Bull Clarification Of National Provider Identifier NPI 3224
User Manual: 3224
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South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov July 14, 2008 MEDICAID BULLETIN TO: Providers Indicated SUBJECT: Clarification of National Provider Identifier (NPI) Billing Instructions for Transactions CHIR CLTC * DEN* DME HH LAB-IND MC-ASC MC-CCDC MC-DE MC-DHEC MC-DRC MC-ESRD MC-FFHC MC-FQHC MC-MCHC MC-PDN MC-RHC MC-SHC MCCA MHRC-ADA MHRC-MHC * MHRC-PMHC * OMP-CRNA OMP-NM OMP-NP OMP-NPS OMP-PSY OMP-THER-AUD OMP-THER-OT 08-03 08-03 08-06 08-05 08-04 08-03 08-07 08-05 08-05 08-07 08-09 08-06 08-06 08-08 08-07 08-05 08-08 08-07 08-02 08-05 08-05 08-03 08-05 08-06 08-06 08-05 08-04 08-06 08-05 OMP-THER-PT OMP-THER-SP PHY-ALG PHY-ANES PHY-CARD PHY-DERM PHY-ENT PHY-ER PHY-MSP-CBP PHY-MSP-HBP PHY-OPHT PHY-PATH PHY-PC-FP/GP PHY-PC-GER PHY-PC-INT PHY-PC-NEO PHY-PC-OG PHY-PC-PED PHY-PC-PED/SUB PHY-PS PHY-RAD PHY-S PHY-SPEC PHY-SURG POD TRANS-AMB VIS XRAY-IND * Targeted Providers the 837 Professional This bulletin is to clarify the NPI billing instructions for the 837 Professional (837P) transactions. • The NPI for the Billing Provider/Pay-To provider is always needed in loop 2010AA. • If you have one NPI that is linked to multiple South Carolina Medicaid legacy numbers the following rules should be followed regarding NPI, taxonomy and zip code in an 837P transaction: • • • The Taxonomy for Billing Provider/Pay-To provider is needed in loop 2000A, unless loop 2310B is utilized. The National Electronic Data Interchange Transaction Set Implementation Guide 837P (004010X098A1) does not allow the provider taxonomy in Loop 2000A if the rendering/line provider Loop 2310B is used. The 9-digit zip code for the Billing Provider/Pay-To provider is needed in loop 2010AA. If the service is rendered in a location other than the Billing Provider/Pay To location, then the 9-digit zip code for the Service Facility Location is needed in loop 2310D. Fraud & Abuse Hotline 1-888-364-3224 08-05 08-05 08-06 08-06 08-06 08-06 08-07 08-06 08-06 08-06 08-06 08-06 08-08 08-08 08-08 08-08 08-09 08-08 08-08 08-06 08-06 08-06 08-07 08-07 08-04 08-04 08-03 08-02 Medicaid Bulletin July 14, 2008 Page 2 • If the Billing Provider is a non group organization, such as a Rural Health Clinic, Home Health, FQHC, Lab, Mental Health Clinic, or DME provider, use Loop 2010AA – Billing/Pay NPI and Loop 2000A for taxonomy. Loop 2310B is not needed. However, if it is used for an organizational provider that is not a practitioner group, the NPI in Loop 2310B must be the same as the NPI in Loop 2010AA. • • If you have multiple legacies that share the same NPI and you utilize Loop 2310B, the taxonomy should be included in Loop 2310B as opposed to Loop 2000A. If your Billing Provider is a practitioner group such as a physician group or podiatry group, etc., the NPI for the rendering practitioner must be included in Loop 2310B. No taxonomy is needed for individual practitioners in Loop 2310B. Please refer to the attached chart as a guide when billing NPI in an 837 transaction. For clarity, the corresponding fields on the CMS-1500 are included. For further information refer to the S.C. Medicaid Companion Guides, which are found at If you http://www.dhhs.state.sc.us/dhhsnew/hipaa/Companion%20Guides.asp. have any questions, please contact your program representative or the South Carolina Medicaid EDI Support Center at 1-888-289-0709. /s/ Emma Forkner Director EF/mrsm Attachment NOTE: To receive Medicaid bulletins by email, please send an email to bulletin@scdhhs.gov indicating your email address and contact information. To sign up for Electronic Funds Transfer of your Medicaid payment, please go to the following link for instructions: http://www.scdhhs.gov/dhhsnew/serviceproviders/eft.asp Fraud & Abuse Hotline 1-888-364-3224 Billing with your NPI Billing with your NPI Always Needed: Information Needed 1. Billing Provider/PayTo NPI Hard Copy Location 33a-enter the 10-digit NPI 837 Location 2010AA-enter the 10digit NPI Needed When One NPI is Used for Multiple Legacy Numbers: 2. Billing Provider/Pay33b-enter ZZ and 2000ATo Taxonomy taxonomy PRV02-enter the qualifier ZZ 3. Billing Provider/PayTo Zip 33-enter the 9-digit zip 4. Service Facility Location Zip 32-enter the 9-digit zip where the services were rendered if different from the billing provider/pay-to provider zip Special Note PRV03-enter the taxonomy 2010AA-enter the 9digit zip The 837 Implementation Guide does not allow the taxonomy in this loop if the line provider loop, 2310B is used. 2310D-enter the 9digit zip Only Needed When the Billing Provider is a Group Practice: This is not needed for organizational providers such as FQHCs, RHCs, Home Health, DME, Lab, Maternal and Child Health Clinic, etc. It is needed if the billing provider is a group practice such as a physician group, podiatry group, etc. since the rendering practitioner must be billed on the line. Information Needed Hard Copy Location 837 Location 1. Rendering Provider NPI 24j unshaded-enter the 10-digit NPI of the individual practitioner rendering the service 24i shaded-enter the 2310B-enter the NPI of the individual practitioner rendering the service 2310BPRV02-enter the qualifier ZZ 2. Rendering Provider Taxonomy-situational qualifier ZZ 24j shaded-enter the taxonomy PRV03-enter the taxonomy Fraud & Abuse Hotline 1-888-364-3224 Special Note Although the line provider is not needed for providers such as FQHC, RHC, Home Health, Lab, DME, Maternal and Child Health Clinic, if used, the taxonomy is required. Taxonomy is not needed for individual practitioners such as physicians, nurses, podiatrists since practitioner NPIs are not shared by multiple legacy numbers.
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