Practice Data Entry

The first screen that presents for data entry is the Demographic information. 

Enter data requested and Save.

Field	Description	Example
Practice Name *	Name of the practice	Kaibigan Clinic
Practice TypeID *	Type of	Group Practice
Legal Name	Legal name for the practice	Kaibigan Clinic LLC
NPI	National Provider Identifier record for the practice	1245840081
TaxIDNumber Practice	Tax ID for the practice	75-1124948
BillingPayableToName Practice	The Billing Payable name for the practice	Kaibigan Clinic
Website *	The website for the Practice	http://www.kaibigan.clinic
Notes	Notes
ElectronicBillingCapability	This checkbox denotes if the practice can perform electronic billing	☒

Fields noted with a red asterisk (*) are required.

Location Data is also required for Practices.

Field	Description	Example
Location ID *	Practice ID	123456789
Address	Physical address of the practice	555 Mariposa Avenue Ste 555 Garland, TX  75044
Legal Name	Legal name of the practice	Kaibigan Clinic
NPI	National Provider Identifier record for the practice	123456789
Tax ID Number	Tax ID for the practice location	75-123456
Location Type ID *	Location type ID	Main Location
Date From	Location start date	01/01/2015
Date to	Location ending date	06/01/2025
Office Manager Name	Office manager of practice location	Jun Inocencio
Website	Website of practice location	http://www.kaibigan.clinic
24 Hour Coverage	Denotes if the Practice location offers 24 hour coverage	☐
Notes	Notes regarding the Practice location	Located in Garland Medical Suites

Fields noted with an asterisk (*) are required.

Once the Demographics and Location data is saved additional menus will become available for entry.  Menus with an arrow next to the name have additional sub menus for data entry.

Screen-level Data Entry

All additional data entry panels function in the same manner.

To create a new row of data:

1. Click the Create New button to open the data entry panel

2. Enter data ensuring all required fields are populated.

3. Save

If additional new data is needed for the same panel, repeat the steps above.

If edits are needed to the existing data clicking on the data hyperlink will open that panel for editing.

Navigate through the menu items and complete all applicable data entry.

Images

The Images panel functions similarly to other data entry panels.

1. Click the Create New button to open the data entry panel.

2. Select the appropriate value from the Document Type dropdown field.

3. Use the Browse button to navigate to the Image file you are uploading and select Open.

4. (Optional) To link the image to a record, click the link icon and select the appropriate record.

5. Save.

If additional images need to be uploaded repeat the steps above.

Submitting Application

Once all necessary data and images have been entered and uploaded select the Submit button and you should see all required panels with a green check mark. 

Users can enter data and add images or documents in multiple sessions if necessary. All updates are saved in between user sign on sessions. Users can return to their application and update as necessary prior to final submission. 

If any sections have been omitted, you will see a red X and this data must be completed before submission can occur. Click Submitting the Application, above, to return to the page to complete the missing information.

The following example shows an application that is ready to be submitted.

Once the application has been successfully submitted you will receive this message and have an opportunity to download a PDF copy of your submitted application data.

The sponsoring organization will be notified of your submission for processing.