(the plus sign) beside a panel to open the panel. Click 
(the minus sign) to close the panel. The following Maintain Entity panel is displayed on the Maintain Entity page when the entity type is for a provider. You use it to add or edit un-enrolled providers. When an un-enrolled provider entity is created, a CM Entity ID is assigned. The CM Entity ID is the contact management specific ID used when creating case records or correspondence records for the un-enrolled provider.
You can open or close certain panels. Click (the plus sign) beside a panel to open the panel. Click (the minus sign) to close the panel.
* indicates a required field. A dimmed field cannot be edited. See the previous image.
| Field | Description |
|---|---|
| Entity Type |
The type of organization, institution, or individual. Examples: Provider, Member, Attorney, TPL Carrier |
| CM Entity ID |
Unique identifier for the contact management entity to identify the un-enrolled entities. |
| Entity ID Type |
The kind of ID entered in the Entity ID field. Examples: Medicaid ID, Member MMIS ID, SSN, etc. This field is displayed when editing. |
| Entity ID |
The unique identifier used for an entity in ND MMIS about which healthcare information needs to be maintained. Note: Entity ID depends on Entity Type. For example, a Provider Entity Type requires a Provider ID. This field is displayed when editing. |
| When editing, after a provider has been enrolled, to associate the un-enrolled provider CM Entity ID with the enrolled provider’s entity ID, click Validate. | |
| Organization Type |
The type of organization to which the un-enrolled provider belongs. Examples: Individual, Group, Both |
| Provider Type |
The provider classification. Based on the Level I Provider Type of the Taxonomy Code Set. Examples: Dental, Pharmacy, Hospital, Vision, Physician |
| NPI | The National Provider Identifier. |
| Prefix |
The preferred title to use before an un-enrolled provider's name. This field is displayed when the Organization Type for the provider is individual or both. Examples: Mr., Mrs., Dr. |
| First Name |
The first name of the un-enrolled provider. This field is displayed when the Organization Type for the provider is individual or both. |
| MI |
The middle initial of the un-enrolled provider. This field is displayed when the Organization Type for the provider is individual or both. |
| Last Name |
The last name of the un-enrolled provider. This field is displayed when the Organization Type for the provider is individual or both. |
| Suffix |
Letters that appear at the end of a person's last name. Indicates if contact is a Senior, Junior, Third, etc. Used when one or more relatives in the same family have the same name to indicate relationship to one another. Format: Up to four alpha characters Examples: I, II, III, IV, V, Jr., Sr. This field is displayed when the Organization Type for the provider is individual or both. |
| Organization Name |
The name of the organization that the entity is associated with. This field is displayed when the Organization Type for the provider is individual or both. |
| SSN |
Social Security Number. A nine-digit number assigned by the Federal government, usually assigned at the time of birth and used for tax purposes. Format: NNN-NN-NNNN or NNNNNNNNN Example: 123-45-6789 Note: This field cannot contain all zeros. |
| EIN |
A nine-digit number called the Employee Identification Number and assigned by the Federal government to a business and used for tax purposes. Format: NN-NNNNNNN or NNNNNNNNN |
| Line of Business |
The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid. |
See Maintain Entity (General) Page for more information.
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.
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