5.6 Understanding PROVIDERnet Account Types
5.6.1 Account Access Types
Primary vs. Standard Account Access
There are two access types for PROVIDERnet accounts.
Primary Account Access
- View pre-authorizations
- Submit Claims
- Access Claim history
- Obtain electronic Claim statements
- View, set up and modify banking information
Standard Account Access
- View pre-authorizations
- Submit Claims
- Access Claim history
Standard Account Access does not include the ability to:
- Obtain electronic Claim statements
- View, set up or modify banking information
5.6.2 Provider IDs and Account Access
A Provider ID is the unique Provider identification number issued by Pacific Blue Cross to a Provider upon registration.
Each Provider ID is associated with one bank account
All payments are deposited directly to the bank account linked to that Provider ID.
Provider IDs are Location-specific
- Each Location is associated with a unique Provider ID, even where multiple Locations are operated by the same Provider.
- Practitioners providing Services at multiple Locations may have multiple Provider IDs associated with their PROVIDERnet account — Claims are submitted under the Provider ID for the Location where the Services were provided.
Account access is individually designated by email address
Each Primary Account Access holder and Standard Account Access holder is linked to a specific email address.
For each Provider ID
- One (1) Primary Account Access holder is required, but only one Primary Account Access holder may be designated at any time.
- Multiple Standard Account Access holders may be designated but are not required.
5.6.3 Account Access and Registration Structures
Examples of common Provider structures for account access and registration are provided in the following table.
| Locations | Provider IDs | Links to a Bank Account1 | Practitioners | Primary Account Access2 | Standard Account Access3 | Specifications |
|---|---|---|---|---|---|---|
| 1 | 1 | 1 | 1 | 1 | 0+ | |
| 1 | 1 | 1 | 2+ | 1 | 1+ |
Each Practitioner submitting Claims must have a PROVIDERnet account. Primary Account Access must be assigned to the legal bank account holder or an authorized representative that manages the business’s bank account.4 |
| 2+ | 2+ | 2+ | 1 | 2+ | 0+ | Each bank account must be linked to a separate Provider ID. A Primary Account Access holder will need to be assigned to each separate Provider ID. |
| 2+ | 2+ | 2+ | 2+ | 2+ | 0+ |
Each bank account must be linked to a separate Provider ID. A Primary Account Access holder will need to be assigned to each separate Provider ID. Each Practitioner submitting Claims must have a PROVIDERnet account. Primary Account Access must be assigned to the legal bank account holder or an authorized representative that manages the business’s bank account.5 |
- Where a Provider operates multiple Locations, the Provider is not required to set up a separate bank account for each Location – payments may be deposited into the same bank account if the Provider maintains one bank account for all its Locations. However, the Provider is required to link a bank account (which can be the same bank account) to each Location/Provider ID by setting up direct deposit separately for each one.
- Primary Account Access may be assigned to a Practitioner or Administrator, for example an office manager or a member of office staff. However, the Primary Account Access holder must be authorized to transact on the associated bank account.
- Standard Account Access can be requested for Administrators who support billing for Practitioners at the Location.
- In a multidisciplinary clinic setting where Claim payments are (or will be) deposited to a shared bank account, the Primary Account Access holder must be an authorized representative that manages the business’s bank account. This may be the ultimate business owner, or it may be another person that has been authorized to manage banking, for example an office manager or a member of office staff. Where a Provider is structured as a multidisciplinary clinic with one bank account for all Claim payments, all Practitioners typically have Standard Account Access, and the Primary Account Access holder is usually a representative acting in an administrative capacity or that has administrative responsibilities.
- In a multidisciplinary clinic setting where Practitioners receive (or will receive) Claim payments directly, each Practitioner must be set up as a Provider with a unique Provider ID. A unique Provider ID is required for each of the Locations at which the Provider-Practitioner provides Services and where Claim payments are deposited directly.
5.6.4 Account Access Assistant
What account-access type is right for me?
Answer the following questions with the option that best describes your role to help determine which account access type is the best fit for you.
5.6.5 Account Access and Registration
When registering a new Provider, one person must be designated as the Primary Account Access holder. The registration process includes steps for completion of Provider, Practitioner and Primary Account Access holder information, which includes contact information and an email address requirement.
Provider
Services provided, business location, contact information and email address
Practitioner
Licensing details, contact information and email address
Primary Account Access
Confirm appointment details, contact information and email address
- Used as the PROVIDERnet login ID — must be unique to the Primary Account Access holder
- Can be the same email address entered for the Provider
- Cannot be the same as any Practitioner email address
- Cannot be the same as any Standard Account Access email at this Location or any other Location
- Cannot have been previously associated with any Pacific Blue Cross account, including a Member, Provider, or Administrator account.
Before you submit the application, confirm that the Primary Account Access email address is correct and that it has not been associated with account access previously used for any Pacific Blue Cross accounts, including a Member account, Provider account or an Administrator account.
Only enter a business name for a Provider if you are the legal bank account holder or an authorized representative. If Claim payments go directly to a Practitioner's personal bank account, enter the Practitioner’s name as the Provider's operating name to avoid processing delays for applications.