ROLE PRIVILEGES NEEDED: <udl-white>Add Referral Source<udl-white> | <udl-white>Edit Physicians<udl-white> | <udl-white>Delete Physicians<udl-white> |

ADD LICENSE | EDIT LICENSE | DELETE LICENSE | ADD IDENTIFIER | EDIT IDENTIFIER | DELETE IDENTIFIER

The Physician's Credentials Tab allows you to add the physician's license information as well as any identifiers for the physician such as:

• Drug Enforcement Administration
• National Provider Identifier - if you enter the NPI, the Physician information is checked against the CMS Referral file (PECOS); if the physician is not listed, you see a warning message. If you want to, you can rearrange the bullets and put the National Provider Identifier bullet at the bottom of the list and then put a Note below that explaining what occurs.
• Tax Identification Number
• Taxonomy Code

ADD LICENSE <returntomenu>menu ↑<returntomenu>

To add the physician's license number, select <icon-greenplussign>xxx<icon-greenplussign> <udl-orange>Add License<udl-orange>.

Enter the required information and select <btnw>   Save   <btnw> when finished.

EDIT LICENSE  <returntomenu>menu ↑<returntomenu>

Select the Edit Pencil <icon-editpencil>xxx<icon-editpencil> to edit the Licenses

Make the necessary changes and select <btnw>   Save   <btnw> when finished.

DELETE LICENSE <returntomenu>menu ↑<returntomenu>

Select the Trash Can <icon-trashcan>xxx<icon-trashcan> icon to delete the License.</icon-trashcan></icon-trashcan>

You will be asked if you are sure you want to delete.  Select "OK" to confirm.

ADD IDENTIFIER  <returntomenu>menu ↑<returntomenu>

To add an Identifier, select the <icon-greenplussign>xxx<icon-greenplussign> <udl-orange>Add Identifier<udl-orange> link.

Enter the required information and select <btnw>   Save   <btnw> when finished.

EDIT IDENTIFIER <returntomenu>menu ↑<returntomenu>

Select the Edit Pencil <icon-editpencil>xxx<icon-editpencil> to edit the Identifier.

Make the necessary changes and select <btnw>   Save   <btnw> when finished.

DELETE IDENTIFIER  <returntomenu>menu ↑<returntomenu>

Select the Trash Can <icon-trashcan>xxx<icon-trashcan> icon to delete the Identifier.

You will be asked if you are sure you want to delete.  Select "OK" to confirm.

ROLE PRIVILEGES NEEDED: <udl-white>View Facilities<udl-white> | <udl-white>Delete Facility<udl-white>

ADD IDENTIFIER | EDIT IDENTIFIER | DELETE IDENTIFIER

The Facilities Credentials Tab allows you to add the identifiers for the facility such as:

• National Provider Identifier - if you enter the NPI, the Physician information is checked against the CMS Referral file (PECOS); if the physician is not listed, you see a warning message. If you want to, you can rearrange the bullets and put the National Provider Identifier bullet at the bottom of the list and then put a Note below that explaining what occurs.
• Tax Identification Number

ADD IDENTIFIER <returntomenu>menu ↑<returntomenu>

To add the physician's license number, click on <icon-greenplussign>xxx<icon-greenplussign> <udl-orange>Add Identifier<udl-orange> .

Select the drop down <btn>   < Select >      ▾   <btn> to the right of Identifier Type. Enter the required information and select <btnw>    Save   <btnw> when finished.

EDIT IDENTIFIERS <returntomenu>menu ↑<returntomenu>

Select the Edit Pencil <icon-editpencil>xxx<icon-editpencil> to edit the Identifier.

Make the necessary changes and select <btnw>   Save   <btnw> when finished.

DELETE IDENTIFIERS <returntomenu>menu ↑<returntomenu>

Select the Trash Can <icon-trashcan>xxx<icon-trashcan> icon to delete the Identifier.</icon-trashcan></icon-trashcan>

You will be asked if you are sure you want to delete.  Select "OK" to confirm.

PECOS Enrollment Verification Process

PECOS is the online Medicare enrollment management system which allows you to enroll as a Medicare provider, renew your enrollment or withdraw from the Medicare program.   Any physicians that refer Medicare patients and signs orders for Medicare patients must be actively enrolled in PECOS.   If not enrolled, you cannot use this physician to accept referrals, sign orders and bill Medicare for services you provide.

Careficient obtains a CMS Referral file knowns as PECOS) every Friday that has the latest physician enrollment information.   The Careficient application checks PECOS as follows:

1. Entering a new physician that includes the NPI
2. Billing Edits check Physician enrollment in PECOS for every invoice if the non-Medicare payer requires the Physician to be enrolled

Adding New Physician with NPI

When you enter a Physician that includes the NPI, the Careficient application automatically checks the Physician’s NPI against the CMS Referral file (known as PECOS).   If the Physician is not actively enrolled, you will receive a “warning” message indicating that the NPI you entered does not appear in the CMS Referral file.  You can still add the Physician but you will not be able to use this Physician for Medicare referrals/physician orders/billing for services.

Billing Edits for PECOS Enrollment  

For non-Medicare payers, you have a payer rule that you can activate if that payment source requires physicians to be enrolled in PECOS.  Typically this will be for Medicaid, and other government payers such as the Veterans Administration.   If any of your non-Medicare payers require physicians to be PECOS enrolled, you must activate this rule as follows:

1. Resources menu
2. Organization Payers option
3. Find/Select the Payer that requires this rule to be active
4. Select the Rules tab
5. Select the “Add Payer Rule” icon for the rule that reads “Check Physician NPI against CMS Ordering and Referring File” (Add Payer Rule pop-up displays)
6. Enter the date you want to start using this rule.
7. Select the Save button.

After you activate this rule, you will see invoices edit/errors indicating that the Physician is not PECOS enrolled.  You must correct this information before you can bill for the services.