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PAP205

Referring Provider Number Requirements


Provider Administrative Policy

Section
Claims Submission
Policy Date
February 2008
Status/Date
Revised/October 2010
Provider Type(s)
All Providers  

Disclaimer

Our 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.

Policy

Referring Provider Number Requirements

All lab, x-ray, and surgery center claims require a referring/attending name and identifying provider number. This is the name and identifying number of the ordering or referring physician for the service(s) provided.

The following claims require referring numbers:

  • CMS 1500 claims with radiology services, laboratory services or Ambulatory Surgery Center claims (field 17 and 17a)
  • UB-04 (inpatient and outpatient) hospital claims (field 76)

If you are the provider ordering and performing the service, your identifying provider number can either be your National Provider Identification (NPI) or state license number.

If you are the provider performing the service, the identifying provider number can either be the NPI or state license number of the provider who referred the lab or radiology services to you. If the referring/attending provider is from another state or not registered with Blue Cross of Idaho, use your NPI in field 17 and 17a and include the referring provider's name in field 19.

Blue Cross of Idaho maintains a current database of all valid contracting and non-contracting Idaho state license numbers and NPIs. If an electronic claim shows “error out” or you receive a returned paper claim because of an invalid NPI number for an Idaho contracting or non-contracting provider, please verify the NPI at NPI Registry Search. In addition, please contact Blue Cross of Idaho provider services to report invalid NPIs so we can update our database.

We no longer accept generic provider numbers OTHOOO, RESOOO or UPINs.


Policy History

Date Action Reason
October 2010 Revised Language Change
March 2009 Revised Removed references to UPINs

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