New Claim Edits for New York Preferred Care HMO

New York Preferred Care HMO CPID# 7434 has new NPI requirements. Because of these changes RelayHealth will be implmenting a new electronic claim exclusion on December 5th 2008 for all claims submitted to CPID# 7434.

EDIT: HU 0021 INVALID CLAIM REF PROV ID QUAL? IN LOOP 2310A(PROF), WHEN NM108 IS SENT MUST BE EQUAL TO XX

Please understand that the NPI is now required when submitting claims through RelayHealth for New York Preferred Care HMO health insurance.


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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.

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Electronic Claims EDI error BO13 Prov Phone 1

For those medical offices billing through RelayHealth to insurance carriers CPID#1405 Illinois Blue Shield, CPID# 1406 Texas Blue Shield, CPID# 7403 New Mexico Blue Shield and/or CPID# 1403 Oklahoma Blue Shield you may have noticed a EDI Denial: B013 PROV PHONE 1 on November 14th 2008.

The invalid rejections have all been corrected and forwarded on to the correct payors. Please be aware of this fix.



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