Classic View: System Administration > Medicaid > Service Providers
Search Terms: Medicaid Service Providers
Medicaid Service Providers are those individuals, usually district employees, who provide the Medicaid services for the student. Medicaid Service Providers can be the same as Health Providers or Special Education Service Providers, but manual entry of the individual's name must happen on the Medicaid Service Provider editor.
Medicaid Service Provider Detail
Medicaid Service Provider Detail Fields
Select an existing Provider name or the New button to view the Provider Detail. The following fields display:
| Field | Description |
|---|---|
| Link to Person | This dropdown is populated with active Special Ed providers marked as Special Ed on their District Assignments tool. The Name field auto-populates with the person's name after selection in this dropdown. |
| Name Required | The first and last name of the person. Names can be manually entered and/or modified after auto-population. |
| Agency | The agency of the person. |
| Address | The street and number of the person's address. |
| City | The city portion of the person's address. |
| State | The state portion of the person's address. |
| Zip | The zip code portion of the person's address. |
| Phone | The phone number for the person. |
| Active | Indicates the person is an active Medicaid service provider. Service Providers that are external agency providers do not have to be found within Infinite Campus, but they should be if the district is billing on their behalf. Active providers display in bold text in the Providers List. Active service providers are the only providers that display in the Primary Provider dropdown list on the student's Medicaid Services editor. Special Education District Assignment settings are only used for Medicaid Service Providers when selecting that staff person from the Link to Person dropdown list. |
| NPI Number | The person's National Provider ID. This is a unique 10-digit number for every medical provider across the nation. |
| Credential Earned Date | The date the person earned the credential. |
| Credential Expires Date | The date the credential expires for the person. |
| NPI Enum Date | The date the NPI was assigned. |
| Primary Taxonomy | The code that identifies the provider's specialty. |
| Medicaid Provider # | The person's Medicaid provider identification number. |
| Service Provider License Types | The type of health licensure the person obtained. Value available in this dropdown are stored in an Attribute Dictionary (System Administration > Custom > Attribute Dictionary > Employment Credential > Health License). |
| License Revocation Date | The date revocation of the person's licensure occurred. |
Add a Medicaid Service Provider
- Select the New button from the Service Provider tool. A Provider Detail screen displays to the right of the Providers List.
- When the person is currently a district employee and has the Special Education checkbox marked on the District Assignment tool, select the person's name from the Link to Person dropdown list. The information associated with that person auto-populates.
- When the person is not currently a district employee, enter the Name of the provider.
- Enter the Agency Name of this provider.
- Enter the Address, City, State, Zip code and Phone number of the person.
- Mark the Active checkbox. This selection indicates the provider is currently active and can be selected as a Medicaid provider.
- Enter the NPI Number or Credential Number.
- Enter the date the credential was earned in the Credential Earned Date in mmddyy format, or click the calendar icon to select a date.
- Enter the date the credential expires in the Credential Expires Date in mmddyy format.
- Enter the NPI Enum Date in mmddyy format, or click the calendar icon to select a date.
- Enter the Primary Taxonomy.
- Enter the person's Medicaid Provider #.
- Select the person's Service Provider License Type.
- Enter the License Revocation Date in mmddyy format, or click the calendar icon to select a date.
- Click the Save button when finished. The service providers displays in the Provider list.
