Have you ever entered a provider number into Genie only to receive a warning to advise the number is incorrect? How does Genie know this is the case?

A doctor's provider number is issued by Medicare and helps identify the doctor and the location that they are providing services at. These provider numbers are comprised of:

- Provider Stem = a 6-digit number
- 1 Practice Location Character (PLV)
- 1 Check Digit

**Validating the provider number**

In order to ensure provider numbers are legitimate, Medicare have an algorithm they apply to provider numbers in order to 'validate' a number. The algorithm used for the Provider Check Digit is:

(digit 1 x 3) + (digit 2 x 5) + (digit 3 x 8) + (digit 4 x 4) + (digit 5 x 2) + (digit 6) + (PLV x 6)

You then need to divide the result by 11. The remainder is allocated an *alpha* that is the Provider Check Digit (see table below for details).

**Example**

To make it easier to understand how the equation works below is an example using the provider number 988939BK.

Digit 1 |
Digit 2 |
Digit 3 |
Digit 4 |
Digit 5 |
Digit 6 |
PLV |
Check Digit |

9 | 8 | 8 | 9 | 3 | 9 | B | K |

*= (9 * 3) + (8 * 5) + (8 * 8) + (9 * 4) + (3 * 2) + (9) + (11 * 6)*

*= 27 + 40 + 64 + 36 + 6 + 9 + 66*

*= 248*

*Now divide 248 by 11 = 22 r 6 (11 goes into 248 22 times with 6 left over). If we then look up 6 in the Provider Check Digit table you will see it equates to a J. As such the provider number listed above is incorrect and instead should be 988939BJ.*

**Practice Location Character**

The Practice Location Character indicates the order of the practices that a provider has been registered at. Each Practice Location Character is allocated a Practice Location Value (PLV) that is used in the Provider Check Digit Routine.

**Check Digit**

The check digits for the resultant remainder are as follows:

Practice Location Character |
Check Digit |
||||

Character |
Value |
Character |
Value |
Remainder |
Check Digit |

0 | 0 | G | 16 | 0 | Y |

1 | 1 | H | 17 | 1 | X |

2 | 2 | J | 18 | 2 | W |

3 | 3 | K | 19 | 3 | T |

4 | 4 | L | 20 | 4 | L |

5 | 5 | M | 21 | 5 | K |

6 | 6 | N | 22 | 6 | J |

7 | 7 | P | 23 | 7 | H |

8 | 8 | Q | 24 | 8 | F |

9 | 9 | R | 25 | 9 | B |

A | 10 | T | 26 | 10 | A |

B | 11 | U | 27 | ||

C | 12 | V | 28 | ||

D | 13 | W | 29 | ||

E | 14 | X | 30 | ||

F | 15 | Y | 31 |

**The end result...**

So, now that you feel like you've just been back in a high school mathematics class what is the take home message? **When Genie tells you a provider number you're entering is incorrect** it's not because we want to make your life more difficult, we promise! **It's because the number you've entered fails Medicare's algorithm and as such is indeed incorrect** (despite what the referral letter in your hand may say)! If you were to submit a claim with those credentials to Medicare they would reject it, so Genie is trying to save you (and your patients) having to reclaim for these services.