Attention Electronic Submitters: NPI Required Phase Extension

Note: the following edit rejection ("R") applies to Illinois, New Mexico and Texas only. This edit will remain as a warning ("W") for Oklahoma.

Formerly, BCBSTX had published December 1, 2007 as the start of our "NPI Required Phase." This deadline date has been changed to January 7, 2008. Please continue to submit claims using dual identifiers (your BCBSTX provider number and your NPI), or only your NPI if you have received approval notification from us to submit NPI-only claims. Claims submitted to BCBSTX without an NPI as of January 7, 2008, will be rejected.

The current warning message, "QGA - Billing Provider NPI missing and is required," will become a rejection as of January 7, 2008. In order to avoid delays in claim payments, it is imperative that you include your NPI in your claim(s) transmission immediately. If you require additional information, please contact your EDI Representative or feel free to call our Electronic Commerce (E-Commerce) Center at 1-800-746-4614.

The QGA message requires the 'XX' qualifier in LOOP ID - 2010AA (Billing Provider Name) segment ID, NM108 and the National Provider Identifier in segment ID NM109.

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~

- IF THE NM102 IS AN ENTITY USE THE VALUE "2."