HealthCare News

Billing Regulations Reminder

Issue: #403 SEP2018

Topic: Coding/Billing


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 ClaimsProfessional 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.


  • Billing Provider’s NPI – Form Locator 56 or Loop 2010AA, Segment NM1, Element 09.

  • Pay-to-Provider NPI (only used if different from the Billing Provider NPI) – Form Locator 2 or Loop 2010AC, Segment NM1, Element 09.

  • Attending Physician NPI – Form Locator 76 or Loop 2310A, Segment NM1, Element 09.

  • Operating Physician NPI – Form Locator 77 or Loop 2310C.

  • Billing Provider Taxonomy Code – Loop 2000A, Segment PRV, Element 03

To correctly submit 837 Professional Claims to BCBSND, the billing, referring and rendering provider NPI must be included in the correct form locator.


  • Billing Provider’s NPI – Form Locator 33a or Loop 2010AA Segment NM1, Element 09.

  • Referring Provider NPI – Form Locator 17 and 17b or Loop 2310A, Segment NM1, Element 09.

  • Rendering provider NPI – Form Locator 24 j or Loop 2310B, Segment NM1, Element 09

  • Billing Provider Taxonomy Code – Loop 2000A, Segment PRV, Element 03

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.

sample ID card annotated