(the plus sign) beside a panel to open the panel. Click 
(the minus sign) to close the panel. You use the Provider Inquiry/Maintenance - Affiliations/Other Service Locations page to view or edit provider affiliations and other service locations. 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. Group providers could also be associated with other group providers or individual providers to other individual providers in a similar type of relationship.
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 have an affiliation.
The page also lists other providers who share the same Tax ID (SSN/EIN) and system-assigned Enterprise ID. These entities represent other service locations for the selected provider or separately enrolled subparts, such as a Rehabilitation unit, that are considered part of the same provider practice.
The Provider Inquiry/Maintenance - Affiliations/Other Service Locations page contains the following pod and panels:
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.
If you access this page through Provider Inquiry, all fields are view-only.
| Fields | Description |
|---|---|
| ID | The provider's ND Medicaid number. |
| Name | The provider's name. |
| Type |
The type of provider enrolling. Examples: Group, Individual |
| Status |
The provider's status Examples: Active, Inactive |
| P-SYS-ID | The provider's internal system identification number. This is a system generated, unique, sequential number. |
| To go to a specific page, in the Details or Maintenance pod, click the link. | |
| Field Name | Description |
|---|---|
| To add a new affiliation, click Add Affiliation. To view or edit, in the Affiliations table, click the appropriate row. | |
| Provider ID | The affiliated provider's identification number. |
| To verify the provider ID and automatically populate the provider's name, click Validate. | |
| Provider Name | The affiliated provider's name. Automatically displayed. |
| Affiliation Type |
The type of affiliation (in what capacity is this provider affiliated with another within the system). Examples: Ind2Grp (individual to group practice), GrptoGrp (group to group), Pharm340b (participates in the 340b Drug Pricing Program) |
|
Effective Date |
The date the provider's affiliation began. Format: MM/DD/YYYY |
|
Expiration Date |
The date the provider's affiliation ends. Format: MM/DD/YYYY |
| Participating PCP |
Indicates that the provider can be selected as a primary care physician (PCP) at this practice. |
| Field Name | Description |
|---|---|
| Provider ID | The provider's identification number. Links to the Name and Address page for the provider at the other service location. |
| Provider Address | The provider's address. |
| Primary | Indicates whether the location is the primary location. |
Version as of 5/16/14.
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