Add or Modify Referring Providers/PCP

One Library is kept for both the Referring Provider and PCP.

System Settings for Referring Provider

Access System Settings

Auto-populate the Referring Provider on the Claim

• If the Referring Provider is chosen on the Add/Modify Patient screen from the Patient Dashboard, it will auto-fill on the Encounter Charge. This is the default.
• If you do not want the Referring Provider to auto-populate on the Encounter:

• In the Charges section, find REFPROVIDER, and change to NO.

Auto-Assign the Referring ID or Create your Own

• In System Settings in the General section > REFAUTOASSIGN

• Yes: The System will Auto-Assign the Referring IDs.

• The System default (---) functions the same as Yes.

• No: Create your own Referring IDs.

Add Referring Provider or PCP using NPPES

1. From the Libraries Dashboard, select Referring Provider.
2. Select Add.
3. From the NPPES Lookup screen, use the filters to find the provider, such as NPI#, first name, last name, state, etc.
4. Select Search.
5. Choose from the responses by selecting the NPI link.

6. On the NPPES Results screen, select Import.  

7. On the Modify Referring Provider screen, the ID field will be grayed out.

• After saving, you can open the Modify Referring Provider screen to change the ID.

• After the Referring Provider has been used, the ID cannot be changed.

8. The Provider's name will Import from NPPES.
9. Enter or change the Abbreviation that will be used on Reports.
10. Valid From: Use if applicable.
11. If you want to add the Referring Provider's Credentials, see the documentation below.
12. EIN: The Tax ID will auto complete.
13. NPI: The NPI auto populates from NPPES.
14. Practice: The Referring Provider's Practice name can be added.
15. Medicaid Provider#: The Medicaid number auto completes if on NPPES, but can be added here if not..
16. Address Info and Contact Info: Auto populates if it exists on NPPES.
17. Select Save [F2].

If you have permission, you can follow the steps above to add Referring Providers from the Patient Demographics or the Modify Encounter screen using the Referring Provider lookup.

Add the Referring Provider's Credentials  

If you get an error message for Credentials: There are a limited number of credentials for referring providers. If you get this error message for the credentials, close the popup and either clear the field or add the credentials.

1. On the Modify Referring Provider's screen, use the Lookup icon to search for existing credentials.

2. If the credentials do not exist, select the Add button.
3. Enter the Code (Credentials).
4. Enter a Description.
5. Select Save [F2].

Modify/Expire a Referring Provider

1. Select the Provider from the Referring Providers screen.

2. To Expire: Enter a Valid Through.
3. To Modify: Make changes.
4. Select Save [F2].

Delete a Referring Provider

Note: A Referring Provide can only be deleted if they have not been previously used on a Patient/Guarantor. If the Delete button is grayed out, the Referring Provider cannot be deleted. Follow the directions above to Expire the Referring Provider.

1. Select the Referring Provider line from the Referring Providers screen.
2. Select the Delete button.

3. Enter the Reason for Deletion.
4. Select Delete.

Import Updated Information for a Referring Provider

For example, an updated Address.

1. From the Modify Referring Provider screen, select the NPPES button.

• This button only exists if you have an NPI listed.

2. Select the Import button at the bottom of the page.
3. Save [F2].

Add a Generic Referring Provider that will not be sent on a Claim

Many groups make the Referring Provider field mandatory on the Patient Registration Screen to ensure the question is asked. If the patient does not have a Referring Provider, you can use a Generic Referring Provider, such as NONE or DECLINED. This can be added manually to the Referring Provider Library.

• Select Add on the Referring Provider screen.
• Select the Search button.
• Select the Add Manually link.
• Enter a RefID and a last name, such as NONE or DECLINED.
• Enter OTH000 in the UPIN field. Entering this code in the UPIN box strips it from the ANSI (Electronic) claim.
• Enter 9999999999 in the NPI field, since the NPI field is mandatory.
• Select Save [F2].