Contents
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Starting the Provider License Status Change
The Change Provider License Status function is a user-generated function that appears on the Account Summary page (PM0083). This function is only available on this page once the Provider has been licensed.
Complete the New Status field by selecting one of the following states from the drop-down list using the down arrow next to the field ():
Denied
Expired
Intent to Deny
Intent to Revoke
Intent to Suspend
Licensed
Pending
Revoked
Suspended
Withdrawn
Click on the Change Status button to initiate the change process. As a result, the Change Provider Status page (LI0174) is accessed.
On the Change Provider Status page (LI0174), the Previous Status and New Status fields are pre-filled by the system based on previously entered data.
Status Change Date*
Enter the date the license status change occurred using the mm/dd/yyyy format. This may not be a future date.
Status Change Reason*
Select one of the following reasons from the drop-down list using the arrow next to the field ():
Inactivity
Request of Provider
Application Approval
Imminent Peril
Failure to Reapply
Non-compliance
Notes
Enter any narrative that further describes or supports the action to change the License Status of the Provider.
More:
Submitting the License Status Change (General)
Canceling the License Status Change (General)