Provider Information

The above screen shows after selecting 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.
  • Geographical Code