Provider master setup - important field details

We have listed based on the software we are using.

Provider Code: Provider code, 4 character code to identify this provider. You may use numbers, ie 1 or
letters.

Name: Provider Name

Box33name: Name that will appear in box 33 of HCFA form 1500.

Box31name: Name for box 31 of HCFA form 1500. Enter the name as First Mi Last, Title.

Address – Phone: Address, city, state zip and phone. This information may be printed in box 33
of HCFA form 1500.

Tax id or  Federal Id number. Will print in box 25 of HCFA 1500. Enter the provider SSN if no
Federal id number has been issued. Set either the SSN or EIN button (see below).

Medicare number: Medicare provider number.

UPIN: Provider universal identification number.

BCBS: Blue Cross/Blue Shield number.

Medicaid: Medicaid provider number.


Default pin #: Provider number to print in box33 if no other number can be found.

Provider Specialty Code: Provider specialty code. This code is needed for electronic insurance filing. Use
the 10 digit taxonomy code. www.wpc-edi.com.

License Number: State Medical License number. Needed for some insurance carriers for
electronic filing.

DEA Number: Drug License Number. Not normally needed, some insurance carriers require this
number. The Medical EMR program will pull this number when printing prescription scripts.

NPI: National Provider Id number.

USE EIN or SSN:Box 25 of the HCFA 1500 needs to know if you are using a Employer ID Number or a Social
Security Number.

Group: Place an X in this box is you are in a Group practice.

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