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 As of January 1, 2008, appropriate National Provider
Identification (NPI) numbers and the Federal Employer
Identification Number (FEIN) are required on all claim
submissions.
Effective May 23, 2008, consistent with the contingency
plans established by CMS and Mercy Health Plans, we will
begin rejecting claims that are submitted without these
required identifiers.
The different types of providers that may be associated
with a claim can be divided into two general categories:
Primary and Secondary. The primary provider identifiers
must be on the claim for it to be processed. The
secondary provider identifiers may be required depending
on the situation (e.g., Operating provider identifiers
are required if there is a surgical procedure on the
claim).
Primary:
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Professional (837P/CMS1500): Billing, Pay-To and
Rendering
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Institutional (837I/UB04): Billing and Pay-To
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Rule Exception:
The Billing provider will be used in the absence of
a Pay-To provider.
Secondary:
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Attending
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Operating
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Other
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Referring
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Ordering
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Supervising
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Facility
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Care plan oversight
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Purchase service
As noted above, the appropriate National Provider
Identification (NPI) numbers and the Federal Employer
Identification Number (FEIN) are required on all claim
submissions. UPIN and Medicare ID are acceptable
in support of the submitted NPI.
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