Transcription
SDI Online Tutorial:Physician/Practitioner andPhysician/Practitioner RepresentativeRegistration, Online Access Information, andForm Submission
SDI Online Overviewfor Physicians/Practitioners andRepresentatives2
The way you access Employment Development Department(EDD) benefits and services has changed.You will now complete a one-time registration for BenefitPrograms Online, but will still file your Disability Insurance (DI)and Paid Family Leave (PFL) medical certifications using SDIOnline.3
Physicians/practitioners andPhysician/practitioner representatives:You may use SDI Online to: Complete medical certifications for Disability Insurance andPaid Family Leave benefits. Complete medical certifications for benefits on behalf of thephysician/practitioners. Update contact information. Access electronic requests for additional medicalinformation.4
A physician/practitioner may have an unlimited number ofauthorized representatives. A physician/practitioner representative may create anaccount after the physician/practitioner has added them asan authorized representative to their SDI Online account. An individual may be an authorized representative for anunlimited number of physicians/practitioners.5
New RegistrationBenefit Programs Online6
You must first complete a one-time registration in BenefitPrograms Online to access SDI Online as aphysician/practitioner or physician/practitionerrepresentative.To register for Benefit Programs Online, visit:edd.ca.gov/BPO.Watch our Benefit Programs Online video for registrationinstructions on a new account.7
SDI Online Account Registrationfor Physician/Practitioners8
Once you have completed your Benefit Programs Online registration, select theBenefit Programs Online button to complete your SDI Online registration process.9
Enter the email address used to register, complete the security check, and select Log In.10
Enter the password you created during the registration process and select Log In.If you do not recognize your personal image and caption, review the email addressentered on the log in screen to make sure it is correct. Call 1-800-480-3287 for furtherassistance.11
To log out ofBenefitProgramsOnline fromany page,select the LogOut link in thetop right handcorner.After you have logged in, select the SDI Online link to complete your registration for SDI Online.12
You will be directed tothe SDI OnlineRegistration Optionspage.Select the link forPhysician/PractitionerRegistration.13
You must agree to the terms and conditions to continue. Select I Agree.14
Complete the account verificationinformation and select Next.Mandatory fields are marked with a redasterisk (*).When creating an SDI Online account,remember to: Enter the personal medical information asit appears in the registration with yourmedical board. Enter the mailing address the medicalboard has on file.Note: You will be able to add treatmentaddresses once the account is created.15
On the Personal Profile Information page, select your preferred method of communication,then select Submit.16
9123456789Be sure to make a note of your EDD Customer Account Number.If you selected electronic communication, a notification will be sent to you via email.If you selected paper mail notification, a letter will be mailed to your address to confirm thisaccount has been created.You may now select the Benefit Programs Online link and log in to access your newlycreated account.17
Access Your Physician/PractitionerAccount18
To access your account, go directly to the Benefit Programs Online page to log in:edd.ca.gov/BPO.Enter the email address used to register, complete the security check, and select Log In.You will then be directed to the Password page.19
Enter the password you created during the registration process and select Log In.If you do not recognize your personal image and caption, review the email address enteredon the login screen to make sure it is correct. Call 1-800-480-3287 for further assistance.20
Select SDI Online.21
John FeelgoodCA00000Once you have successfully logged into your account, you will be directed to your SDI OnlineHome page.22
On the Home page, underthe search section, thereare four ways to beginsearching for certificationsand forms:CA00000 Search by “Last 4 digitsof SSN” or “PatientReceipt Number” andenter the patient’s date ofbirth. Search by “Claim ID” tosubmit medicalextensions. Search by “My ReceiptNumber” to view formsyou have submitted. Search by “Patient/PFLReceipt Number” tosubmit Paid Family Leaveforms.You must also enter theclaimant’s last name tobegin the search.23
John FeelgoodCA00000The Main Menu appears on most screens and has additional options.Inbox: Access the Message Center to view messages from the EDD.Drafts: View previously saved drafts of forms that were started, but not completed or submitted.Profile: Update your mailing address, phone number, and preferred.24
Inbox: Access the Message Center to view messages from the EDD.Drafts: View previously saved drafts of forms that were started, but not completedor submitted. Note: Saved Drafts are deleted after 30 days.25
Add a Treatment Address26
John FeelgoodCA00000To add a treatment address, select the Profile link on your Home page Menu.27
John FeelgoodCA00000From the Profile Page Menu, hover over Change and select Manage Treatment Addressfrom the Page Menu.28
You will be directed to the Treatment Address page. Select the Add button to bedirected to the Add Modify Treatment Address page.29
On the Add Modify Treatment Address page, complete all fields and select Save.Note: You will need to repeat this process to add all treatment addresses where you practice.30
123 Main StreetFolsom, CA 95630-7325United States916-444-5555Treatment addresses added are displayed on this page.Select Modify or Delete to manage your treatment addresses.To add additional treatment addresses, select Add.31
Assign a Physician/PractitionerRepresentative32
John FeelgoodCA00000Physician/practitioner representatives can complete and submit forms on behalf of theregistered physician/practitioner once they have been added to the account.To add a physician/practitioner representative, select Profile from the Main Menu.33
John FeelgoodCA00000123 Main St Suite 1Anytown, CA 95814United StatesFrom the Profile Page Menu, hover over Change and select Manage Medical Representative.34
On the Add Delete Medical Representative page, select Add.35
Complete the required fields and select a treatment address from the drop downmenu. Then select Save.36
Physician/practitioner representatives added are displayed on this page.Select Modify or Delete to manage your medical representatives.To add additional representatives, select Add.37
SDI Online Account Registrationfor Physician/PractitionerRepresentatives38
Once you have completed your Benefit Programs Online registration, select Log Into navigate to the Benefit Programs Online login homepage to complete your SDIOnline registration process.39
Enter the email address used to register, complete the security check, and select Log In.40
Enter the password you created during the registration process and select Log In.If you do not recognize your personal image and caption, review the email address enteredon the login screen to make sure it is correct. Call 1-800-480-3287 for further assistance.41
To log out ofBenefitProgramsOnline fromany page,select the LogOut link in thetop right handcorner.After you have logged in, select SDI Online link to complete your registration for SDIOnline.42
You will be directed to theSDI Online RegistrationOptions page.Select the link n.43
You must agree to the terms and conditions to continue. Select I Agree.44
Complete the physician/practitioner representative information section. Be sure to enter yourname exactly as provided to the EDD by the physician/practitioner authorizing your account,then select Next.45
Verify the treatment address, enter the phone number, and select your preferred method ofcommunication, then select Submit.Note: The physician/practitioner can change the fields that a physician/practitionerrepresentative cannot.46
A letter will be mailed to the physician’s/practitioner’s address to confirm this account hasbeen created.If you selected electronic communication, a notification will also be sent to you via email.Select the Benefit Programs Online link and log in to begin working on aphysician/practitioner account.47
Enter the email address used to register, complete the security check, and select Log In.You will then be directed to the Password page.48
Enter the password you created during the registration process and select Log In.If you do not recognize your personal image and caption, review the email address enteredon the login screen to make sure it is correct. Call 1-800-480-3287 for further assistance.49
John FeelgoodBob SmithJane DoeYou may now select the physician/practitioner account you wish to work on.50
John FeelgoodCA00000You will then be directed to the physician/practitioner’s Home page.51
Submit a DE 2501 Part B –Physician’s/Practitioner’s Certificate52
John FeelgoodCA00000On the Home page, under the Search section, there are two ways search for the DE 2501Bto find your patient’s claim: Search by “Patient Receipt Number.” Search by the last four digits of the patient’s SSN and Date of Birth.You must also enter the patient’s last name to begin the search.In order to submit the DE 2501 Part B online, the patient must have already submitted theDE 2501 Part A – Claimant’s Statement.53
John FeelgoodBob SmithJane DoePhysician/Practitioner RepresentativesOn the Home page, select the physician/practitioner you are submitting the DE 2501B onbehalf of.You may select only one physician/practitioner at a time.You may switch to a different physician/practitioner account by selecting Home from theMain Menu and selecting Choose Physician/Practitioner.54
DoeJane DoeSelect a preferred search method from the Search By drop down menu.Verify the information in the Search Results section matches the patient’s records.The Receipt Number link will allow you to view what the patient submitted on their portion ofthe DE 2501 Part A – Claimant’s Statement.Select the Submit Physician/Practitioner Certificate link under the action column.Note: If the certificate is already submitted by another user (i.e., physician/practitionerrepresentative), the Submit Physician/Practitioner Certificate link will not be available.55
On the View ClaimantPortion, you may selectthe link to view theclaimant portion of theform.Select Next to completethe certificate.On the TreatmentAddress page, selectthe treatment addressof where the patient isbeing treated.56
Complete the PatientInformation section.Mandatory fields aremarked with a redasterisk (*).John Feelgood7500 Hospital Dr.Sacramento, CA 95823United StatesCA00000Note: Do not use the Back button on the browser. If you need to go to a previous screen,select the Previous button.Tip: Select Save as Draft at any point in the process to complete the form at a later time.57
John Feelgood7500 Hospital Dr.Sacramento, CA 95823CA00000When all fields arecomplete, select Next.Note: Marking No willend your submissionand make patientineligible for benefits.Tip: Select Save as Draft at any point in the process to complete the form at a later time.58
Complete the ClaimInformation sections4A and 5.Mandatory fields aremarked with a redasterisk (*).59
SDI Online will acceptvalid ICD-9 and ICD-10codes.If the patient’s disability isdiagnosed as permanentand you have selectedthe “permanent disability”box, you do not need toprovide a date in the“Date you released oranticipate releasingpatient to return to his/herregular or customarywork” field.In the “Findings” field,please provide a detaileddescription of why youconsider the disability tobe permanent.60
Continue completingthe Claim Information.Mandatory fields aremarked with a redasterisk (*).61
Physicians/practitioners can provide an estimated number of days they anticipate the patientto be disabled postpartum. Example: If the physician/practitioner allows the patient 6-8 weeks of postpartum disability,depending on the delivery type, then: Enter the number 42 in the Vaginal Delivery field (6 weeks x 7 days a week 42)OR Enter the number 56 in the Cesarean Delivery field (8 weeks x 7 days a week 56).Select Next.62
Verify the ICD code(s) is correct for the claim and select Next.If it is not correct, select Delete and re-input the correct code(s) in the Claim Information section.63
Complete section 6 and select Next.64
Once the form is completed, select the box in the certification section to authorize anelectronic signature. Before submitting the form, you may view the form by selecting the link atthe bottom of the page.Select Submit. You will be directed to the Confirmation page and provided a form receiptnumber.65
On the Confirmation screen, select the Form Receipt Number link to open a PDF printerfriendly view of the information that is submitted.66
Submit an online DE 2525XXSupplemental Medical Certificatefor Continued Benefits67
CA00000John FeelgoodDoeOn the Home page, to submit a DE 2525XX – Supplemental Medical Certificate:Select a preferred search method from the Search By drop down menu.68
DoeJane DoeVerify the information in the Search Results section matches the patient’s records.Then select the Claim ID link.69
Jane DoeJane DoeJane DoeJane DoeUnder the My Forms Available to Submit section, select the 2525XX SupplementalMedical Cert link.70
Complete thePhysician/PractitionerSupplementaryCertificate Part 1then select Next.Mandatory fieldsare marked with ared asterisk (*).71
Complete thePhysician/PractitionerSupplementaryCertificate Part 2then select Next.Mandatory fieldsare marked with ared asterisk (*).72
7500 Hospital Dr.Sacramento, CA 95823United StatesOn the Treatment Address page, select the treatment address of where the patient wastreated.73
John FeelgoodOnce the form is completed, select the box in the certification section to authorize anelectronic signature.Select Submit. You will be directed to the Confirmation page and provided a form receiptnumber.74
On the Confirmation screen, select the Form Receipt Number link to open a PDFprinter-friendly view of the information that is submitted.75
Submit a Physician/practitionerCertificate for a PFL Care Claim76
On the Home page, underthe search section, youmay search for yourpatient’s care provider’sPFL claim:John FeelgoodCA12345 Search by “Patient/PFLReceipt Number” tosubmit PFL forms for yourpatient’s care provider. Search by the last fourdigits of the patient’sSSN, date of birth, andlast name.JohnsonYou must also enter thepatient’s care provider’s lastname to begin the search.R10000000012345Johnny JohnsonNote: In order to submit the physician/practitioner portion of theDE 2501F online, the patient’s care provider must have alreadysubmitted their part of the DE 2501F.77
Sue JohnsonXXX-XX-XXXXJohnny JohnsonIn the View Claimant DE 2501F section, you may select the link to view the claimantportion of the form.Select Next to complete the certificate.78
1000 Main StSan Francisco, CA 94115United StatesOn the Treatment Address page, select the treatment address of where the patient isbeing treated.79
Verify the informationshowing is correct andcomplete thePhysician/PractitionerInformation sectionand select Next.Mandatory fields aremarked with a redasterisk (*).John FeelgoodCA123451000 Main StSan Francisco, CA 94115United States4154445555Sue JohnsonXXX-XX-XXXXJohn Johnson80
SDI Online will accept validICD-9 and ICD-10 codes.Complete all applicablefields, then select Next.81
Once the form is completed, select the box in the Certification section to authorize an electronicsignature.Before submitting the form, you may view the form by selecting the link at the bottom of the page.Select Submit. You will be directed to the Confirmation page and provided a form receiptnumber.82
R10000000012345On the Confirmation screen, select the Form Receipt Number link to open a PDFprinter-friendly view of the information that is submitted.83
Submit a Paper Claim Form84
To avoid delays in claims processing, complete theform as follows: Use black ink only. Type or write clearly within the boxes provided. Fill out only the physician’s/practitioner’s portion of the form:o Part B of the Claim for Disability Insurance (DI) Benefits (DE 2501)o Page D of the Claim for Paid Family Leave (PFL) Benefits (DE2501F) Provide only one medical license number. If licensed in multiple scopes ofpractice, use the license for the type of disability you are certifying for. Do not fax or photocopy the form. Mail the completed form to the EDD in the pre-addressed envelope provided. Do not mail this form to the EDD if you have already submitted this claim online.85
Claim for Disability Insurance (DI)Benefits (DE 2501)Part A - Claimant’s Statement, pages7-10.Page 7 – The Health InsurancePortability and Accountability (HIPAA)Authorization needs to be signed bythe claimant.Do not photocopy or fax this form.86
Claim for Disability Insurance (DI)Benefits (DE 2501)Part B - Physician’s/Practitioner’sCertificate, pages 11-13.All appropriate information includingdates, diagnosis, and treatment codesmust be completed by thephysician/practitioner. Thephysician/practitioner needs to signpage 13.87
Claim for Paid Family Leave(PFL) Benefits (DE 2501F)Part A -Statement of Claimant,page 1.Complete the information,including whether this is for abonding or care claim. Make sureto sign and date the form.Care Recipient Authorization forDisclosure of Personal-HealthInformation, page 2.The person receiving care, orhis/her authorized agent, mustsign the bottom of this page.Page 2 of 488
Claim for Paid Family Leave (PFL)Benefits (DE 2501F)Part B - Bonding Certification(bonding claims only) and Part C Statement of Care Recipient (careclaims only), page 3.Part B – For bonding claims theclaimant must complete all bondinginformation and sign the form.Part C – For care claims thepatient/care recipient or claimantmust fill out the appropriate careinformation. The care recipient ortheir authorized representative mustsign the form.Claimant/patient will complete eitherPart B or Part C – but never both forone claim.Page 3 of 489
Claim for Paid Family Leave (PFL)Benefits (DE 2501F)Part D – Physician/Practitioner’sCertification, page 4.Care Claims:You (the physician/practitioner) mustcomplete all patient information forcare claims, including dates anddiagnosis codes and you must signthe bottom of the form.You and your patient and the claimantcaregiver should make sure all pagesare completed and all signatures areobtained before the claim form ismailed back to the EDD forprocessing.Page 4 of 490
Visit www.edd.ca.gov/disability for more informationabout State Disability Insurance.For help with SDI Online for physicians/practitioners,call 1-855-342-3645(Please do not give this number out to patients. This number is forphysician/practitioners only. All other callers will be redirected.)The EDD is an equal opportunity employer/program. Auxiliary aids andservices are available upon request to individuals with disabilities. Requestsfor services, aids, and/or alternate formats need to be made by calling1-866-490-8879 (voice), or through the California Relay Service at 711.91
asterisk (*). When creating an SDI Online account, remember to: Enter the personal medical information as it appears in the registration with your medical board. Enter the mailing addres
