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Electronic Claims Submission Tips for Group Practices
Posted 11/26/07
If you are a Group practice provider, it is imperative that you transmit the Group NPI (Type 2) in Loop 2010AA, with your Rendering NPI (Type 1) for Professional Providers as well as a State License Number in Loop 2310B, (state license number is a Blue Shield requirement strictly for Illinois). If you are reporting an attending physician on an Institutional claim, transmit your Attending NPI (Type 1) for the Institutional claim in Loop 2310A.
The following are representations of how you might complete the 837 Professional and the 837 Institutional claims that contain this data. Complete the following segments for claims submitted for Blue Cross and Blue Shield of Illinois, (Payer ID G00621), Blue Cross and Blue Shield of Texas (Payer ID G84980), Blue Cross and Blue Shield of New Mexico (Payer ID G00790), and Blue Cross and Blue Shield of Oklahoma (Payer ID G00840):
837 Health Care Claim: Professional
LOOP ID 2000A – (Billing/Pay-To Provider Hierarchical Level)
PRV*BI*ZZ*TAXONOMY CODE~
LOOP ID 2010AA – (Billing Provider Name)
NM1*85*2*CORPORATION*****XX*GROUP NPI NUMBER~
N3*BILLING ADDRESS~
N4*CITY*ST*ZIP~
REF*EI*TAX IDENTIFICATION~
REF*1B*BLUE SHIELD PROVIDER NUMBER~
LOOP ID 2310B – (Rendering Provider Name)
NM1*82*1*LAST NAME*FIRST NAME*MIDDLE IN***XX*RENDERING NPI NUMBER~
PRV*PE*ZZ*TAXONOMY CODE~
REF*EI*TAX ID~
REF*0B*(STATE LICENSE NUMBER)~ (Illinois Only Requirement)
837 Health Care Claim: Institutional
LOOP ID 2000A – (Billing/Pay-To Provider Hierarchical Level)
PRV*BI*ZZ*TAXONOMY CODE~
LOOP ID 2010AA – (Billing Provider Name)
NM1*85*2*NON-PERSON ENTITY*****XX*GROUP NPI NUMBER~
N3*STREET ADDRESS~
N4*CITY*ST*ZIP CODE~
REF*EI*TAX IDENTIFICATION~
REF*1A*BLUE CROSS PROVIDER NUMBER~
LOOP ID 2310A – (Attending Physician Name)
NM1*71*1*LAST NAME*FIRST NAME*MIDDLE INITITAL***XX*NPI NUMBER~
PRV*AT*ZZ*TAXONOMY CODE~
REF*EI*TAX IDENTIFICATION~
Note: When sending information on the electronic claim referencing a referring, operating and supervising provider as well as a facility where services were rendered, a taxonomy code and NPI are required.
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