Overview

 The Plan: New and Plan: [name] pages are comprised of twelve tabs:

The Provider IDs tab collects the unique identification numbers issued by the plan to providers. Use the Provider IDs tab to record identification numbers issued by the plan to each provider whether the provider participates with the plan or not. By default, the plan inherits the provider identification numbers recorded in its parent payer configuration.

Note: This tab is not accessible from the Plan: New page until the General tab has been populated and applied.

How to Get Here?

To open the Provider IDs tab for new plan:

From the Home Page:
From the Menus:
Via Shortcut Keys: 
  1. Click Payers & Plans from the Admin list 
  2. Click Create Plan
  3. Populate the General tab
  4. Click Apply
  5. Click the Provider IDs tab
  1. Open the Admin menu and select Payers & Plans
  2. Click Create Plan
  3. Populate the General tab
  4. Click Apply
  5. Click the Provider IDs tab
  1. From the Payers & Plans page, press [Alt] + [P]
  2. Populate the General tab
  3. Click Apply
  4. Click the Provider IDs tab
 


To open the Provider IDs tab for existing plan:

From the Home Page:
From the Menus:
Via Shortcut Keys: 
  1. Click Payers & Plans from the Admin list 
  2. Select the plan to be modified
  3. Click Update*
  4. Click the Provider IDs tab

*Alternate Navigation: Double-click the plan from the list

  1. Open the Admin menu and select Payers & Plans

  2. Select the plan to be modified

  3. Click Update*

  4. Click the Provider IDs tab

*Alternate Navigation: Double-click the plan from the list

  1. From the Payers & Plans page, select the plan to be modified
  2. Press [Alt] + [U]
  3. Click the Provider IDs tab

 

(Click an image below to enlarge.)

Plan: New Page / Provider IDs Tab  

 


Plan: [name] Page / Provider IDs Tab

 


Field Definitions

Field

Type

Required

Description

Provider ID Type

Filter

Yes

Specifies whether provider identification numbers are issued for general use or for facility-specific use. Options include:

  • General Provider ID
  • Facility-Specific
  • Does Not Issue IDs 
Practice FilterYes The list of the practices to which providers are affiliated.
Find SearchNoFilter for locating a provider. The provider name or identification number can be entered. The values entered are matched to the items in the list as you type.
Hide Expired Checkbox NoIf checked, hides the providers who are not currently active. If not checked, both active and inactive providers are displayed.
Provider Name 

Display Only

(Pulled from created/updated Providers)

YesThe name of the provider. By default, the provider name is listed by last name, first name in ascending order.
PAR CheckboxNo 

Indicates whether the provider participates in the payer or plan as a network provider. If checked, the provider is PARticipating.  

Use the effective and expiration dates to manage the status of PARticipating and non-PARticipating providers.

  • For a PAR provider who is renewing the contract as a PAR provider, enter the ending date of the contract in the Expiration column.

  • For a PAR provider going to a non-PAR provider status, enter the ending date of the contract in the Expiration column.

  • For a non-PAR provider going to a PAR provider status, enter the date the provider ends the non-PAR status in the Expiration column. 

Accepts Assign CheckboxNo

Indicates whether the provider can receive reimbursement directly from the payer or plan on behalf of the patient, and that the provider accepts the contractual amount for reimbursement.

If PAR is selected, the Accepts Assign option is automatically selected.

  • If the payer or plan does not accept reimbursement on behalf of the patient, remove the check mark from the Accepts Assign checkbox.
  • If the provider participates with the payer or plan, this option must be selected.

If the PAR option is cleared, the Accepts Assign can be selected independently. Select this option if the patient has given the provider permission to accept payment from the payer or plan on the behalf of the patient; otherwise leave blank.

Effective Date (mm/dd/yyyy)Yes (for PAR provider)

The date the provider begins accepting the insurance of the payer or plan as either a non-PARticipating or a PARticipating provider. 

For a PAR provider, this date is required.

Expiration Date (mm/dd/yyyy)No

The date the provider no longer participates in the payer or plan, or the day before a non-PARticipating provider goes to a PARticipating provider. Typically, this date is the expiration date of the payer or plan contract.

Use the effective and expiration dates to manage the status of PARticipating and non-PARticipating providers.

  • For a PAR provider who is renewing the contract as a PAR provider, enter the ending date of the contract in the Expiration Date column.

  • For a PAR provider going to a non-PAR provider status, enter the ending date of the contract in the Expiration Date column.

  • For a non-PAR provider going to a PAR provider status, enter the date the provider ends the non-PAR status in the Expiration Date column.

For example, the provider starts participating on 03/01/2016. Enter 02/29/2016 as the expiration date in the existing row, then click Add to add a new row. In the new row, select the PAR checkbox, and then enter 03/01/2012 as the effective date, and the provider identification number in the appropriate columns.

Provider IDFree TextNoThe general identification number issued to the provider by the payer or plan. This column appears when the Provider ID Type is set to General Provider ID.
Suspend Claims CheckboxNo Indicates claims will not be generated for a particular provider. If checked, all claims submitted from a provider are suspended. If charges are entered for the provider in Connect Back Office, an error displays during the error checking process, and no claims are generated for the provider.
Contract Code Free TextNo Specifies the contract code for the payer or plan. For Medicaid OK, type the applicable contract code in this column to include this code in the 2300 loop, CN1 segment of the electronic claim.
Facility Provider IDsDrop Down / Free TextNo

The facility identification number issued to the provider by the payer or plan. This column appears when the Provider ID Type is set to Facility-Specific.

Note: To populate the field, open the drop down list and then enter the Provider ID next to the relevant facility in the list.

Link Status 

Display Only

(Based on Restore Link/Unlink option selected)

YesBy default, the plan inherits the provider identification numbers recorded in its parent payer configuration. If the plan issues different identification number, the payer and plan identification numbers can be unlinked. The Link Status provides the current status, if the payer and plan IDs are linked or unlinked.

 



 

Related Topics

Payers & Plans

Payers & Plans Page

Payer / General Tab

Payer / Provider IDs Tab

Payer / Referring Physician IDs Tab

Payer / Facility IDs Tab

Payer / Group IDs Tab

Plan / General Tab

Plan / Claims Tab

Plan / Statements Tab

Plan / Anesthesia Tab

Plan / Referring Physician IDs Tab

Plan / Facility IDs Tab

Plan / Group IDs Tab

Plan / Practices Tab

Plan / Paper Claim Options Tab

Plan / Electronic Claim Options Tab

Plan / Other Insurance Codes Tab

Configuring Payers

Configuring Plans

Updating Payers

Updating Plans

Deleting Payers & Plans

Cloning Payers & Plans

Copying Paper Claim Settings to Other Plans



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