Add New Provider

To add a new provider to the local provider file:

1. click on Add New Provider on the main Provider Support File page,

2. if the provider to be added is an existing Medicaid provider:

   • enter the last name OR Provider Number ( 8 digit Medicaid ID or 10 digit National Provider ID) in the corresponding fields under the heading Add an existing Provider,

   • • Entering the Last Name followed by a single space and the First Name will narrow the list of returned Provider Names.

     • If both Last Name and Provider Number are entered, Number will be used alone as it will ensure a unique match.

   • click Go,

   • if a Last Name or name combination (LastName <space> FirstName) is entered and matches one or more existing records in the provider master file, the records will be displayed on the resulting page,

   • review the retrieved record(s) and select the desired provider to be added to the local file,

   • click Submit to add the record to the file and return to the main Provider Support File page,

   • if the desired provider is not returned in the result set, click <<Back to return to the main Add New Provider Page.

3. if the provider to be added is a Non-Medicaid provider:

   • Select the proper entity type, Person or Non-Person, for the Provider to be entered,

   • enter the complete name of the provider, either the Employer Identification Number (EIN) or Social Security Number (SSN) of the provider, and the National Provider ID and/or State License.

   • • EIN/SSN: valid values must be 9 digits and may or may not contain dashes

     • State License Number: Enter the 3-digit Profession Code, 2-character State Code (out of state providers) or Privilege Code (in state providers) and 6-digit license for a total of 11 characters. If the license number does not equal 6-digits, zero-fill the appropriate positions preceding the license number.

     • NPI# : Enter 10 digit National Provider ID

   • if known, you may also enter the following Optional Information:

   Provider Type: Select the Provider Type to be used and displayed along with the Provider Name to differentiate Providers who may have the same name.

   Address: If entered, the address information will be displayed as Contact Information when selecting a Provider during the Claim Entry, SA/DVS/Eligibility or Prior Approval Request process.

   Telephone: As with the Address, if entered, the telephone number will be displayed as part of the Provider's Contact Information.

   • click Go and the provider will be added to the local provider file, therefore available for selection when entering other claims or prior approvals.

   • If the State License Number, National Provider ID or SSN entered already exists in your local Provider Support File, an error will be displayed informing you of the duplication.  

NOTE: If the provider being added is a Non-Person Entity, the organization or facility name should be entered into the Last Name field and the First Name/Middle Initial fields should remain blank.