Changes to New York Medicaid Electronic Claims

For all clients who are submitting claims to New York Medicaid effective September 1, 2008 New York Medicaid is requiring claims be submitted with both the NPI and the Legacy numbers until New York Medicaid announces the NPI only requirement.

NPI is required in the following Loops for Electronic Claim Submission:

Institutional Loops UB-04 claim format:
2010AA Billing Provider
2310A Attending Physician
2310B Operating Physician
2310C Other Provider loop (used for referring provider)
2420A Attending Provider
2420B Operating Physician
2420C Other Provider

Professional Loops CMS-1500 format:
2010AA Billing Provider
2010AB Pay-to provider
2310A Referring provider (required for DN and P3 qualifiers)
2310B Rendering Provider
2310D Service Facility
2310E Supervising Provider
2420A Rendering Provider
2420C Service Facility
2420D Supervising Provider
2420E Ordering Provider
2420F Referring Provider (required for DN and P3 qualifiers)

On September 5th 2008 RelayHealth will have a Provider Test Environment for NPI information. RelayHealth will notify clients of any changes that maybe required of them but for now please begin transmitting the Medicare Legacy and NPI numbers for the following CPID#'s.

CPID 1422 New York Welfare - Phase II
CPID 1500 New York Medicaid Title XIX - Phase II
CPID 1501 New York Medicaid Inpatient - Phase II
CPID 1502 New York Medicaid Outpatient - Phase II

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