Physician Information

For an Institutional Claim, there may be up to 3 Physicians listed. These would be the Attending/Servicing, Operating, and Referring. Each will be handled in the same manner, however in their own individual sections. NOTE: NYS expects to receive the referring provider for all claims that are the result of a referral. In the case of a restricted recipient, the recipient's primary care provider must be reported.  

For each type of Physician, 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.

Attending/Servicing Physician

An Attending/Servicing Physician is required on all Claims.

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.

Operating 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.

Referring 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

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

Click here for the controls located at the bottom of the page or continue to the Diagnosis/Procedure tab.