Provider Information

The above screen shows after selectiong Provider Data from the menu bar

  • Then selecting Add, Change, Terminate

The Provider ID is a FEIN or SSN depending upon the type of provider.

  • The Suffix box behind the Provider ID - should be left blank
  • TIN Type: use 01 for FEIN and 02 for SSN. Other TIN types are available when the F1 key is used.
  • Leave Term Date blank unless you are done using the provider
  • Complete all information down through the Operator box.
  • Information below the Operator Box is optional.
  • Refer to the Geographical Code information for the County and Township codes.