Performing Provider Registration

Define basic information for a performing provider. Multiple registrations are permitted. The performing provider information is used for two primary purposes: 

• In a facility, all the clinical staff providing services can be tracked here. When providing authorizations, the MSO can assign a specific performing provider to provide the service. Upon the receipt of the claim, the performing provider is validated and the service can be denied based on this. A performing provider’s License Type is also defined for the performing provider. This value is not associated to the Performing Provider License Data, but is used in the Provider Fee Table and the search criteria ONLY.
• The search criteria for a contracting provider is assigned in the performing provider’s information. (If the performing providers for a facility are not tracked, a single entry for the search criteria is recommended. For contracting providers who are non-facilities, a single entry is recommended for the search criteria of that person.) The performing provider’s information is associated to a specific Contracting Provider Registration. If a performing provider’s information is valid for multiple funding sources supported by the MSO, the performing provider’s information must be entered for each Contracting Provider Registration.
• Access to the Social Security Number field is defined in the User Definition, and User Role Definition forms (Social Security Number Access field). This is defined by a system administrator.
• For ProviderConnect NX users, this form must be added in  User Role Definition or User Definition. An organization’s system administrator will need to update ProviderConnect NX user roles to give end users read/write access to the form.

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

2. In the Select Performing Provider screen, enter the provider name. Click Select.

   • If the provider is found, click OK.
     • If the provider has previous registration records, select the record. Click Edit to change the information, Delete to remove the record, or Add to create a new record.
   • If the provider is not found, click New.
     • The Auto Assign dialog displays.
     • Click Yes to assign an ID.
     • Click No to display the ID Number dialog and enter an ID.In the Inactive Performing Provider Registration? field, select whether or not this registration record is inactive. Selecting Yes will disable the registration for editing, and flag this provider with "Inactive" in the name. This would be used for unused entries such as duplicates or those submitted in error.
3. In the Name field, enter the provider name.
4. In the Registration Start and End Date fields, enter the timeframe for the registration.
5. In the Performing Provider's Birth Date field, enter the provider's birth date.
6. In the Performing Provider's Social Security Number field, enter the social security number.
   • Enter new data for a client, edit and view data
   • Enter new data for a client, and view data
   • Enter new data for a client
7. In the Performing Provider's E-mail Address field, enter the e-mail address.
8. In the Performing Provider's License Type field, select the license types.
9. In the Primary License Type for Claims field, select the license type to be included when generating 837 P or 837 I claims. This field defines the default primary license type for a performing provider when the provider is selected to be linked to a contracting provider.
   
   Result: This information is sent to the Contracting Provider Registration form but can be updated there to be customized to the contracting provider.

   • If the primary license type being used by a contracting provider is removed from the Performing Provider's License Type list, then the primary license type for that contracting provider will be blank.

   • If the primary license type is the same as the primary license type in the performing provider's registration, then the newly-selected default value will be used for the Contracting Provider's Primary License Type.

10. In the Performing Provider's Gender field, select the performing provider's gender.
11. In the Performing Provider's Race/Ethnicity field, select the race or ethnicity.
12. In the Performing Provider's Age Group field, select the age groups.
13. In the Treatment Age Group Specialties field, select the age groups the provider specializes.
14. In the Hospital Privileges field, select the hospitals where the provider has privileges.
15. In the Special Accommodations field, select the special accommodations the provider has available.
16. In the Other Languages field, select the other languages the provider can knows.
17. In the Specialties field, select the provider's specialties.
18. In the Insurance Companies field, select the insurance companies.
19. In the Counties Served field, select the counties.
20. In the Does Performing Provider have Accessibility for Handicapped Persons field, select Yes if the provider has handicapped accessibility.
21. In the Performing Provider's Address ZIP Code field, enter the performing provider's ZIP code.
22. In the 'Performing Provider Address' fields, enter the information as appropriate.
23. In the Medicaid Provider # field, enter the provider's Medicaid number.
24. In the Performing Provider's State Reporting # 1 field, enter the provider's state reporting number.
25. In the Provider ID Qualifier field, select whether the ID is a Health Care Financing Administration National Provider Identifier, or a Unique Physician Identification Number.
    Note: This field is used to populate the Rendering Provider Identification Qualifier (2100-NM1-08) on an 835. The Provider ID Qualifier currently supports the values 'XX-Health Care Financing Administration National Provider Identifier' and 'UP-Unique Physician Identification Number (UPIN)'. Any additional values can be supported by adding the code/value to the Provider ID Qualifier dictionary and specifying the appropriate ID in the Provider ID field.
26. In the Provider ID field, enter the number.
27. This field is used to populate the Rendering Provider ID (2100-NM109) on an 835. 
28. In the DEA License # field, enter the provider's DEA License number.
29. In the Degree/Year Graduated field, enter the degree and year the provider graduated.
30. In the Residency Institution Name field, enter the institution name.
31. In the Residency Institution Address field, enter the institution address.
32. In the From And To Month/Year of Residency MM/YY - MM/YY field, enter the residency date range.
33. In the Have Copies of Curriculum Vitae been Received field, select Yes if the provider has copies of the curriculum vitae.
34. In the Board Certified field, select Yes if the provider is board certified.
35. In the Credential Board Approval Date field, enter the date the provider received their credentials.
36. In the Board Eligible field, select Yes if the provider is board eligible.
37. In the Received Copies of Board Certification Etc field, select Yes if the provider submitted copies of their board certification.
38. In the Are You Available for Evaluations on an Immediate Basis field, select Yes if the provider is available for evaluation.
39. In the Are You Available for Evaluations in 48 Hours field, select Yes if the provider is available for evaluations within 48 hours.
40. In the Have You Ever Had a Problem with Hospital Membership or Privileges field, select Yes if the provider has had these problems.
41. In the Explanation of Membership or Privileges Problem field, enter information to describe problems encountered by the provider.
42. In the Have You Ever Been Convicted of a Felony field, select Yes if the provider has been convicted of a felony.
43. In the Explanation of Felony Conviction field, enter information to describe the provider felony.
44. In the Primary License Type Effective Dates field, choose either Create New or select an existing Provider License Type Claim to edit.
45. In the Effective Start and End Date field, select the date range for the entry.
46. Choose from the following options:
    • File Primary License Type Effective Date to process the dates for that entry.
    • Delete Primary License Type Effective Date to remove the dates for that entry from the system.
    • Display Primary License Type Effective Dates to see a report of the entries that exist for the performing provider. 

► Additional Sections

• Performing Provider's License Data

► Registry Settings

•  Overwrite All Contracting Provider Registration Associations on Update

► SQL Tables

• SYSTEM.performing_license_dates
• SYSTEM.provider_license_dates 
• SYSTEM.provider_performing_data