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Contracting Provider Registration

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Assign a contracting provider to a funding source in order to assign service authorizations to the contracting provider.

  1. In the Select Provider screen, enter the provider name. Choose the provider name from the list of Results, and click Select.

    Result: If the provider has been registered, a pre-display dialog displays.

    • Select Edit to edit a contracting provider and funding source association.
    • Select Add to register a contracting provider with a funding source.
    • Select Delete to delete the selected registration.

    Note: Registrations where the performing provider and/or the contracting provider program are actively associated with services or authorizations cannot be deleted.

Provider Basics 

  1. Go to: Avatar MSO > Provider Management > Contracting Provider Registration

  2. The Type of Contracting Provider field populates from the Applying Contracting Provider form.

  3. In the Name field, enter the provider name.

  4. In the Registration Date field, enter the provider registration date. This is the first date the provider can perform services for the funding source.

  5. In the In Network/Out of Network field:

  • Select In Network if the provider is a network provider.

  • Select Out of Network if the provider is not a network provider.

Funding 

  1. In the Eligible Funding Source field, select the funding source. Leave blank to allow all funding sources.

  2. In the Use Eligible Funding Source For 837 Processing field, select Yes to use the funding source for 837 files.
  • Select Yes to apply the provider selected in the Contracting Provider’s Eligible Funding Source field for the claimed service.
  • Select No to use the client’s enrollment (if available), or the funding source for the authorization.

  1. In the Classification field, select a classification for the contracting provider for scheduling EOB Creation in the Import/Export File Configuration form.

  2. In the Federal Tax ID# field, enter the tax ID for this provider.

  3. In the Submitter Identifier field, enter a unique ID for association with the funding source. This is needed to identify which provider the 837 is associated to.

Demographics

  1. Enter Primary Mailing address information for the location that is to receive applicable communications.

  2. In the Primary Mailing Address - County field, select the county.

  3. If the physical office location is different than the primary mailing address, enter the address information in the 'Office Address' fields.

  4. If the location managing billing is different than the primary mailing address, enter the addressing information in the 'Billing Address' fields.

Additional Registration Information

  1. In the Is Signed Confidentiality Agreement Attached field, select Yes if the agreement is attached.

  2. In the Member Service Authorization Requires field, select Yes to require the Contracting Provider Authorization field on the Service Authorization form.

  3. In the Make Checks Payable To field, enter the provider name.

  4. In the 'Office Hours' fields, enter the time in the format HH:MM-HH:MM.
    The first HH:MM is the office opening time, the second HH:MM is the closing time. Leave the field blank if the office is closed on that day.

  5. In the Restrict Member Authorizations to Contracting Provider Authorization Limits field:
    Define the level of restriction for the total estimated liability of a member authorization associated with a contracting provider authorization.
  • Yes - Member service authorizations associated to a contracting provider service authorization cannot exceed the total estimated liability of the contracting provider service authorization minus dollars claimed against it, and the sum of the total estimated liabilities of currently linked member authorizations.
  • Error - Unlimited member service authorizations can be associated to the contacting provider service authorization. An error message will display if a member service authorization with a total estimated liability greater than the remaining liability of the contracting provider authorization.
  • Warn - An unlimited number of member service authorizations can be associated to the Contracting Provider Service Authorization. A warning message will display if a member service authorization has a total estimated liability greater than the remaining liability of the contracting provider authorization.
  • Silent - An unlimited number of member service authorizations can be associated to the contracting provider authorization. 
    Note: This field cannot be changed if a member authorization linked to any contracting provider authorization conflicts with the newly selected value.
  • All linked Member Authorizations associated to any of the current Contracting Provider's Authorizations must be updated to not conflict with the desired setting before being able to select  that value.

Billing Provider Data

  1. In the Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08) field, select the qualifier.

  2. In the Billing Provider Tax Identification Code Qualifier (2010AA-REF-01) field, select the qualifier.

  3. In the Billing Provider UPIN/License Information Code Qualifier (2010AA-REF-01) field, select the qualifier.

  4. In the Billing Provider UPIN/License Information Code Qualifier - 2 (2010AA-REF-01) field, select the qualifier.

  5. When finished, select Submit.

► Additional Sections
► Dictionary Values
► SQL Table
  • SYSTEM.provider_current_demographics
► Registry Settings