Billing Regulations Reminder
Issue: #405 DEC2018
Blue Cross Blue Shield of North Dakota (BCBSND) would like to provide a reminder regarding billing requirements for submitting NPI’s and Taxonomy Codes on claims. Please review the below chart for the correct breakdown of professional and institutional claim requirements.
|Institutional Claims||Professional Claims|
|To correctly submit 837 Institutional Claims to BCBSND, the billing, pay-to-provider, attending physician and operating physician NPI’s must be included in the correct form locator.
||To correctly submit 837 Professional Claims to BCBSND, the billing, referring and rendering provider NPI must be included in the correct form locator.
Using the Rendering Provider NPI as the Billing Provider on the claim will cause the claim to reject. If the Taxonomy code is not present on the claim, it will hit a front end edit which will cause the claim to automatically reject.
For Eligibility and Benefits transactions only, the Organizational NPI should be utilized. If an NPI other than the Organization’s NPI is used, the transaction will return an “entity not found” error.
Note: For additional X12 file format instruction, please consult the 5010 implementation guides for the 837I and 837P transactions.