Bull Clarification Of National Provider Identifier NPI 3224
User Manual: 3224
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Fraud & Abuse Hotline 1-888-364-3224
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 the 837 Professional
Transactions
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.
CHIR 08-03
CLTC * 08-03
DEN* 08-06
DME 08-05
HH 08-04
LAB-IND 08-03
MC-ASC 08-07
MC-CCDC 08-05
MC-DE 08-05
MC-DHEC 08-07
MC-DRC 08-09
MC-ESRD 08-06
MC-FFHC 08-06
MC-FQHC 08-08
MC-MCHC 08-07
MC-PDN 08-05
MC-RHC 08-08
MC-SHC 08-07
MCCA 08-02
MHRC-ADA 08-05
MHRC-MHC * 08-05
MHRC-PMHC * 08-03
OMP-CRNA 08-05
OMP-NM 08-06
OMP-NP 08-06
OMP-NPS 08-05
OMP-PSY 08-04
OMP-THER-AUD 08-06
OMP-THER-OT 08-05
* Targeted Providers
OMP-THER-PT 08-05
OMP-THER-SP 08-05
PHY-ALG 08-06
PHY-ANES 08-06
PHY-CARD 08-06
PHY-DERM 08-06
PHY-ENT 08-07
PHY-ER 08-06
PHY-MSP-CBP 08-06
PHY-MSP-HBP 08-06
PHY-OPHT 08-06
PHY-PATH 08-06
PHY-PC-FP/GP 08-08
PHY-PC-GER 08-08
PHY-PC-INT 08-08
PHY-PC-NEO 08-08
PHY-PC-OG 08-09
PHY-PC-PED 08-08
PHY-PC-PED/SUB 08-08
PHY-PS 08-06
PHY-RAD 08-06
PHY-S 08-06
PHY-SPEC 08-07
PHY-SURG 08-07
POD 08-04
TRANS-AMB 08-04
VIS 08-03
XRAY-IND 08-02
Fraud & Abuse Hotline 1-888-364-3224
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
http://www.dhhs.state.sc.us/dhhsnew/hipaa/Companion%20Guides.asp. If you
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
Always Needed:
Information Needed Hard Copy Location 837 Location Special Note
1. Billing Provider/Pay-
To NPI
33a-enter the 10-digit
NPI
2010AA-enter the 10-
digit NPI
Needed When One NPI is Used for Multiple Legacy Numbers:
2. Billing Provider/Pay-
To Taxonomy
33b-enter ZZ and
taxonomy
2000A-
PRV02-enter the
qualifier ZZ
PRV03-enter the
taxonomy
The 837 Implementation Guide
does not allow the taxonomy in
this loop if the line provider loop,
2310B is used.
3. Billing Provider/Pay-
To Zip
33-enter the 9-digit zip 2010AA-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
2310D-enter the 9-
digit 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 Special Note
1. Rendering Provider
NPI
24j unshaded-enter the
10-digit NPI of the
individual practitioner
rendering the service
2310B-enter the NPI
of the individual
practitioner rendering
the service
2. Rendering Provider
Taxonomy-situational
24i shaded-enter the
qualifier ZZ
24j shaded-enter the
taxonomy
2310B-
PRV02-enter the
qualifier ZZ
PRV03-enter the
taxonomy
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.
Billing with your NPI
Billing with your NPI
