To access the Provider screen (Fig. 1), go to on File > Setup > Provider on the main application menu. From here you can add and modify insurance providers.

Providers could be groups or individual practitioners. There are two basic roles for them: billing and rendering. A group has its own NPI number, has typically the name of your office or practice and is used for billing purposes. An individual practitioner has an NPI number under his personal name and could act as rendering provider, billing provider or both.

You can add a provider by importing his or its information as it appears on the NPPES database maintained by the Centers for Medicare & Medicaid Services (CMS). To do so, click on Import… to open the Lookup Service dialog box (Fig. 2). Type the name of the provider that you want to import in the ‘Search’ field and click Search. On the search results, mark the ‘Selected’ checkbox on the provider record that you want to import and click OK.

To add a provider from scratch, click Add and enter the relevant information on the bottom section of the screen. If you are adding a group provider, enter the full group name on the ‘Last/Practice’ text box. Otherwise, you will need to enter the first and last name for the rendering provider.

Select a ‘Location’ for the provider. If this parameter is not specified, the provider will be available on all locations.

If the provider is an outside lab, make sure that the ‘Outside Lab’ checkbox is checked.

Specify the signature line under ‘Provider Signature’. If this text box is left blank, box 31 of the HCFA/CMS 1500 form will read “Signature on File”.

Enter the contact information for the provider and the corresponding tax ID number. For the tax ID, you must specify whether SSN or EIN are being used on the ‘Federal Tax Type’ drop-down box and then fill the ‘EIN’ or the ‘SSN’ text box.

If you will use this provider on authorizations and claims submitted through the Eyefinity/VSP interface, you must enter the VSP ‘User ID’, ‘VSP Password’ and ‘VSP Office ID’ assigned by Eyefinity/VSP to this provider. The user ID and password are the same that you would use to log in to the Eyefinity website. However, before you start using the Eyefinity/VSP interface, you must notify Eyefinity’s Customer Care (877-448-0707) that you intend to use My Vision Express to submit claims. They will then give you the ‘VSP Office ID’ number required here. Contact Eyefinity at least two business days before the date when you would like to start processing claims through the My Vision Express Eyefinity/VSP Interface.

To Enter the Provider’s insurance numbers, click Add on the lower right of the Provider screen. Fill in the ‘Insurance Number’ field and make a selection from the ‘Insurance Type’ drop-down list. To delete an insurance number, click to highlight the appropriate number and click Delete at the lower right of the Provider screen.

In the ‘Facilities’ tab (Fig. 3) you can link a provider with one or more facilities. In the previous section of this chapter, you saw how to setup the facilities that are listed on this tab. To link a facility to the provider selected at the top of the screen, click on the appropriate facility line to highlight it. You may select multiple facilities for any given provider. If you need to correct the selection of facilities, click on the appropriate line or lines to toggle the selection on and off.

After you have selected the facilities for the provider, you should go back to the ‘Details’ tab and designate one of them as the default for that provider on the ‘Default Facility’ drop-down box.