Provider Inquiry/Maintenance

You are here: Provider > Providers > Provider Inquiry/Maintenance > Provider Inquiry/Maintenance Field Descriptions > Provider Inquiry/Maintenance - Financial Page

Provider Inquiry/Maintenance - Financial Page

You use the Provider Inquiry/Maintenance - Financial page to view or edit provider information related to payments to that provider. Tax reporting information is used for 1099 reporting. The Electronic Funds Transfer (EFT) information allows ND MMIS to deliver payments to the provider via direct deposit to a designated bank account.

The Provider Inquiry/Maintenance - Financial page contains the following pod and panels:

Details/Maintenance
Tax Reporting
Financial Indicators
SSN/EIN
EFT

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.

Details/Maintenance Fields

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.

Tax Reporting Fields

Field Name	Description
Legal Name as it appears on W9	The name the provider has filed with the IRS.
First B Notice Date	The date the first B notice was sent.
For Tax Year	The tax year related to the date the first B notice was sent.
Fiscal Year End	The provider's fiscal year end date.
Cost Settlement Date	The cost settlement date.
Second B Notice Date	The date the second B notice was sent.
For Tax Year	The tax year related to the date the second B notice was sent.

Financial Indicators Fields

Field Name	Description
In - Kind Indicator	If Yes, this provider represents a State agency or department. Therefore, payments will be reduced to the federal match amount. The default is No.
For Profit	If No, the provider is a non-profit organization. The default is Yes.
1099 Indicator	If Yes, this provider receives a 1099 form. The default is Yes.
Public Indicator	If Yes, this provider is a government-owned/operated provider. It will be used in calculating the Federal Medical Assistance Payment (FMAP) amount when the claim is adjusted.
Billing Code	Restricts the provider's authorization to Billing Only, Servicing (rendering) Only, Medicare Crossover Only, Encounter Only, or Unrestricted. The default is Unrestricted.
Vendor #	The number assigned by the financial system in order to issue payments. This number will be populated by an interface process but may also be modified here.

SSN/EIN Fields

Field Name	Description
To view details, in the SSN/EIN, table, click the appropriate row. If a provider changes owner, requiring a new SSN/EIN, the provider must complete a CHOW (Change of Ownership) Request on the Provider Inquiry/Update Request page available to a logged-in provider.
Tax ID Type	The ID (EIN or SSN) used for IRS tax reporting.
SSN/EIN	The Social Security number or employer identification number of the provider.

Field Name

Description

To view details, in the SSN/EIN, table, click the appropriate row.

If a provider changes owner, requiring a new SSN/EIN, the provider must complete a CHOW (Change of Ownership) Request on the Provider Inquiry/Update Request page available to a logged-in provider.

Tax ID Type

The ID (EIN or SSN) used for IRS tax reporting.

SSN/EIN

The Social Security number or employer identification number of the provider.

EFT Fields

Field Name	Description
To add new EFT information, click Add EFT. To view or edit, in the EFT table, click the appropriate row.
Begin Date	The date that the EFT transactions are to begin.
End Date	The date that the EFT transactions are to end.
Status	The status of the EFT transactions.
Pre-Note Date	The date the zero dollar transaction was sent to test the validity of the payee's bank account information that was provided at the time of enrollment or if subsequently changed.
Financial Institution Name	The name of the provider's financial institution where EFT payments are deposited. Up to 255 alphanumeric characters.
Account Type	The type of account where EFT payments are to be deposited.
Routing	The provider's bank routing number for EFT. Validated using a check digit test.
Account #	The provider's bank account number for EFT transactions.
Bank Address	The address of the provider's bank.
City	The city where the provider's bank is located.
State	The state where the provider's bank is located.
Zip	The zip code and extension where the provider's bank is located.
Account Holder Name	The account holder's full name.
Bank Phone #	The area code and phone number of the bank where EFT payments are deposited.
Payee Provider Name	The full name of the provider listed as the payee.

Version as of 5/16/14.