NPI Submission Edit Update Effective June 7, 2010

The BCBSTX NPI Submission edit QGC, which currently reads; ‘NPI IS NOT ON FILE’, has been updated and will be set to a Reject ("R") effective June 7, 2010. The edit will now read as follows:

QGC - Billing NPI IS NOT ON FILE FOR PAYOR

The QGC message requires the ‘XX’ qualifier in LOOP – 2010AA (Billing Provider Name) segment ID, NM108 and the National Provider Identifier (NPI) segment ID NM109. The “EI” qualifier requires the corresponding Tax Identification Number or the Social Security Number with “SY” qualifier in segment REF02.

Example:
LOOP ID 2010AA – (Billing Provider Name)

NM1*85*1*LAST NAME*FIRST NAME*MIDDLE IN***XX*NPI NUMBER~
N3*BILLING ADDRESS~
N4*CITY*ST*ZIP~
REF*EI*TAX IDENTIFICATION~

  1. IF THE NM102 IS AN ENTITY USE THE VALUE “2”.

 

In order to avoid a delay in claim processing, it is important that you include the corresponding Tax Identification Number or Social Security Number (SSN) along with your assigned NPI. The Tax ID or SSN on your electronic claim must match the Tax ID/SSN that is currently on our Provider File.

If you have any questions regarding this edit, please contact our E-Commerce Center at (800) 746-4614 for assistance.