Change Healthcare ProviderNet Adding an Additional NPI/Provider Instructions
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1 Change Healthcare ProviderNet Adding an Additional NPI/Provider Instructions Page 1 of 5 Change Healthcare ProviderNet Adding an Additional NPI/Provider Instructions 1. Go to 2. Log into your already existing ProviderNet account. 3. On your Control Panel click the Provider Info tab. 4. Click the New button.
2 Change Healthcare ProviderNet Adding an Additional NPI/Provider Instructions Page 2 of 5 5. Enter the Provider Information. a. Input the Provider s Name. b. Input the Doing Business as Name (DBA). c. Input the Provider Address - Enter the mailing address exactly as it appears your Remittance Advise in the upper left hand corner. d. Input the Provider s Tax Id Number (TIN) without dash. e. Input the Provider s National Provider Id Number (NPI) f. Click the Next button.
3 Change Healthcare ProviderNet Adding an Additional NPI/Provider Instructions Page 3 of 5 6. Enter the Provider Contact Information. The contact information fields should auto populate with the contact information of the NPI(s) already registered, but if any fields need to be updated/changed please do so here. a. Input updated/changed information or leave as is. b. Click the Next button
4 Change Healthcare ProviderNet Adding an Additional NPI/Provider Instructions Page 4 of 5 7. Enter the Provider Account Information. The bank account information fields should auto populate with the banking information of the NPI(s) already registered, but if any fields need to be updated/changed please do so here. If account information does not need to be changed click the Next button. For changing the bank account information a. Input the Financial Institution Name b. Input the Institution Routing Number c. Select the type of account (savings/checking) d. Input the Account Number with the Financial Institution e. For this field, if your payer is Molina select National Provider Identifier (NPI) Qualchoice select Provider Federal Tax Identification Number (TIN) Kaiser GA - select Provider Federal Tax Identification Number (TIN) Neighborhood Health Plan - select National Provider Identifier (NPI) Rocky Mountain Health Plan (HMO/HCO) select Provider Federal Tax Identification Number (TIN) f. Click the Next button
5 Change Healthcare ProviderNet Adding an Additional NPI/Provider Instructions Page 5 of 5 8. Enter the Provider Account Information. a. Reason for Submission leave field as is. Adding a New Provider is considered a New Enrollment. b. Include with Enrollment Submission select the document you will submit with your ACH Authorization Form (voided check or bank letter). c. Authorized Signature leave field as is. The person signing the ACH Authorization Form is authorizing us to make deposits to the designated account on behalf of your payer. d. Click the Finish button. 9. Retrieve your ACH Authorization Form. a. On your control panel click the Accounts tab. b. Down towards the bottom of the accounts page you will see your banking information. Click the PDF icon = ACH Authorization Form c. Print out your ACH Authorization Form d. Sign and fax your ACH and either your voided check or Bank Verification Letter to Your documents will be processed within hours.
1. Go to https://providernet.adminisource.com. 2. Click the Register button. 3. Accept the Terms and Conditions
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