Friday, December 5, 2008

Illinois Blue Cross Blue Shield Insurance Claims

Blue Cross Blue Shield of Illinois has required medical offices to bill using a Rendering NPI number. If you use RelayHealth as your electronic insurance claim filing clearinghouse you will get specific denials relating to this issue.

BA7: NPI is not valid as rendering

If you receive this exclusion it means that "The NPI submitted on the claim to identify who provided the services is identified in our files as a billing entity, not a rendering provider." To rectify the above error message, the NPI of the provider who rendered the services should be populated in Loop 2310B - Data Element NM109, which is equivalent to Box 24J on the CMS-1500 claim form.

NOTE: You must continue to include the Billing NPI in Loop 2010AA - Data Element NM109. This Data Element is equivalent to Box 33A in the CMS-1500 Form.

If receiving Warning message: BAJ - Rendering Provider Loop (2310B) is Missing
Please be advised that this Warning message alerts you that "If the NPI billing provider record is NOT established as 'valid as rendering,' then the claim rendering provider loop (2310B) is required." In this situation, you must include the rendering provider's NPI in Loop 2310B - Data Element NM109. This Data Element is equivalent to Box 24J on the CMS-1500 claim form.

When filing claims, it is imperative, to include the rendering NPI (Type 1) in the rendering field (2310B Loop) and the billing NPI (Type 2) in the billing field (2010AA). The appropriate billing and rendering NPI must be entered properly to avoid claim rejection(s) and ensure proper payment.

Questions on Electronic Medical Billing and Claims then view medical claims electronic billing

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