Trading Partner Enrollment (Provider Affiliations) Page

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Trading Partner Enrollment (Provider Affiliations) Page

You use the Provider Affiliations page to add or edit the providers on whose behalf you, as a trading partner, can receive electronic transactions to the enrollment application.

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.
Alaska Medical Assistance Provider #	Alaska Medicaid provider number.
Begin Date	Date the affiliation began.
End Date	Date the affiliation ends.
Transactions Fields These fields indicate the transactions the trading partner intends to 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.
278 (Service Authorization 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.
820 (Premium Payment)	Indicates you want to retrieve this transaction for this provider.
824 (Exception Reporting)	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.
835 (TPL)	Indicates you want to retrieve this third-party liability remittance advice transaction for this provider.
837	Indicates you want to retrieve this transaction for this provider.
NCPDP D.0	Indicates you want to retrieve this National Council for Prescription Drug Program transaction for this provider.

Version as of 6/30/2015.