Trading Partner Enrollment (Provider Affiliations) Page
You use the Provider Affiliations page to add or edit the providers for which you, as a trading partner, can receive electronic transactions on behalf of or from to the enrollment application.
Provider Affiliations is not displayed in the Applications Links pod if the Trading Partner's classification is Carrier. Instead, Carrier Affiliations is displayed.
Providers Fields
| Field | Description |
|---|---|
|
To add a new provider affiliation, click Add Provider. Existing affiliations, if any, are displayed in a table. To edit, in the Providers table, click the appropriate row. After changing or adding information, on the Provider action bar, click Save. |
|
| NH Title XIX Provider # | New Hampshire Medicaid provider number. |
| Begin Date | Date the affiliation began. |
| End Date | Date the affiliation ends. |
| Provider Name |
Full name of the provider. After the information is saved, the provider's name is displayed in the table. |
|
Transactions Fields These fields indicate the transactions the trading partner can receive for this provider. |
|
| All | This option selects all the transactions listed. |
| 271 (Eligibility Response) | Indicates you want to retrieve this transaction for this provider. |
| 277 (Claim Inquiry Response) | Indicates you want to retrieve this transaction for this provider. |
| 278 (Service Authorization Response) | Indicates you want to retrieve this transaction for this provider. |
| 820 (Premium Payment) | Indicates you want to retrieve this transaction for this provider. |
| 834 (Managed Care Enrollment) | Indicates you want to retrieve this transaction for this provider. |
| 835 (Remittance Advice) | Indicates you want to retrieve this transaction for this provider. |