Overview

Purpose

This report is used to review provider configurations and demographic information.

Category

System

Type

Detail

Mode

Not applicable

Output Options

CSV or Excel

How to Get Here?

From Portal:
From Back Office:
  1. From the Reports tab, locate the Provider Details Report.
  2. Click Edit for the report.
  3. Enter/select filter criteria on the Criteria page.
  4. Click Run Report.
  1. Open the Manage menu and select Reports.
  2. From the Reports page > Modern tab, select the Provider Details Report from the list of reports.
  3. Click Run (or press [Alt] + [R]).
  4. Enter/select the filter criteria from the Parameters window.
  5. Click Run (or press [Alt] + [R]).

 

Sample Reports

(Click an image to enlarge)

Portal

Back Office


Field Definitions

Field

Description

Provider NameThe Last, First, and Middle names of the primary contact at the provider.
PracticeThe practice associated with the provider.
Practice Term DateIdentifies the termination date for the provider with an associated practice.
Address Line 1 The address line 1 of the street address of the provider.
Address Line 2 The address line 2 of the street address of the provider.
City The city for the provider address. 
State The two-character state abbreviation of the provider address. 
ZIP CodeThe five-digit plus 4-digit postal code of the provider address.
SpecialtyThe field of medicine the provider specializes in, for example, Anesthesiology, General Practice, or Urology.
Provider TypeThe professional designation of the provider that determines how fees are billed for the provider. Provider types include: Physician, CRNA, Registered Nurse, Physician's Assistant, Anesthesia Assistant, CRNA (Hospital Employed), SRNA, or Resident.
Practice ProviderSpecifies whether the provider is affiliated to practices. 
Can ReferThe flag to indicate the provider can refer patients to other providers.
Medicare Assignment Code

This option is specific to electronic claim generation for specifying whether Medicare sends reimbursement directly to the provider or patient. Options include:

CodeNameDescription
AYesProvider receives reimbursement directly from Medicare. Patient has agreed to allow the payer to pay the provider directly.
C  NoProvider does not receive reimbursement directly from Medicare. Payment is sent to the patient.
BOnly on Clinical Lab ServicesProvider for clinical lab services receives reimbursement directly from Medicare.
PPatient Refuses to Assign BenefitsProvider does not receive reimbursement directly from Medicare. Payment is sent to the patient.
Medicare Assignment Code NameThe code name associated with the Code found in the Medicare Assignment Code field.
Office PhoneThe 10-digit telephone number and extension, if applicable, at the office location.
Home PhoneThe 10-digit telephone number and extension, if applicable, at the home of the provider.
Mobile PhoneThe 10-digit telephone number and extension, if applicable, of the mobile phone.
PagerThe 10-digit telephone number and extension, if applicable, of the pager.
FaxThe 10-digit telephone number and extension, if applicable, of the fax machine.
EmailThe electronic mail address of the provider.
NPI NumberThe National Provider Identifier number of the provider.
UPINThe Unique Physician Identifier Number of the provider.
State License NumberThe state medical license number of the provider.
SSNThe Social Security Number of the provider.
Hire DateThe hire date of the provider.
Term DateThe term date of the provider.
Send to AQI

Specifies if the provider is set up to send to AQI.

This is set up for a Provider by selecting the Send to AQI checkbox in the Admin / Provider / Provider Type section.

Additional Info

Custom information/notes pertaining to the provider.

Available Report Filters

Option

Type

Required 

Description

PracticesList SelectionNo 

Filters by all practices or one or more practices for which the Provider is associated. By default, this filter is set to All.

Only active practices are returned in the search results.

FacilitiesList SelectionNo

Filters by all facilities or by one or more facilities for which the Provider is associated. By default, this filter is set to All.

Provider Billing TypesList SelectionNoFilters by all provider billing types or by one or more provider billing types. By default, this filter is set to All.
Practice ProviderDrop DownYesFilters by specification of provider as Practice Provider or not.
Report FolderDrop DownYesDesignates where to place or save the output from the executed report.


 

Related Topics

Portal

Reports (Portal)



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