Provider Information
Provider InformationAll information pertaining to the Rendering, Referring, Primary Care, or Supervising Provider is entered on this tab.
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.
Rendering Provider: Select a Rendering Provider from the drop down. If the provider you want to select does not exist in the drop down, you can search for a Medicaid provider by entering the last name or Provider Number/NPI number. If the provider you want to enter is a non-Medicaid provider, then the user can enter a new Provider on the right side by entering the provider’s NPI.
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 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.
Primary Care Provider: May be used if more than one referral exists and there is a requirement to report the additional referral. The Primary Care Provider indicates the source of the initial referral for this client's episode of care being billed/reported on this claim. NOTE: A Referring Provider must be selected if the Primary Care Provider is selected.
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.
Supervising Provider: Select a Supervising Provider from the drop down. If the provider you want to select does not exist in the drop down, you can search for a Medicaid provider by entering the last name or Provider Number/NPI number. If the provider you want to enter is a non-Medicaid provider, then the user can enter a new Provider on the right side by entering the provider’s NPI.
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 Diagnosis tab.
