Provider Portal - View/Update Provider Data

The Maintain Provider Information hyperlink enables you to view your current information recorded in the WCMBP system and make changes to certain fields.

To view or update your provider information:

From the Provider Portal home page, select the Maintain Provider Information hyperlink.

The system displays the View/Update Provider Data page. This page displays 12 categories of information that you can view and update plus a Step 13 that you use to submit any changes you make to your provider information.

Each of the information categories is described in the following sections.

Step 1: Basic Information

Selecting this hyperlink displays the Provider Details page. This page shows your basic provider details:

• Provider type
• Programs your serve
• Provider name details
• Federal Provider Identification Number (FEIN)
• National Provider Identifier (NPI)
• Entity type
• Email address

Of these fields, you can update the name fields, entity type, and email address, and, if applicable, you can add a program by selecting the new program’s checkbox.

When you have finished viewing or updating the information on this page, click OK to exit back to the View/Update Provider Data page.

Step 2: Location

Selecting this hyperlink displays the Provider Locations page. This page shows a list of your locations.

To view or update your location information:

1. Select the hyperlink under the Location Name column for the location you want to view or update.

The system displays the Location Details page. This page identifies the contact name and contact information and, in the Address List section, lists your addresses and address types.

2. Under the Location Details section, make any updates to the information as needed.
3. Click Save.
4. To view or update an address, select the hyperlink under the Address Type column for the address you want to view or update.

The system displays the Location Address page, which shows your address information.

5. To update the address information, click the Address button.

The system displays the Address Details dialog.

6. Update the Address Line 1 field and the Zip Code field and click Validate Address.

The system validates the address and auto-populates the remaining address fields.

7. Click OK to exit back to the Location Address page where the address information has been updated on the page.
8. Click Save and then click Close to exit back to the Location Details page.
9. Click Close at each page to exit back to the View/Update Provider Data page.

Step 3: Taxonomies

Selecting this hyperlink displays the Taxonomy List page, which enables you to view your existing taxonomy code and code type, and add a new taxonomy code, if needed, to your practice. Taxonomy codes refer to the Healthcare Provider Taxonomy Code Set, which categorize the type, classification, and/or specialization of health care providers. The WCMBP system responds to these codes throughout the application process to ensure the required information is collected.

The Taxonomy List page shows your taxonomy code(s), the code’s type, the specialty or sub-specialty of the code, and the current operational and OWCP statuses.

To add a new taxonomy code and specialty/sub-specialty:

1. At the top of the Taxonomy List page, click the Add button.

The system displays the Select Taxonomy Code Type/Specialty dialog.

2. At the Taxonomy Code Type drop-down, select the taxonomy code type.

The dialog refreshes and populates the Specialty drop-down with selections applicable to the taxonomy code type you selected.

3. Select the specialty from the Specialty drop-down.

The dialog refreshes and populates the Available Taxonomy Codes list box with selections applicable to the specialty you selected.

4. Enter or select the start date for the taxonomy in the Start Date field.
5. Select one or more taxonomy codes from the Available Taxonomy Codes list box that you want to add and click the right double-arrow button to move your selection to the Associated Taxonomy Codes list box.
6. When you are finished, click OK to exit back to the Taxonomy List page where the list now displays the taxonomy(ies) and specialty(ies) you added.
7. Click Close to exit back to the View/Update Provider Data page.

Step 4: Ownership Details

This hyperlink displays the Ownership List page, which enables you to view and update the ownership details for your practice. This page shows the owner ID, owner name, ownership type, and OWCP status.

Viewing or Updating an Existing Owner

1. Select the hyperlink under the Owner ID column for the ownership information you want to view or update.

The system displays the Ownership page, which shows the ownership type, owner name, SSN/FEIN number, and owner’s address.

2. Make any updates, as needed, to the name field for the owner and the SSN/FEIN field and click Save.
3. To update the address information, click the Address button.

The system displays the Address Details dialog.

4. Update the Address Line 1 and Zip Code fields and click Validate Address.

The system validates the address and auto-populates the remaining address fields.

5. Click OK to exit back to the Ownership page where the address information has been updated on the page.
6. Click Save and then click Close to exit back to the Ownership List page.
7. Click Close to exit back to the View/Update Provider Data page.

Adding a New Owner

1. At the Ownership List page, click the Add button.

The system displays the Add Ownership dialog.

2. At the Ownership Type drop-down, select whether the ownership type is individual or organization.

Depending on your selection, the system enables either the Organization Name field or the Last Name and First Name fields.

3. Enter the ownership name in the Organization Name field or the Last Name and First Name fields if an individual.
4. Enter the SSN or FEIN in the SSN/FEIN field.
5. To update the address information, click the Address button.

The system displays the Address Details dialog.

6. Update the Address Line 1 field and the Zip Code field and click Validate Address.

The system validates the address and auto-populates the remaining address fields.

7. Click OK to exit back to the Add Ownership dialog where the address information has been updated on the page.
8. Click OK to exit back to the Ownership List page.
9. Click Close to exit back to the View/Update Provider Data page.

Step 5: Licenses and Certifications

This hyperlink displays the License/Certification List page, which enables you to view and update current licenses and certifications, or add a new license or certification.

Viewing and Updating Existing Licenses and Certifications

1. 1. Select the hyperlink under the License Category column for the license or certification you want to view or update.

The system displays the Manage License/Certification page, which shows the details of the currently selected license or certification.

2. Make any updates, as needed, to the editable fields on the page and click Save.
3. Click Close to exit back to the License/Certification List page where the license or certification information you updated is now listed on a new line with the status of “In Review.”
4. Click Close to exit back to the View/Update Provider Data page.

Adding a New License or Certification

1. At the License/Certification List page, click the Add button.

The system displays the Add License/Certification dialog.

2. Select the proper radio button to indicate if this is a new required certification or required license, or if this specifies a new license or certification that is not required.
3. Enter the recipient’ name in the Name field.
4. Enter the license or certification type in the License/Certification Type field.
5. Enter the license or certificate number in the License/Certification # field.
6. Enter or select the initial issue date and expiration date in the Initial Issue Date and the Expiration Date fields.
7. At the Issued State drop-down, select the state where the license or certification was issued.
8. Enter the issuing agency in the Issuer Agency field.
9. In the Web Link field, enter the web link to the issuing agency.
10. When finished, click OK to exit back to the License/Certification List page where the license or certification information you updated is now listed on a new line with the status of “In Review.”
11. Click Close to exit back to the View/Update Provider Data page.

Step 6: Identifiers

This hyperlink displays the Provider Identifiers page, which enables you to view existing identifiers and add new identifiers as needed. This page records identifiers that are typically issued by external entities that uniquely identify the provider and are required to maintain provider enrollment.

Note: The Required Credentials button links to the Required Credentials for Provider Type dialog. This dialog gives you a view of the required credentials for your provider type.

To view the details of an existing identifier, select the hyperlink under the Identifier Type column for the identifier you want to view. The Manage Identifier page appears with the identifier type, identifier value, status, and start and end dates displayed in view-only format. Click Close to exit back to the Provider Identifiers page.

To add an identifier:

1. At the Provider Identifiers page, click the Add button.

The system displays the Add New Identifier dialog.

2. Select the identifier type from the Identifier Type drop-down.
3. Enter the identifier value in the Identifier Value field.
4. Enter or select the start and end dates in the Start Date and End Date fields.
5. Click OK to exit back to the Provider Identifiers page where the new identifier is now listed with a status of “In Review.”
6. Click Close to exit back to the View/Update Provider Data page.

Step 7: EDI Submission Method

This hyperlink displays the EDI Submission Method page, which enables you to view, update, or add the electronic data interchange (EDI) method(s) for your organization.

Adding an EDI Submission Method

If no EDI method is listed on the EDI Submission Method page, click the Add button to add the method. The EDI Submission Details dialog is displayed. Select one or more of the Mode of Submission checkboxes for your EDI submission method(s) and click OK.

The dialog closes and the EDI Submission Method page appears with your added EDI submission method(s) displayed with the status of “In Review.”

Click Close to exit back to the View/Update Provider Data page.

Updating Your EDI Submission Method

At the EDI Submission Method page, select the hyperlink under the EDI Submission Method column. The EDI Submission Details dialog is displayed. Select or deselect the Mode of Submission checkboxes to update your EDI submission method(s) and click OK.

The dialog closes and the EDI Submission Method page appears with your added EDI submission method(s) displayed with the status of “In Review.”

Click Close to exit back to the View/Update Provider Data page.

Step 8: EDI Submitter Details

This hyperlink displays the Billing Agent/Clearinghouse/Submitter List page, which enables you to view, update, or add the EDI submitter(s) for your organization.

Adding an EDI Submitter

1. At the Billing Agent/Clearinghouse/Submitter List page, click the Add button.

The system displays the Associate Billing Agent/Clearinghouse dialog.

2. Enter the OWCP ID of the billing agent or clearinghouse in the Billing Agent/Clearinghouse OWCP ID field.
3. Enter or select the start and end dates in the Start Date and End Date fields.
4. Click OK to exit back to the Billing Agent/Clearinghouse/Submitter List page where the added EDI submitter now appears with a status of “In Review.”
5. Click Close to exit back to the Billing Agent/Clearinghouse/Submitter List page.
6. Click Close to exit back to the View/Update Provider Data page.

Updating an EDI Submitter

1. At the Billing Agent/Clearinghouse/Submitter List page, select the hyperlink under the OWCP ID column for the submitter you want to update.

The system displays the Associate Billing Agent/Clearinghouse dialog.

2. As needed, update the start and end dates in the Start Date and End Date fields.
3. Click OK to exit back to the Billing Agent/Clearinghouse/Submitter List page where the added EDI submitter now appears with a status of “In Review.”
4. Click Close to exit back to the Billing Agent/Clearinghouse/Submitter List page.
5. Click Close to exit back to the View/Update Provider Data page.

Step 9: EDI Contact Information

This hyperlink displays the EDI Contact Information List page where you can view, update, or add EDI contacts for your organization.

Adding an EDI Contact

1. At the EDI Contact Information List page, click the Add button.

The system displays the Add EDI Contact Information dialog.

2. Enter the title of the contact in the Contact Title field.
3. Enter then name of the contact in the Last Name and First Name fields.
4. Enter the contact’s phone number, fax number, and email address in the appropriate fields.
5. Enter the start and end dates in the Start Date and End Date fields.
6. To update the address information, click the Address button.

The system displays the Address Details dialog.

7. Update the Address Line 1 and Zip Code fields and click Validate Address.

The system validates the address and auto-populates the remaining address fields.

8. Click OK to exit back to the Add EDI Contact Information page where the address information has been updated on the page.
9. Click OK to exit back to the EDI Contact Information List page where the new EDI contact is now displayed with a status of “In Review.”
10. Click Close to exit back to the View/Update Provider Data page.

Viewing or Updating an EDI Contact

1. 1. At the EDI Contact Information List page, select the hyperlink under the Contact Title column for the contact you want to view or update.

The system displays the Manage EDI Contact Information page.

2. As needed update the contact information and click Save.
3. To update the address information, click the Address button.

The system displays the Address Details dialog.

4. Update the Address Line 1 and Zip Code fields and click Validate Address.

The system validates the address and auto-populates the remaining address fields.

5. Click OK to exit back to the Manage EDI Contact Information page where the address information has been updated on the page.
6. Click Save and then click Close to exit back to the EDI Contact Information List page where the updated EDI contact is now displayed with a status of “In Review.”
7. Click Close to exit back to the View/Update Provider Data page.

Step 10: Payment Details

This hyperlink displays the Payment Details page where you can view, update, or add payment information for your organization.

Adding New Payment Information

1. At the Payment Details page, click the Add button.

The system displays the Payment Details dialog.

2. Under the Payment Details section, enter the start date for the payment method in the Requested EFT Start Date field.
3. Enter an end date in the End Date field.
4. Under the Financial Institution Information section, enter the name of the financial institution, the institution’s routing number, phone number, your depositor account number, the type of account, and ACH coordinator name.
5. Add the financial institution’s address information by clicking the Address button.

The system displays the Address Details dialog.

6. Enter the first line of institution’s address in the Address Line 1 field, enter the Zip code, and click Validate Address.

The system validates the address and auto-populates the remaining address fields.

7. Click OK to exit back to the Payment Details page where the address information has been updated on the page.
8. Select the Signed by Representative checkbox to indicate that the ACH form has been signed by a representative of the financial institution.

Important Note: A signed ACH form must be submitted (mailed or uploaded as an attachment) to complete the provider enrollment.

9. Enter the title of the financial institution’s representative in the Title of Representative field.
10. Enter the representative’s phone number in the Representative Phone Number field.
11. Click OK to exit back to the Payment Details page where the payment information you entered is displayed with a status of “In Review.”
12. Click Close to exit back to the View/Update Provider Data page.

Viewing or Updating Payment Information

1. At the Payment Details page, select the hyperlink under the Account Number column for the payment information you want to view or update.

The system displays the Payment Details dialog.

2. Under the Payment Details section, update the start date for the payment method in the Requested EFT Start Date field.
3. Under the Financial Institution Information section, update the name of the financial institution, the institution’s routing number, phone number, your depositor account number, the type of account, and ACH coordinator name.
4. To update the financial institution’s address information, click the Address button.

The system displays the Address Details dialog.

5. Enter the first line of institution’s address in the Address Line 1 field, enter the Zip code, and click Validate Address.

The system validates the address and auto-populates the remaining address fields.

6. Click OK to exit back to the Payment Details page where the address information has been updated on the page.
7. Select the Signed by Representative checkbox to indicate that the ACH form has been signed by a representative of the financial institution.

Important Note: A signed ACH form must be submitted (mailed or uploaded as an attachment) to complete the provider enrollment.

8. Enter the title of the financial institution’s representative in the Title of Representative field.
9. Enter the representative’s phone number in the Representative Phone Number field.
10. Click OK to exit back to the Payment Details page where the payment information you entered is displayed with a status of “In Review.”
11. Click Close to exit back to the View/Update Provider Data page.

Step 11: Complete Provider Disclosure

This hyperlink displays the Provider Disclosure page where you can answer the disclosure questions required for enrollment. If the disclosure is not current, update the disclosure answers, click Save, and then click Close to exit back to the View/Update Provider Data page.

Step 12: View/Update Attachments

This hyperlink displays the Attachment List page where you can upload required attachments to your enrollment. You can also download any of the attachments shown in the list.

Note: The Required Credentials button links to the Required Credentials for Provider Type dialog. This dialog gives you a view of the required credentials for your provider type.

To upload an attachment:

1. 1. At the Attachment List page, click the Upload Attachments button.

The system displays the Attachment page.

2. Select the document type from the Document Type drop-down.
3. Click the Browse button.

The system displays the Open window.

4. Locate and select the file from your local drive that you need to upload and click the Open button.

The system updates the File Name field.

5. Click OK.

The System uploads the selected file displays the Attachment List page.

6. Click Close to exit back to the View/Update Provider Data page.

Step 13: Submit Maintenance Request for Review

This hyperlink displays the Final Submission page so that you can submit your provider information updates to OWCP for review.

Note: All of the required categories in the preceding steps must be complete before you can complete the submission.

To submit the provider information updates for review, follow the instructions indicated on the Final Submission page for submitting signatures and supporting documentation. When complete, click the Submit Enrollment button. The updates are then submitted for review.

Click Close to return to the Provider Portal home page.

Related Topics

Provider Portal