Location Information

This page enables you to enter contact and address information for your business. You can enter data manually or, if you have chosen to pre-populate your enrollment data from PECOS, select from the options in the Contact Name, Physical Address, and Mailing Address drop-down lists and have the System auto-populate the fields on this page. As needed, you can edit any of the information pre-populated from PECOS.

Location Information Using PECOS

To enter contact and address information from PECOS:

1. Select the Contact Name whose location information you want to provide. If you need to enter the contact name manually, leave the field as --SELECT--.
2. As needed, enter or update the fields in the Contact Information section.
3. Select the Physical Address you want to associate to the contact. If you need to enter an address manually, leave the field as --SELECT--.
4. If an update is needed for the current physical address or you want to add a new physical address, select Address.

   The System displays the Address Details page.

5. Enter the appropriate address in the Address Line 1 field.
6. Enter the appropriate Zip Code.
7. Select Validate Address.

   The System auto-populates the remaining fields with the appropriate information.

8. If needed, manually edit the fields.
9. Select OK.

   The System saves the address details, displays the Location Information page, and auto-populates the Physical Address Information details.

10. Select the Mailing Address you want to associate to the contact. If you need to enter an address manually, leave the field as --SELECT--.
11. In the Mailing Address Information section, select the appropriate Address Input Option.

    If you select Same as Physical Address, the fields in this section auto-populate with the physical address information.

12. If you select Manually Input, select the Address button in this section.

    The System displays the Address Details page.

13. Enter the appropriate address in the Address Line 1 field.
14. Enter the appropriate Zip Code.
15. Select Validate Address.

    The System auto-populates the remaining fields with the appropriate information.

16. Confirm that the auto-populated information is correct and select OK.

    The System saves the address details, displays the Location Information page, and auto-populates the Mailing Address Information details.

17. Select Submit.

    The System saves the Location Address information and returns to the location step page.

18. Select Close

    The System displays the Enroll Provider page for the provider type.

Location Information by Manual Entry

To add contact and address information manually:

1. Enter the information in the Contact Information section. Fields with an asterisk (*) are required.
2. If desired, select the checkbox for I wish to opt-in for paperless correspondence.
3. In the Physical Address Information section, select Address.

   The System displays the Address Details page.

4. Enter the appropriate address in the Address Line 1 field.
5. Enter the appropriate Zip Code.
6. Select Validate Address.

   The System auto-populates the remaining fields with the appropriate information.

7. If needed, manually edit the fields.
8. Select OK.

   The System returns to the Location Information page where the Physical Address Information fields are populated.

9. In the Mailing Address Information section, select the appropriate Address Input Option.

   If you select Same as Physical Address, the fields in this section auto-populate with the physical address information.

10. If you select Manually Input, select the Address button in this section.

    The System displays the Address Details page.

11. Enter the appropriate address in the Address Line 1 field.
12. Enter the appropriate Zip Code.
13. Select Validate Address.

    The System auto-populates the remaining fields with the appropriate information.

14. If needed, manually edit the fields.
15. Select OK.

    The System returns to the Location Information page where the Mailing Address Information fields are populated.

16. Select Submit.

    The System saves the Location Address information and returns to the location step page.

17. Select Close

    The System displays the Enroll Provider page for the provider type.

Related Topics

Individual

Facility/Agency/Organization/Institution

Group Practice