BCBS EDI changes that can deny claims as of 1 Jun 2014
Posted: Fri Apr 04, 2014 3:54 pm
Just learned that BCBS FL (don't know about other states) has instituted a change in their EDI format affecting 837P claims transmits that can deny claims submitted after 1 Jun 2014. In essence, the change is as follows: If the NPI value for the Service Facility Location ID Code (Loop 2310C/NM109) is the same as the NPI for the Billing Provider ID Code (Loop 2010AA/NM109), then the claim will be denied (eff June 1, 2014).
Called local BCBS EDI office thru Availity and was told that this affects mainly individual providers that have only one NPI (as individuals, no group NPI) and not those that render services under a different and, presumably, group NPI. Idea being that there cannot be any duplication of the same NPI if the billing provider AND service facility NPIs are the same. This occurs with individual/sole owner providers who see patients in their office, which is then entered as the "Service Facility Location" with the billing provider's same NPI as it appears under "Practice Information." From what I was told, the way to comply with the change is to NOT enter a Service Facility Location IF the the POS = 11 (office), which would be the way NPI's would be duplicated and, hence, cause the denial.
Does anyone else have info on this issue, either in corroboration or otherwise?
Called local BCBS EDI office thru Availity and was told that this affects mainly individual providers that have only one NPI (as individuals, no group NPI) and not those that render services under a different and, presumably, group NPI. Idea being that there cannot be any duplication of the same NPI if the billing provider AND service facility NPIs are the same. This occurs with individual/sole owner providers who see patients in their office, which is then entered as the "Service Facility Location" with the billing provider's same NPI as it appears under "Practice Information." From what I was told, the way to comply with the change is to NOT enter a Service Facility Location IF the the POS = 11 (office), which would be the way NPI's would be duplicated and, hence, cause the denial.
Does anyone else have info on this issue, either in corroboration or otherwise?