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Partner Portal

The electronic application that automates Medicaid Provider communication, enrollment, validations, and maintenance. It will enable Providers to enter and manage Medicaid enrollments, and Program Integrity staff to review, validate, and access reports on enrollments.

PCC

The new concept of providing comprehensive acute and chronic medical care in the same environment, with maintenance in continuity of care and physician-patient relationship. In Partner Portal, this is a Provider Type selection (Number 31) under Group/Entity.

Person with an ownership or control interest

\"A person or corporation that:  • Has an ownership interest totaling 5% or more in a disclosing entity  • Has an indirect ownership interest equal to 5% or more in a disclosing entity  • Has a combination of direct and indirect ownership interests equal to 5% or more in a disclosing entity  • Owns an interest of 5% or more in any mortgage, deed of trust, note, or other obligation secured by the disclosing entity if that interest equals at least 5% of the value of the property or assets of the disclosing entity  • Is an officer or director of a disclosing entity that is organized as a corporation; or  • Is a partner in a disclosing entity that is organized as a partnership\"

Primary Care Center

The new concept of providing comprehensive acute and chronic medical care in the same environment, with maintenance in continuity of care and physician-patient relationship. In Partner Portal, this is a Provider Type under Group/Entity.

Primary NPI

A National Provider Identifier or NPI is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). Limit is thirty (30) NPI numbers. All NPI numbers must be listed on the National Plan and Provider Enumeration System website (NPPES), which is the NPI Registry Public Search, and Partner Portal validates against the NPPES website.  Primary NPI is the first NPI number entered by the Provider.

Primary Physical Address

The “bricks and mortar” location of a Provider. A Provider may have more than one physical service address, but Primary is considered the main site.

Primary Taxonomy

Healthcare Provider Taxonomy Codes are designed to categorize the type, classification, and/or specialization of health care providers.  The Code Set consists of three sections:  Individuals, Groups of Individuals, and Non-Individuals. All Taxonomies must be listed on the NPPES website. Primary Taxonomy is the Taxonomy tied to the Primary NPI.

Provider

An individual, group, or entity that assists Medicaid recipients by providing medically necessary services.

Provider Agreement

The contractual agreement between DMS and a Medicaid Provider.

Provider Type

The classification for a Medicaid Service Provider. For example, an individual physician is Provider Type 64. The term Provider Type is also known as a Provider specialty or taxonomy.

PRTF

Provide a less medically intensive program of treatment than a psychiatric hospital, or psychiatric unit of a general hospital.

Psychiatric Residential Treatment Facilities

Provide a less medically intensive program of treatment than a psychiatric hospital, or psychiatric unit of a general hospital.



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