Provider Web Portal Quick Guide: Provider Maintenance - Update License

Last updated: 09/03/2020

Provider Maintenance is where a provider will update their information, including license updates.

  1. Login to Provider Web Portal
  2. Click Provider Maintenance
    provider maintenance link on home page
  3. Click Provider Maintenance again
    click on second Provider Maintenance link
  4. Click on the Provider Identification Changes page

    On the "Provider Maintenance: Provider Identification" page, a new license can be added or an existing license displayed in the grid can be updated.

    • New license: Enter data for all required fields in the "License" section. Press the "Add" button to add the record to the grid.
    • Existing license: If a license is displayed in the grid, update the information as necessary and click "Save".
    • Click "Go to Submit".


    Provider Identification link
    Provider Identification changes screenshot

    Clinical Laboratory Improvement Amendments (CLIA) Certification

    A CLIA Certification can be added or changed through the "Provider Maintenance: Provider Identification" page. A copy of the CLIA certificate is required as an attachment in order to process the request.

    When viewing an existing CLIA Certification on the "Provider Identification" page, do not be concerned if the "Effective Date" displayed does not match the "Effective Date" originally entered or the date of the most recent certification. The Effective and End Dates for all CLIA licenses are as follows:

    Effective Date:1/1/1900
    End Date: 12/31/2299

    CLIA dates

    When adding or changing a license, a copy of the license must be submitted on the "Provider Maintenance: Attachments and Submit" page. Attach a license under the "Attachments" section and enter data for all required fields. Press "Add" to add the attachment to the grid.

    Under the "Submit" section, click the "I accept" checkbox and enter the name of the person reporting the change. Click "Submit". An auto-generated tracking number will be generated.

    Attachments and Submit screenshot
  5. Retain the tracking number
    tracking number
  6. Check the status of an update request
    1. Click the "Provider Maintenance Status" link.
      provider maintenance status link
    2. Enter the "Tracking Number" for the update request and click "Search".
      enter tracking number
    3. View the status details under the "Provider Maintenance - Summary" section.
      status details

Need More Help?

Please visit the Quick Guides web page to find all the Provider Web Portal Quick Guides.