You use the Group Affiliation page to add or edit the group providers on whose behalf you perform services to the enrollment application. You can also indicate that you can be selected as a primary care physician (PCP) at one of these affiliations.
Providers can be affiliated with group or institutional providers for billing purposes, where the group/institutional provider is the billing provider and the individual provider is the rendering provider. In this type of affiliation, for individual providers the affiliation is to the group providers, or practices, for whom the provider performs services and for group providers, the affiliation is to the individual providers that make up the group. If an individual provider does not want payment made to the group, there is no need to do an affiliation, and the individual provider must be the billing provider on claims.
In addition, pharmacy providers and other providers who participate in the 340b Drug Pricing Program, where pharmacies provide drugs at a reduced rate to other providers who service vulnerable populations, also may have an affiliation.
| Field | Description |
|---|---|
| To add a new group, click Add Group. Existing group information, if any, is displayed in a table. To edit, in the Group Affiliation table, click the appropriate row. After changing or adding new group practices, on the Group action bar, click Save. | |
| Name of Group Practice | Name of the group practice. |
| North Dakota Provider # | North Dakota Medicaid provider number belonging to the group practice, specific to the service location on this application. |
| Effective Date of Affiliation |
Date the group affiliation began. Format: MM/DD/YYYY, or click the calendar to select a date. |
| Participating PCP |
Indicates that you can be selected as a primary care physician (PCP) at this practice. You may only select this field for one group. |
Version as of 5/16/14.
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