Add a Provider using the NPPES Import Tool

1. From Libraries on the left Sidebar menu, choose Billing/Rendering Providers.

2. Select Add from Billing/Rendering Provider Library.

3. Enter the Provider NPI for the fastest results or enter the Provider's name.
4. Select Search.
5. Select the NPI number link of the correct provider.

6. Review to make sure you have the correct Provider and then at the bottom of the page, select Import [F2] to import the information into the Library. You will be able to make changes to the imported information.
   

7. To make necessary changes on the imported page Provider information, follow the step-by-step documentation below for Adding a Provider Manually.

An Add Manually option appears if there are no search results.

Add Provider Manually

• Select the Add Manually link on the NPPES Lookup screen.
  
• This link will display after entering any Search criteria and selecting the Search button; or
  
• Selecting a blank field and using your Enter Key on your keyboard.
  
• Complete the fields on the Provider screen.
• Do not use any punctuation on this screen.

Provider Info Panel

1. Add a Provider ID. Use a simple alphanumeric code to identify this Provider that will be easy for data entry, such as a short numeric code or the Provider's initials.

• Up to 10 digits can be used but 2-3 digits are recommended.

2. Entity Type: Person is used most often but can be a non-person, such as an organization.
3. Billing Status: Select one of the following:

• Billing and/or Rendering
• Rendering Only: If this is chosen, the Default Billing Provider Field opens.
  
• If a Default Billing Provider is set, the Billing Provider field will automatically populate when the attached Rendering Provider field is selected.

4. Enter the Provider's Last Name and First Name.

Status Panel

• Enter the Active Date: This date is when you will start entering charges in the System for the Provider.

• Not specifying an Active Date will leave this provider in a New holding status until changed with the current date as the Effective Date.
• If you do not add a live Active date, you will need to come back before you begin Charge Entry and change the status from New to Active.

• You cannot back-date the Active Date. You will need to use the current or future date. (This does not affect the DOS that you can enter into the System.)

• See Change a Provider's Status to learn more.
  

• Before Go-Live, your Implementation Manager will update your database from Training to Production to allow you to upload claims to our Clearinghouse.

Reporting information

1. Abbreviation: Used for reports and on screens where space is limited. The abbreviation must fit in the yellow box.
2. HCFA Box 31: Name that the Provider is credentialed under (first name, last name, credentials).
3. Statement: Use only if the Statement Type is different for this provider than it is for the practice in general. If anything is entered here it overrides the setup in System Settings.

• Caution: If you select Hold Statement, no Statements will be batched for this Provider.

4. Reporting group: Can be set up to report several providers together, such as all Physical Therapists PT.

Licensure/Credentialing

1. Credentials: The imported credentials. These may require some formatting changes based on the lookup. If this is a non-person use ANC Ancillary.
2. Specialty: Enter the Specialty for informational purposes only.
3. Taxonomy Code: Enter the Provider's Taxonomy Code.
4. License Number: This number is informational only and not transmitted on the claims.
5. EIN: Enter the Provider's Tax ID.
6. NPI: Enter the Provider's Individual NPI.
7. Medicaid Number: Enter the Provider's Medicaid Number if applicable.

Geographic Info Panel

1. Billing Location:

• Choose the Billing Location ID if the practice bills as a Group (most common).
• Choose $SELF, if the Individual Provider's Tax ID and NPI are used for billing.
• Choose $FAC, if the Claims are billed by Facility (least common). If at least one provider has $FAC for the Billing Location, the Service Facility can be linked to a Pay/To Billing Location in the Service Facility Library.

2. Pay To Location:

• Example: There is a PO Box for your mail and a physical address for your facility. The Pay To Location would be the PO Box and the Physical Location would be your Billing Location.

3. Address: If the address did not populate, enter it here.

Contact Info

• Office Phone: This will be shown in HCFA box 33. (Mandatory)

Additional Info

• Patient Facing Description: This field is available through the API and can be used when integrating to Patient-facing portals to determine the Provider's name that Patients will see.

Link Provider to Facility

1. Select Link.

2. Select the checkboxes for Facilities where this Provider has privileges.
3. Select Save [F2].

Provider Billing with SSN 

If a Provider is exclusively billing under their SSN, on the Modify Provider screen, choose:

1. Enter the Provider's SSN.

2. Leave the EIN field blank.

• Leaving the EIN blank will automatically cause the 2010AA REF segment to populate the SY Qualifier with the SSN instead of Qualifier EI and Tax ID.

3. For Billing Location, select $Self.

If a Provider is using their SSN for some Payers and their Tax ID for others, contact Support or your Implementation Manager to add a Code to enable this feature.