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Elizabeth M. Whitehorn, Director

Provider Notice issued 08/13/08

Revised Implementation Date - Reporting of National Provider Identifiers (NPIs) for Other Physician IDs

To:​

Participating Hospitals: Chief Executive Officers, Chief Financial Officers, Patient Accounts Managers, and Health Information Management Directors; Hospice Agencies; Renal Dialysis Facilities; and Ambulatory Surgical Treatment Centers (ASTCs)

Date:​ ​August 13, 2008
​Re: Revised Implementation Date - Reporting of National Provider Identifiers (NPIs) for Other Physician IDs​

On June 24, 2008, the department posted a notification on its Web site at regarding a delay in the implementation date for the reporting of NPIs for Other Physician IDs, such as Attending, Operating and Other.  Providers who did not receive an electronic notification of this posting are encouraged to go to http://www.hfs.illinois.gov/provrel/ to register for e-mail notification. The purpose of this notice is to advise providers that the implementation date for reporting the NPI for Other Physician IDs will be October 1, 2008.  Until then, providers should continue to bill as they have previously.

The reporting of NPIs for Other Physician IDs applies to claims submitted via the UB-04, 837I, and Direct Data Entry (DDE) formats.  All providers should have a copy of the UB-04 Data Specifications Manual for reference.  To become a UB-04 Subscriber, refer to the following Web site at: http://www.nubc.org/become.html

The following provides additional guidance for the preparation of claims:

Attending Provider Name and Identifiers

  • UB-04 - FL76; 837I - Loop ID 2310A; DDE - Physician Info Tab

  • This field is required on all claims except category of service 25 (outpatient renal dialysis).

  • Applicable claims that do not contain this entry will be rejected with new error message H43 - Missing/Invalid Attending NPI.

  • Providers may submit a secondary identifier (see UB-04 Manual) in addition to the NPI, but it will not be used for processing of the claim.

Operating Physician Name and Identifiers

  • UB-04 - FL77; 837I - Loop ID 2310B; DDE - Physician Info Tab 

  • This field is required on all inpatient claims and outpatient categories of service 24 (general outpatient) and 29 (outpatient physical rehabilitation), if a surgical procedure is performed.

  • Applicable claims that do not contain this entry will be rejected with new error message H44 - Missing/Invalid Operating NPI.

  • Providers may submit a secondary identifier (see UB-04 Manual) in addition to the NPI, but it will not be used for processing of the claim.

Other Provider (Individual) Names and Identifiers

  • UB-04 - FLs78 and 79; 837I - Loop ID 2310C; DDE - Physician Info Tab

  • This field is required for outpatient categories of service 25 and 29.

  • Applicable claims that do not contain this entry will be rejected with new error message H45 - Missing/Invalid Other Physician NPI.

  • Providers may submit a secondary identifier (see UB-04 Manual) in addition to the NPI, but it will not be used for processing of the claim.

Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 877-782-5565.

 

Theresa A. Eagleson, Administrator

Division of Medical Programs