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PAP250

Facility Claim Submission Number Requirements


Provider Administrative Policy

Section
Claims Submission
Policy Date
May 2008
Status/Date
Revised/June 2013
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

Facility Claim Submission Number Requirements

You must submit all claims on a UB04 form with billing, attending and referring provider numbers. See PAP205 for more details about referring provider numbers.

We will return paper claims submitted without a National Provider Indicator (NPI) . Electronic claims filed without NPI numbers are not acceptable and require correction before the system processes them for payment.

The Health Insurance Portability and Accountability Act (HIPAA) mandates all providers must acquire a National Provider Identifier (NPI) for all electronic transactions. Blue Cross of Idaho will accept NPI numbers on paper claim submissions.

Billing Number
The billing number indicates who receives payment. When billing paper claims, the organizational NPI number goes in field 56.

Claims billed electronically will need to populate in the 2010AA loop, NM108=XX. NM109=NPI.

Attending/Referring number
The attending/referring provider number is for the individual who is attending the services or referring for services being rendered. The individual NPI number of the attending/referring goes in field 76 of the UB04 when billing paper. For Electronic claims, the attending/referring needs to populate in the 2310A, NM108=XX, NM109=Attending number. For Referring, 2310Dloop, NM108=XX, NM109=Referring number.

Taxonomy number
The Taxonomy number may help in processing claims to the appropriate provider contract. Populate the provider's taxonomy number in field 81 with a qualifier of B3 - Health Care Provider Taxonomy Code. For electronic billing: please following the HIPAA Guidelines specified in the current implantation guides (004010X096A1/005010x223). The PRV Segment (BILLING/PAY-TO PROVIDER SPECIALTY INFORMATION) is required when the provider taxonomy code impacts adjudication, and the Service Facility Provider is the same entity as the Billing and/or Pay-to Provider. In these cases, we identify the Rendering Provider at this level for all subsequent claims/encounters in this HL and Loop ID-2310E is not used.


Policy History

Date Action Reason
June 2013 Revised Removed reference to BCI Legacy numbers
November 2008 Revised Language clarification

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