Professional Claim Submission Number Requirements
Provider Administrative Policy
DisclaimerOur provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.
Submit hard copy claims on a CMS1500 form with billing, performing and referring provider numbers. See PAP205 for more details about referring provider numbers. Blue Cross of Idaho will return paper claims without provider numbers.
The Health Insurance Portability and Accountability Act (HIPAA) mandates all providers must have a National Provider Identifier (NPI) for all electronic transactions. Electronic claims without NPI numbers will "error" and require correction and resubmission before the system can process them for payment.
The billing number indicates who should be paid and is the same as the performing provider number if the provider is in a solo practice (only one provider in a practice), or the number assigned to a clinic (a practice with more than one provider under one tax identification number) if the provider is in a group practice. The NPI billing number or the organizational NPI number goes in field 33a. If using the Blue Cross of Idaho legacy billing number, it goes in field 33b when submitting hard copy claims. Claims billed electronically need to populate in the 2010AA loop, NM108= XX, NM109= Billing NPI.
The performing number is for the individual rendering the service. The individual NPI number goes in field 24J when submitting hard copy claims. When submitting a claim electronically, enter your performing number in the 2310B loop, NM108=XX, NM109= Performing or Rendering NPI. If you belong to a clinic, your performing number is different from the billing number.
The taxonomy number may help in processing claims to the appropriate provider`s location. Populate the provider`s taxonomy number in field 24J with the appropriate qualifier of ZZ in 24I in addition to the NPI number when billing hard copy claims. When billing electronically, please follow the HIPAA Guidelines specified in the current implantation guide (004010X098A1/005010x222). For example, professional entity providers (including but not limited to medical suppliers, labs, Home IV, DME, Pharmacy, etc) who do not have an individual rendering provider should submit a taxonomy number in the 837p HIPAA standard transaction Loop ID-2000 PRV.
All services must be billed by the provider who is performing the service.
If different providers within a clinic perform services, please submit a separate claim for each provider of service.
To ensure correct and timely processing of your claims, field 32 on the CMS1500 form must include the location of where you render the services. Claims missing this information may experience processing delay or payment could go to the incorrect service location.
Blue Cross of Idaho will not recognize the patient account information identified in field 26 when submitted via hard copy on the CMS 1500.
This will not affect:
- Corrected claims
- COB claims
- Electronic claim submissions
|June 2012||Revised||Language added re: services must be billed by provider performing the service.|
|March 2009||Revised||Hard copy claim information added|
|November 2008||Revised||Language clarification|