Provider Information

For Dental Claims, there may be up to 3 providers listed. The providers may be the Referring, Rendering, Assistant Surgeon or Supervising. Each will be handled in the same manner, however in their own individual sections. You may not enter a Rendering Provider and Assistant Surgeon on the same claim; in this section, you must select which type of physician you are entering using the radio buttons provided.

For Referring, Rendering, Assistant Surgeon and Supervising there are three ways in which to enter the name onto the claim, you may select an existing provider, search for a Medicaid provider, or enter a new Non-Medicaid provider.The Service Facility however is entered in a different manner.

Referring Provider

If the service you are billing for was referred by another provider, enter that provider here. There are three ways in which to enter the name onto the claim, you may select an existing provider, search for a Medicaid provider, or enter a new non-Medicaid provider. See Appendix for details.

Use an Existing Provider

Select a Name: If using an existing provider, you can select the name of the provider in the list.

Last Name: You can also enter the last name of the provider and click "Go".

Provider Number: You can also enter the provider's MMIS ID and click "Go".

Enter a New Non-Medicaid Provider

If you are entering a new non-Medicaid provider, you can enter the NPI # and/or the State License # here.

Rendering Provider or Assistant Surgeon

Rendering Provider: Cannot be entered in conjunction with the Assistant Surgeon. In the case of a dental school, the teacher in charge should be listed as the Supervising Physician. The Rendering Provider will be the student.

Assistant Surgeon: Cannot be entered together with a Rendering Physician as the Assistant Surgeon will be processed as the Service Provider for the claim.

Use an Existing Provider

Select a Name: If using an existing provider, you can select the name of the provider in the list.

Last Name: You can also enter the last name of the provider and click "Go".

Provider Number: You can also enter the provider's MMIS ID and click "Go".

Enter a New Non-Medicaid Provider

NPI: If you are entering a new non-Medicaid provider, you can enter the NPI of the provider here.

Taxonomy Code

Taxonomy Code: If applicable, enter the taxonomy code in this field.

Supervising Provider

If you are entering rendering provider that has non-billable category of service, enter the billing provider as the supervising provider. In the case of a dental school, the teacher in charge should be listed as the Supervising Physician.

Use an Existing Provider

Select a Name: If using an existing provider, you can select the name of the provider in the list.

Last Name: You can also enter the last name of the provider and click "Go".

Provider Number: You can also enter the provider's MMIS ID and click "Go".

Enter a New Non-Medicaid Provider

NPI: If you are entering a new non-Medicaid provider, you can enter the NPI of the provider here.

Click here for the controls located at the bottom of the page or continue to the Other Payers tab.