National Provider Identifier (NPI) – Electronic Remittance Information

Your NPI is currently being returned in the 835 transaction when it is received in the ANSI 837 format for both Institutional and Professional claims, or when it is received on paper claim forms.

Note: During our transition to an NPI-only environment, providers will receive payments and supporting information based on the way they submit claims, regardless of whether a Type 1 or a Type 2 NPI is used.* If you submit claims using only your BCBS provider number, your payment information will only contain your BCBS provider number; if you submit claims using dual identifiers, your payment information will contain a combination of the NPI and the BCBS provider number that was submitted; if you have been approved for and submit NPI-only claims, your payment information will contain only your NPI.

(*For clarification on differences between Type 1 and Type 2 NPIs, please reference the September issue of the NPI Times.)

Please understand that, during the dual-identifier phase, the combination of NPI and BCBS provider number that you submit could result in multiple payments for one NPI if that NPI is submitted with multiple BCBS provider numbers. As we move toward the completion of the transition period, providers submitting NPI-only claims and using multiple NPIs where they formerly had a single BCBS provider number will receive payments for each of the NPIs submitted.

Please be aware of the variations that your 835 ERA and/or supporting payment documents (PCS/EPS) may take during and after the NPI transition period at BCBS. This situation is being pointed out to assist in planning and avoiding any reconciliation issues that might arise.

The following section represents the formats that would be returned to you based on the claims you submit:

Institutional/Professional Segment Identifiers
GS02 usually identifies if the data contained in the 835 transaction is for an Institutional or Professional Provider. If the file contains both professional and institutional remits between one ISA and IEA, there will only be one GS segment and it will be as follows based on the first provider identified in the file:

GS*HP*HCSCBD or GS*HP*HCSCBS

HCSCBD = Blue Cross File
HCSCBS = Blue Shield File

Payee Identification Loop – 1000B (page 72 of IG) – BCBS provider number only

1A = Blue Cross #
1B= Blue Shield #

N1*PE*ANY HOSPITAL*FI*TAX ID #~
N3*ANY STREET ADDRESS~
N4*CITY*ST*ZIP~
REF*1A*BLUE CROSS #~

N1*PE*ANY PROFESSIONAL PROVIDER*FI*TAX ID #~
N3*ANY STREET ADDRESS~
N4*CITY*ST*ZIP~
REF*1B*BLUE SHIELD #~

Note:

• If a claim was received with only a BCBS provider number, only a BCBS provider number will be returned on the 835.

Payee Identification Loop - Dual usage of the NPI and BCBS provider number

N1*PE*HOSPITAL/PROFESSIONAL PROV NAME*XX*10 digit NPI #~
N3*ANY STREET ADDRESS~
N4*CITY*ST*ZIP~
REF*1B or 1A*BS # or BC #~
REF*TJ*TAX ID #~

Note:

• REF*1A or 1B (BCBS provider number) cannot be the same as the 10-digit NPI
• If a claim was received with dual IDs, both the NPI and BCBS provider number will be returned on the 835

Payee Identification Loop with NPI only

N1*PE*ANY HOSPITAL or PROFESSIONAL PROVIDER*XX*10 digit NPI #~
N3*ANY STREET ADDRESS~
N4*CITY*ST*ZIP~
REF*TJ*TAX ID #~

Note:

• If a claim was received with only an NPI, only an NPI will be returned on the 835