Providers
The people and places a claim names. This page covers the Providers and Locations screens and the provider page, because they answer one question together: where a claim’s provider and location details come from, and where to correct them.
Who Can See It
Section titled “Who Can See It”User and Administrator, each screen when the client is licensed for it.
Providers
Section titled “Providers”| Column | What it shows |
|---|---|
| Name | The provider. The name opens the provider page; selecting elsewhere on the row opens Edit |
| NPI | Their national provider identifier. A new or changed NPI must be exactly ten digits |
| Type | The role the provider plays on a claim |
| Status | Active, Starts or Ends a date, or Inactive Since a date |
| Phone, Email | Contact |
| Type | What it means |
|---|---|
| Rendering | Performed the service |
| Referring | Sent the patient |
| Billing | Bills for it |
| Supervising | Oversaw it |
A visit carries its providers onto the claim it generates. A service a covering substitute performed under a coverage arrangement bills under the regular provider with the arrangement’s Q5 or Q6 modifier, and names the substitute only as the line’s performer.
Above the list, Current counts the providers shown, or Total with Show Inactive on, beside With NPI. Search matches the name or NPI.
The Provider Page
Section titled “The Provider Page”The header names the provider with their status, and beneath it the NPI, type, taxonomy code and the date they are active from.
| Payer Enrollments | What it shows |
|---|---|
| Payer, Payer ID | The plan the provider is enrolled with |
| Provider Number | The number that payer knows the provider by |
| Effective, Terminated | The enrollment’s window |
Add Enrollment… asks for the Payer, Provider Number, Effective Date and, if known, Termination Date. A row opens it to edit, and its menu offers Edit and Delete. Changing a plan’s payer ID on Insurance Plans carries the enrollments with it.
| Coverage Arrangements | What it shows |
|---|---|
| Substitute | The provider who covers for this one |
| Kind | Q6 · Fee-for-time locum or Q5 · Reciprocal |
| From, To | The coverage window |
| Status | Starts a date, “Day 12 of 60” while the substitute is within 60 days, Past 60 Days, or Ended |
Add Arrangement… asks who the arrangement Covers, the Substitute, the Kind, From and, if known, To. The substitute must be a rendering or supervising provider, and “A provider can’t cover for themselves.” A substitute covers one provider at a time, so an overlapping arrangement for the same substitute is refused. Once claims bill under an arrangement, its kind, substitute and start can’t change and it can’t be deleted: set a To date to end it instead.
Locations
Section titled “Locations”| Column | What it shows |
|---|---|
| Name | The location |
| NPI | The facility identifier. A new or changed NPI must be exactly ten digits |
| Billing Profile | The profile its claims bill under, or Practice default |
| Status | Active, Ends a date, or Inactive Since a date |
| Location | Its facility or address |
| Phone | Contact |
A location’s Code is the name a feed uses for it, such as a hospital unit’s point-of-care code. An import links a visit or charge to the location with that code, and creates one named after the code when none has it. Rename it freely: the code keeps the link. The form’s Billing Profile offers Practice default with the default profile’s name, or a profile by name and NPI.
Actions
Section titled “Actions”| Action | What it does | When it is offered |
|---|---|---|
| Create | Adds a provider or location | Always |
| Edit | Changes one | From the row menu, or by selecting the row |
| View History | Shows who changed the provider or location and what they changed | From the row menu |
| Deactivate… | Asks for the Last Day Active. The provider or location stays on every claim and visit it is on, and visits and services dated after that day can’t pick it | From the row menu, until that day has passed |
| Reactivate | Clears the last active day | From the row menu, once that day has passed |
| Delete | Removes one nothing uses yet, such as one added by mistake. One that claims, visits or fee schedule prices use is refused with the counts, and the dialog offers Deactivate… instead | From the row menu |
Providers hides a provider whose last day has passed; turn on Show Inactive to see it and Reactivate it. Locations always lists them.
If someone else changed the provider or location after you opened Edit, the dialog stays open with a notice and Reload, which refills the form with their version. See A Save Was Refused.
Fix It Here, Not on the Claim
Section titled “Fix It Here, Not on the Claim”A claim failing review on provider or location details is usually a source-record problem. Correcting it here means every future claim built from that source inherits the correction, rather than you repairing each claim in turn. It does not revisit claims already built.
States
Section titled “States”- Empty - a client with no providers or locations says so. With Show Inactive off, a roster whose providers have all ended reads empty too.
- No payer enrollments yet. and No coverage arrangements yet. on a provider page with none.
- A location whose NPI or code another location already has is refused with “another location already has this NPI or code”. A blank one never collides.
- Blocked - each screen has its own module. Without it the entry is not in the sidebar, and a saved link to it says the module is not part of your plan.
Related: Visits · The Claim Page · Check and Fix a Claim