Adding a New Provider in Medisoft

1. Open the Provider List. At the top menu bar select Lists->Provider->Providers


2. Click the New button on the bottom left of the Provider List Window.

3. Enter the provider's name and address information. The full 9 digit zip code is required for electronic claim submission. You do not need to put the dash in the zip code, but it will not have a negative effect if you do include it.

NOTE: You do not need to enter a Code for the provider. Medisoft will create one based on the provider's name if the field is left blank. However, you may add a custom, 5 character long, code in this box if desired.

4. Go to the Provider IDs tab and click the New button on the bottom left of the window to create a new “rule” for the provider's NPI information.

5. Check the box for National Provider ID, Taxonomy, and Tax Identifier and fill in the providers INDIVIDUAL NPI, Taxonomy, and Tax ID numbers.

NOTE: Legacy Identifier 1. This field is where you can fill in the provider's UPIN or any other number assigned to the provider by an insurance company. Each Legacy Identifier must be accompanied by a “Qualifier” in the box to the right that designates what kind of identifier it is. I.E. Medicare number, BCBS number, etc. Legacy numbers appear in box 24J above the NPI number and in box 33b on the standard CMS 1500 claim form, but are not transmitted electronically.

NOTE: Group Claims. If the provider is submitting under a group NPI number, check the option to “File Claim As: Group”. This will allow the provider to submit their own individual NPI number along side the Group NPI number as required by ANSI 5010 standards. Always put the provider's individual NPI information on this screen.

NOTE: Facility Information. Do not fill in a Facility on this screen. If a facility is chosen here, the following NPI information will only be sent on claims that have the listed facility attached to the claim and will not function on any other claims.

6. Click the OK button to save the information. You should see the NPI information appear on the list in the Provider IDs screen. The Insurance Carrier, Insurance Class, and Facility column for the first line should read “All”, signifying that this information will be sent to all insurance carriers, and along side all facilities, unless otherwise specified.

7. Your basic provider setup is now complete. Click Save to commit the information to the provider list. For additional settings continue to step 8.

Sending special NPI or Legacy information to specific Insurance carriers:

8. Create a New “rule” on the Provider IDs screen. (see Step 4)

9. Fill in the NPI, Taxonomy, Tax ID, and Legacy Identifier 1 (optional) you want to send to a specific insurance company. (see Step 5)

NOTE: Be sure to check the File Claim As: Individual or Group as needed.

10. Check the box for Insurance Carrier and type in the code for the insurance carrier who will receive the information below

11. Click OK. You will see a new line on the Provider IDs screen with the new information along side the “generic rule” for all Carriers. When a claim is filed with the carrier listed on any of the lines on this screen, they will use the NPI information on that line, otherwise the claim will be sent with the NPI information on the line for “All” carriers.