Provider Inquiry/Maintenance - Identifiers/Enrollment Page

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Provider Inquiry/Maintenance - Identifiers/Enrollment Page

You use the Provider Inquiry/Maintenance - Identifiers/Enrollment page to view or edit a provider’s identifying numbers and codes as issued by Centers for Medicare and Medicaid Services (CMS), Drug Enforcement Agency (DEA), National Council for Prescription Drug Programs (NCPDP), and etc. If DEA or NCPDP numbers vary by location, you use this page to edit that information.

You can view and edit a provider’s overall enrollment to change the reverification date or terminate a provider from all programs.

You can also view and edit network enrollment spans and participation details for the Primary Care Case Management (PCCM) program. You can terminate a provider's participation in individual networks or the PCCM program.

You also use this page to view and edit the provider's previous Medicaid IDs.

The Provider Inquiry/Maintenance - Identifiers/Enrollment page contains fields in the following pod and panels:

Details/Maintenance
Identifiers
Enrollment
Network Enrollment
PCCM Participation
Previous Medicaid

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.

Identifiers Fields

Field Name	Description
To add an identifier, click Add Identifier. To view or edit, in the Identifiers table, click the appropriate row. When the ID Type is for a payee, to view the provider's financial information, on the panel’s action bar, click Financial Entity (Payee/Payer). Links to the Financial Accounting Entity page in the Financial Accounting Entity function for more details.
ID Number	The number that uniquely identifies the provider.
ID Type	The type of number (classification).
Begin Date	The date the ID went into effect.
End Date	The date the ID is no longer valid.

Enrollment Fields

Field Name	Description
Application Received	The date the application was received.
Application Approved	The date the application was approved.
Reverification Due Date	The date reverification is due.
Requested Application Effective Date	The date the provider requested the application to become effective.
Enrollment Spans Fields To view or edit enrollment periods, in the Enrollment Spans table, click the appropriate row.
Begin Date	The beginning date of enrollment.
End Date	The ending date of enrollment.
Status	The status of the enrollment. Example: A-Active
Reason	The reason for the enrollment status.

Network Enrollment Fields

Field Name	Description
To add a network association, click Add Network. To view or edit, in the Network Enrollment table, click the appropriate row.
Network ID - Name	The ID and name of the network the provider is enrolled in.
Begin Date	The date the provider's network participation begins.
End Date	The date the provider's network participation ends.
Status	The status of the provider's network participation.
Reason	The reason for the network enrollment status.

PCCM Participation Fields

Field Name	Description
To add Primary Care Case Management participation information, click Add PCCM Participation. To view or edit, in the PCCM Participation table, click the appropriate row.
Program Name	The name of the managed care participation program in which the provider participates.
Begin Date	The date the provider's participation begins.
End Date	The date the provider's participation ends.
Status	The status of the provider's participation.
Reason	The reason for the participation status.
Maximum # of Members	The maximum number of members the provider is responsible for in the program.
Actual # of Members	The actual number of members the provider is responsible for in the program.

Previous Medicaid Fields

Field Name	Description
To add previous Medicaid information, click Add Previous Medicaid Data. To view or edit, in the Previous Medicaid table, click the appropriate row.
Provider ID	The previous Medicaid provider ID.
To verify the provider ID and automatically populate the provider's name, click Validate.
Provider Name	The name of the provider. Automatically displayed.
Begin Date	The date the previous Medicaid began.
End Date	The date the previous Medicaid ended.
SSN/EIN	The provider's Social Security number or employer identification number.

Version as of 5/16/14.