Provider Set Maintenance

Use Provider Set Maintenance to maintain additional information an insurance carrier may require for receiving claims from a provider who performs services at multiple locations or within multiple departments.  Certain insurance carriers may assign additional billing numbers to a provider to identify and track the specific locations or departments where the services are performed.

Tips:  

• In addition to Provider Sets, you can maintain Group Sets, Location Sets, and Insurance Sets for the additional information required for processing the billing claims for the provider services.

• Some insurance carriers may require specific entries in certain Provider Set fields and those fields are noted in this topic.  For entry details, please contact the appropriate insurance carrier.

• For more information about working with data in fields, see the Data Entry Guidelines.

Directions:

To see directions for...

• Opening Provider Set Maintenance, click More.

   

  1.  Click File Maintenance from the Menu Bar.

  2.  Click Standard Maintenance.

  3.  Click Provider.

  4.  Click Additional from the Provider Maintenance Menu Bar.

  5.  Click Provider Set.

   

  Provider Set Maintenance Window Example:

  

   

• Creating a New Provider Set, click More.

   

  To create a new record choose one of these methods:

  • Enter the new Provider Code, Location Code, Department Code, Insurance Set, and Sub Set (if applicable), then  click Retrieve , or press [ENTER].
    Keyboard shortcut:  [ALT + t]

  • Or, enter the new Provider Code and click File from the Menu Bar; next click New.
    Keyboard shortcut:  [ALT] [f] [n]

  Tip:  To indicate that you are building a new Provider Set, New  displays near the Provider Code.  Default entries display and the first field is highlighted to let you know you can begin entering information.

   

  Provider Set Maintenance Prompts Tip:  To see more information about a field, click the hyperlink for the field name.
  Provider Code	Enter the defined Provider Code for the Provider Set. (up to 4 characters)
  Location	Enter the Location Code or press [TAB] to assign this information to all locations. (up to 2 characters)
  Department	Enter the Department Code or press [TAB] to assign this information to all departments. (up to 2 characters)
  Insurance Set	Enter the defined Insurance Set or press [TAB] to assign this information to all insurance sets. (up to 5 characters)
  Sub Set	Enter the defined Sub Set or press [TAB] to assign this information to all sub sets. (up to 2 characters)
  	To update the new or changed information, click Save or press [ENTER]. Keyboard shortcut:  [ALT + s]
  	CAUTION To avoid losing data, you must save new or changed records.
  	To view all of the existing Providers, click Search.  From the Search list you can select the record to change or delete. Keyboard shortcut:  [ALT + r]
  	To display an existing Provider Set, enter the Provider Code, Location Code, Department Code, Insurance Set, and Sub Set, then click Retrieve, or press [ENTER]. Keyboard shortcut:  [ALT + t]
  Federal ID	Enter the Federal Tax Identification for the provider set, if applicable. (up to 15 characters) Note:  Leave this field blank, unless specified by the insurance carrier.
  Print Code	Enter the Print Code for the provider set, if applicable. (up to 15 characters) Note:  Leave this field blank, unless specified by the insurance carrier.
  Billing Number	Enter a Billing Number for the provider set, if applicable. (up to 10 characters) Notes:   Leave this field blank, unless specified by the insurance carrier. The Billing Number may be used for billing different types of insurance plans or types of commercial insurances.
  Servicing Number	Enter a Servicing Number for the provider set, if applicable. (up to 10 characters) Note:  Leave this field blank, unless specified by the insurance carrier.
  Referring Number	Enter a Referring Number for the provider set, if applicable. (up to 15 characters) Note:  Leave this field blank, unless specified by the insurance carrier.
  Network ID	Enter the Network ID for the provider set, if applicable. (up to 15 characters) Note:  Often Aetna and Cigna require a Network ID.  For more information, please contact the insurance carrier.
  Star Number	Enter the Star Number for the provider set, if applicable. (up to 6 characters) Note:  Leave this field blank, unless specified by the insurance carrier.
  Suffix Number	Enter the Suffix Number for the provider set, if applicable. (up to 4 characters) Note:  Leave this field blank, unless specified by the insurance carrier.
  National ID	Enter the National Provider Identifier for the provider. (up to 15 characters)
  Specialty	Enter the Taxonomy Code (Specialty Code) for the provider, if applicable. (up to 16 characters)
  UPIN Number	Enter the Provider UPIN Number. (up to 6 characters)
  Site Number	Enter the Site Number for the provider, if applicable. (up to 15 characters) Note:  Leave this field blank, unless specified by the insurance carrier.

   

• Editing an Existing Provider Set, click More.

   

  CAUTION:  To avoid losing data, you must save new or changed records.

  1.  To display the record to be changed, enter the Provider Code, Location Code, Department Code, Insurance Set, and Sub Set (if applicable), then click Retrieve , or press [ENTER].
  Keyboard shortcut:  [ALT + t]

  2.  To position the pointer to the information that you want to change, press [TAB] or click the field using the mouse.

  3.  Enter the data changes.

  4.  To complete the edit process, click Save , or press [ENTER].
  Keyboard shortcut:  [ALT + s]

   

• Deleting an Existing Provider Set, click More.

   

  1.  To display the record to be deleted, enter the Provider Code, Location Code, Department Code, Insurance Set, and Sub Set (if applicable), then click Retrieve , or press [ENTER].
  Keyboard shortcut:  [ALT + t]

  2.  Click File from the Menu Bar, and next click Delete.
  Keyboard shortcut:  [ALT] [f] [d]

  3.  At the Delete Records prompt, click Proceed to delete the record, or click Cancel to escape from the delete routine.

  Example:

  

   

  Note:  After you click Proceed, you will see the following message on the Status Bar.