⚠️ The Referring Providers feature is currently in Limited Release to a select group of Members and will be gradually rolled out in the future. This article reflects the new updates to come.

Overview

This article reviews how to manage your referring providers and add a provider to a client's case. Entering a Referring Provider to a client's chart populates Box 17 on the CMS-1500 claim form.

Manage Referring Providers

Hover over Providers, then select Referring Providers. At the top of the screen, you are given the option to upload a CSV file to import multiple providers or even add an individual provider. Below, each line will display the provider's name and NPI along with the Edit and Deactivate icons.

Edit Referring Providers

1. Select the Edit icon. 
2. On the Edit Referring Provider window, update any necessary information.

   1. The system is connected to the NPPES NPI Registry and will perform a check to verify that the NPI is valid. This does not check that the name matches the NPI, only that the NPI itself is valid.

      📌 Note: If a payer requires additional information about a Referring Provider, that can be entered into the Box 17a field. This is most common with Medicaid Montana.
3. Once you have completed the necessary fields, select Save & Done.

Add/Edit a Referring Provider to a Client's Case

1. Navigate to Clients > Client List.
2. Locate the desired client and click the Edit icon.
3. Under the Cases section, click the Edit icon to add or edit a Referring Provider.
4. Select Yes if the Client was referred by a Provider, then search for a Referring Provider using the text box. Select Update.

Inactivate a Referring Provider

Inactivating a referring provider allows the provider to still exist in the system and can be reactivated in the future.

1. From the Referring Providers page, select the Deactivate icon.
2. On the warning dialog box, click Yes, Deactivate Provider. 
                       

Search for an Inactive Referring Provider

If you are searching for a Referring Provider and they do not populate in your list, they may be inactive. Click the Show Inactive Referring Providers to view a list of inactivate users. 

Here, you can select Reactivate to make the Referring Provider active again.