Group Provider Enrollment (Provider Identifier Numbers) Page
You use the Provider Identifier Numbers page to add or edit identification numbers to a group provider's enrollment application.
The Provider Identifier Number page for Group Provider Enrollment contains the following panels:
Provider Identifier Numbers-Section 3 Fields
| Field | Description |
|---|---|
|
National Provider Identifier (NPI) Fields To add a new NPI, click Add NPI. Existing NPIs, if any, are listed in a table. To edit, in the NPI table, click the appropriate row. After changing or adding an NPI number, on the NPI action bar, click Save. |
|
| NPI | Provider's National Provider Identifier number. |
|
Drug Enforcement Administration (DEA) Fields To add a new DEA, click Add DEA. Existing DEA numbers, if any, are displayed in a table. To edit, in the DEA table, click the appropriate row. After changing or adding a DEA number, on the DEA action bar, click Save. |
|
| DEA # | The provider's Drug Enforcement Administration number. |
|
National Council for Prescription Drug Programs Fields To add new National Council for Prescription Drug Programs information, click Add NCPDP. Existing NCPDP information, if any, is displayed in table. To edit, in the NCPDP table, click the appropriate row. After changing or adding the information, on the NCPDP action bar, click Save. |
|
| NCPDP |
The seven-digit National Council for Prescription Drug Programs (NCPDP) provider ID for a licensed pharmacy or qualified non-pharmacy dispensing site. |
| Other State Medicaid Program Information Fields | |
| Are you currently enrolled as a Medicaid provider in another state? | Select Yes or No if the provider is currently enrolled as a Medicaid provider in another state. If Yes, select the state in which the provider is currently enrolled |
| Please select all states others than NH in which you are currently enrolled as a Medicaid provider |
Select all states other than NH in which you are currently enrolled as a Medicaid provider. To move an item from the Available list to the Selected list, select the item, and then click To move an item from the Selected list to the Available list, select the item, and then click |
(the right arrow).
(the left arrow).
Medicare Crossover Payment- Section 3 Fields
| Field | Description |
|---|---|
| To add new Medicare information, click Add Medicare. Existing Medicare information, if any, is displayed in a table. To edit, in the Medicare Numbers table, click the appropriate row. After you edit or add Medicare information, on the Medicare # action bar, click Save. | |
| Medicare # | The Medicare number of the provider or group. |
| Parts |
The Medicare payments you are currently authorized to receive. Examples: All, Parts A, Part B, Part C, and Part D |
|
Medicare History Fields To add new history information, click Add History. Existing Medicare history information, if any, is displayed in a table. To edit, in the Medicare History table, click the appropriate row. After you edit or add history information, on the History action bar, click Save. |
|
| Medicare # | Any provider or group Medicare number assigned to you in the past. |
| Carrier/Intermediary Name | Name of the Medicare carrier or intermediary. |
| Parts |
Check the Medicare payments you were authorized to receive. Examples: All, Parts A, Part B, Part C, and Part D |