New Mexico Medicaid requires Rendering Provider Tax ID

CPID# 1492 New Mexico Medicaid requires the Rendering Provider Tax ID number when the NPI only is sent. RelayHealth has identified that a lot of clients are getting claim exclusions for not submitting this information so they have added a new edit to scrub for this.

Edit: 33 0011C: Missing rendering Provider EIN with NPI in Loop 2310B, when NM108=XX, Must have ref~EI

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Medicares Quarterly Updates - holding checks

The Centers for Medicare and Medicaid Services (CMS) requires and schedules standarda quarterly updates that each Medicare contractor must load into their claim processing system. These quarterly updates take place each January, April, July and October. The July 2008 update will take place the weekend of July 5th 2008. Medicare (CMS) will create a hold edit and place it in the system on July 1st 2008, to ensure that all claims submitted to Medicare on or after July 1, 2008, with 2008 dates of services, are held in the system until the July update has been completed.

Once Medicare confirms and validate that the system updates are processing correctly, they will start releasing the medical claims from the hold edit. Due to the volume of claims, it may take Medicare a few business days to release all claims from the hold edit.

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New Mexico Medicare and Oklahoma Medicare

CPID's 1457 New Mexico Medicare and 1458 Oklahoma Medicare require the Facility information to be present on claims that contain a Facility code Value other than 12 Home. Because of these new changes RelayHealth has added a new edit to scrub for this value:

Edit 57 0037D: Missing Service Facility Information in Loop 2400, If SV105 is not 12, then Loop 2310D (Professional Service Facility) or 2420C (Professional Service Facility) must be sent.

This new edit will begin populating on July 8th 2008.


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