Posted 11/28/07

Blue Cross Blue Shield of Illinois
Blue Cross Blue Shield of Texas
Blue Cross Blue Shield of New Mexico
Blue Cross Blue Shield of Oklahoma

Two sets of HCSC NPI Edits will go into effect on 09/08/07.

The first set of edits will apply to claims submitted with only an NPI and consist of:

QGC – Billing NPI is not on file
QGD – NPI is not valid as billing
BA4 – Rendering Provider NPI Invalid
BA5 – Rendering Provider ID Qualifier Must = ‘XX’
BA6 – Rendering NPI is not on file
BA7 – NPI is not Valid as Rendering
CA4 – Rendering Provider NPI Invalid
CA5 – Rendering Provider ID qualifier Must = ‘XX’
CA6 – Rendering NPI is not on file
CA7 – Rendering NPI is not valid as Rendering

The second set of edits will apply to claims submitted with Dual IDs (both the NPI and the BCBS Provider number) and consist of:

QGY – Billing NPI is not on file
QGZ – NPI is not valid as billing
BAW – Rendering Provider NPI Invalid
BAX – Rendering Provider ID Qualifier Must = ‘XX’
BAY – Rendering NPI is not on file
BAZ – NPI is not Valid as Rendering
CAW – Rendering Provider NPI Invalid
CAX – Rendering Provider ID qualifier Must = ‘XX’
CAY – Rendering NPI is not on file
CAZ – Rendering NPI is not valid as Rendering

NPI Only and Dual ID Edits above will remain with the current Message Action Code W’ - Warning in all cases until further notice.

Note: QBD is an existing edit that is designed for the "Legacy and NPI (DUAL ID)” submissions – if the NPI is present but the Legacy ID is not given on the claim - it will continue to reject with this QBD edit until the HCSC provider is approved for NPI only submission. Continue submitting the Legacy and NPI Numbers until the provider alerts you that they are approved to submit NPI only.

If you have any questions on these edits, please contact our E-Commerce Center at 1.800.746.4614.