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.
Comments
4 comments
The expression: Site]ProviderNum only seems to work in pathology forms and invoices and billing, it does not seem to work in letter templates and now with the new radiology templates recent upgrade, it is now causing multiple times daily bugs, and errors in radiology ordering and needs to be urgently fixed. As far as I can see the only place the Pathology Form is pulling it from is the 5th Tab “Practice Sites” in User preferences, linking that with the default site for which practice specification within that tab, but for some reason it doesn't seem to work in letters and radiology templates. This also suggests it is a 4D writer related issue.
Please investigate and remedy ASAP. Genie is predominantly used by Specialists and specialists often work across many sites so I assume this will be affecting many practices.
Dr Brian Conway Adelaide
Hi Brian Conway,
Apologies for the delay in response. I can confirm that we have taken this request onboard and will be releasing an update in our new Genie v9.4.1 - due for release in late April 2021. While this change will automatically apply to the updated Pathology Request templates we are implementing in v9.4.1, it unfortunately isn't possible for us to retroactively modify the radiology request templates in your Genie.
For your radiology request templates, you will need to edit each custom form and replace the [Preference]ProviderNum field with the [Site]ProviderNum field once you have updated to v9.4.1. The [Site]ProviderNum field in v9.4.1 (for both Radiology and Pathology requests) will pull in the default site for the practice that you are currently logged in as (as decided in your User Preferences > Practice Sites). We will also have a "Load Site" expression available where you can choose a provider number listed against any of the users at the practice. This will mean that administrative staff can create requests on behalf of providers and they will still be able to pull in the correct details of the requesting doctor.
I will be documenting this in more detail once v9.4.1 is ready for release, however, thought I would provide some minor details for you now!
Genie9.4.2 The Site provider number still only works in forms and not in letters
Brian Conway Adelaide
Hi Brian Conway, you are correct that the Load Site expression is not available in Referral/Reply letters. Apologies if I misread your original comment and focused more on the radiology aspect of your reply. We focused on implementing this within custom forms in v9.4 to ensure that pathology and radiology forms could be printed with the correct provider number. I have added your suggestion to our feedback repository to hopefully add this expression into red quill letters in a future release of Genie!