You use the Group Affiliation page to add or edit a group provider's affiliation to individual providers that perform services for them to the enrollment application. Group providers could also be associated with other group providers for whom they perform services.
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, may also have an affiliation.
| Field | Description |
|---|---|
| To add new individual practitioner, click Add Affiliation. Existing affiliations, if any, are displayed in a table. To edit, in the Affiliations table, click the appropriate row. After changing or adding an individual practitioner, on the Affiliation action bar, click Save. | |
| ND Provider # | The North Dakota Medicaid provider number of the practitioner affiliated with your group. |
| Name of Individual Practitioner |
The name of the individual practitioner. |
| Effective Date of Affiliation |
Date the group affiliation began. Format: MM/DD/YYYY, or click the calendar to select a date. |
Version as of 5/16/14.
Copyright © 2017 Conduent, Inc. All rights reserved. Conduent and Conduent Agile Star are trademarks of Conduent, Inc. and/or its subsidiaries in the United States and/or other countries.