Billing Regulations Reminder
Issue: #403 SEP2018
Blue Cross Blue Shield of North Dakota (BCBSND) would like to provide a reminder of billing requirements for submitting NPI’s and Taxonomy Codes on claims. Below is a breakdown of professional and institutional claim requirements for your convenience.
|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.
When submitting claims, it is also very important to verify that the full Unique Member Identifier (UMI) is present on the claim. For migrated members, the UMI number is now a 12-digit number which is longer than the 9-digit UMI number for non-migrated members. While not preferred for migrated members, if you have the member’s old identification number, you can submit that identification number on the claim and the system will recognize that number and cross it over to the new system.