Provider Setup

After setting up your security profiles, you will now need to begin entering various items into the Medisoft program. Normally, the first data entered is the Provider information.

When we use the term “Provider” we are generally, but not always referring to doctors. Other examples of employees who must be set up as providers would be Nurse Practitioners and Physician Assistants. In general, anyone whose name will be listed on a claim as the person rendering medical services should be set up as a provider.

The provider information window is accessed by clicking the Lists menu, Provider, and Providers.


 

You will now see the Provider List window. Click New.


The Provider entry screen will now appear.


Tips and Tricks:
You may find that the Medisoft program has many fields that do not apply to your office. You do not have to enter data in non-applicable fields.

 

Address

Code: The code field is going to be used to identify this provider throughout the Medisoft program. If you leave this field blank (recommended), the program will assign a value based on the provider’s name.

 

Tips and Tricks:
Medisoft used what is known as a relational database. This means that there are various data tables that hold different pieces of information. One table for the providers, one for the patients, one for the transactions, etc… When you want to assign a provider to a patient, you will be entering the provider code into the patient record, rather than entering all of the provider information into the patient record as well.

Medisoft Reports generally run based on codes as well. If you assign your own codes, it is possible that the sorting order will not make sense. If you allow the Medisoft program to assign the codes, the codes will be based on the names, and therefore the reports will print in alphabetical order.

 

Inactive: Because Medisoft uses a relational database, you do not want to delete records that are referenced in different places throughout the program. Additionally, Medisoft will not allow you to delete a record that is referenced somewhere else within the program.

Instead of deleting the record, you have the option to make it inactive. This will prevent new entries from being made using this provider. It will also protect the integrity of the data that was previously entered using this provider.

Provider Demographics: Provider demographics include Name, Address, Credentials, Email, and Phone Numbers. Most of these fields are self-explanatory. However, it is crucial that this information be accurate. If the information is not entered properly, you may encounter problems when you bill your insurance claims.

Signature on File: This field will affect both paper and electronic claims. Most insurance carriers do not require an actual signature on a claim. If you check this box, paper claims will print the words “Signature on File” in box 31. Electronic claims will also signify to the insurance carrier that the signature is on file.

 

Tips and Tricks:
The Signature on File fields work in conjunction with fields that are set up in the individual insurance carriers. This is due to the fact that different carriers can have different requirements. Both the provider and insurance carriers must be set up properly in order for this feature to function properly.

 

Signature Date: The Signature Date field will only affect paper claims. If you enter a date in this field, and this provider is the provider on a claim, that claim will have this date entered in the Date portion of box 31. If you do not have any date entered in this field, the program will automatically populate box 31 with the date the claim was created.

Medicare Participating: This field will not affect either paper or electronic claims. This is a reference field that will allow you to specify which doctors in the office are Medicare participating, and which are not. The benefit to using this field would be in reporting. For example, if you would like to compare the revenue for participating vs. non-participating providers, this field would help you do so.

License Number: The License Number field is used to hold the doctor’s medical license number. This field will not affect paper claims, but can be transmitted on electronic claims in certain circumstances.

 

Tips and Tricks:
On the provider setup screen and throughout the Medisoft program, you will see a button labeled Set Default. This button is used to create default values for fields that will generally contain the same values for each record entered into that screen.

On the provider screen, the address fields are fields that often qualify as default fields.

This button can also cause confusion if used improperly. If you press the Set Default button with a provider record open, that information will automatically populate whenever the New button is pressed. Customers may then call and state that when they press the New button, Medisoft brings up a different provider account.

In order to remove previously set default values, hold the CTRL button. You will see that the default button now says Remove Defaults. While holding CTRL, click this button.

 

Reference

 

The Reference tab displays data converted from the Default Pins and Default Group IDs tabs, which were replaced in Medisoft 16 and above with the Provider IDs tab.

This tab is primarily for reference. The only field with functionality is the Provider Class field.

Provider Class: Provider Class allows you to run more effective reports by grouping providers. Provider classes are designed to let you filter for a group of providers that are not listed consecutively in the provider list.

 

 

 

Provider IDs

All providers should have at least one grid entry on the Provider IDs grid for each provider. This grid works in conjunction with the Practice IDs grid in Practice Maintenance. If you have a provider that in some instances bills using his/her own NPI number for a specific insurance carrier, you can create an extra grid entry for this provider in which you specify the insurance company and select to pull the provider’s NPI number from the Provider IDs grid.

Click New to add an item to the grid.

 


 

 

 

Tips and Tricks:
Similar to the Tax ID number field in the practice information, you do not want to enter any symbols or spaces along with any ID or Number.

 

 

National Provider ID: The NPI is the standard unique health identifier for health care providers. It consists of a 10 digit identifier (9 numbers followed by a check-digit) that standardizes one number for each provider used by every insurance carrier. This standard was part of the HIPAA legislation to establish a unique identifier to improve the efficiency and effectiveness of electronic health information. Once established, the provider’s NPI will not change regardless of job or location changes.

Taxonomy Code: Taxonomy Codes are a 10 character provider specialty code used for electronic billing. There will be circumstances when submitting electronic claims where you will be asked to supply a Taxonomy Code. Enter this code here. Refer to your electronic claims documentation for more information regarding this field.

Mammography Certification: If a provider has been issued a Mammography Certification number, enter it here. This will only affect EDI claims in certain circumstances.

Care Plan Oversight: Enter the provider’s Care Plan Oversight number here for electronic claims.

Legacy Identifiers: The Legacy Identifiers available on this screen are rarely used. If the Insurance Carrier required a legacy ID, it may be input here. If these IDs are input, they should be specific to one Insurance Carrier or Class.

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