Add Servicing Provider Information
Use this link to add each Provider who will be providing services to the Claimants under the Provider group. This information is used to adjudicate bills and is needed only for Group Practice Providers.
Note: You must complete all previous steps before you can complete the following procedure.
Important Note: If you chose to populate data from PECOS when starting the application, you must verify the information is correct and complete in this enrollment step. You do this by selecting an existing record link and editing the pre-populated information, if needed. You can also add and delete a record.
To add the Servicing Provider information:
- Select the Add Servicing Provider Information hyperlink.
The System displays the Servicing Providers page.
- Select the Add button.
The System displays the Associate Servicing Provider page.
- Select a Provider Type.
- Enter the required (*) information based on your previous selection.
- Enter the Licensing/Certification information.
- Select the OK button.
The System saves the Servicing Provider information and displays the Servicing Providers page.
- Select the Close button.
The System displays the Enroll Provider-Group Practice page.
To delete a Servicing Provider:
- Select the Add Servicing Provider Information hyperlink.
The System displays the Servicing Providers page.
- Select the checkbox beside the record you want to delete and select Delete.