Dallas County residency showing patient name and address. In order of preference, please submit one of the following:

• Rental agreement or mortgage statement
• Utility bill
• A statement of assistance from a homeless shelter or other housing service.
• Picture ID with current address
• Any other official piece of mail, EXCEPT for cell phone bills.
• If none of the above can be provided, a letter from individual(s) assisting the patient with housing may be accepted. It must state the address where the patient is residing, and be signed, dated by the person assisting the patient and provide a phone number to reach this individual.
  

E-mail

Email Janie Ortega, Patient Enrollment Coordinator, at janie@dallas-cms.org and cc: Eber Bueno, Manager of Patient Enrollment, at eber@dallas-cms.org to change the patient’s status to Active, once the administrative enrollment process is complete. Include the Patient Name, PAD ID number, and Date of Birth in the email. If you need the patient to be activated immediately, you can call Janie at 214-413-1442 or Eber at 214-413-1440. If neither is available, contact Billy Lane, Director of Patient Enrollment, at billy@dallas-cms.org or 214-413-1433.

Once the patient’s enrollment has been activated, enter them in the Caremark on-line website:

Please refer to Caremark Pharmacy Benefit Management Instructions for detailed instructions on the process of entering a patient into Caremark. If you do not have access clearance in the Caremark website, contact Billy Lane at billy@dallas-cms.org, or 214-413-1433.


Last revised 04/06/2011