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Elizabeth M. Whitehorn, Director

Provider Notice issued 04/28/10

Elimination of the One-Digit Payee Code

To:​ All Participating Providers & Pay-To Providers (Payees)​
Date:​ April 28, 2010​
Re:​ Elimination of the One-Digit Payee Code​

 

The purpose of this notice is to provide updated information regarding the elimination of the one-digit payee code. The Pay-To Provider Loop was eliminated from the HIPAA 837 5010 Versions, except for the Pay-To Provider Address. Implementation of the HIPAA 837 5010 Versions is January 1, 2012.

 

Effective with claims received on or after October 1, 2010, the department will no longer accept the one-digit payee code to designate the appropriate payee for electronic claim submittals in the following formats: 837P, 837I or Direct Data Entry (DDE). The one-digit payee code will continue to be required for all paper claim forms, with the exception of the UB04. The elimination of the one-digit payee code will not apply to the atypical providers, who are not required to obtain NPIS.

Effective with claims received on or after May 3, 2010, the department will implement informational messages for the purpose of assisting the providers and payees with the transition from using the one-digit payee codes. Providers and Payees must ensure that a unique NPI is registered with the department for each one of their 16-digit payee numbers. The new informational messages are as follows:

I31 Payee NPI Required

Conditions when this message will be sent:

837P Electronic Claim Submittals

  1. A claim was submitted with a one-digit payee code in the Pay-To Loop, 2010AB and no Payee NPI was reported.
  2. A claim was submitted with a SSN or FEIN in the Pay-To Loop, 2010AB and no Payee NPI was reported.
  3. A claim was submitted with no Payee NPI in the Billing Provider Loop, 2010AA, no NPI reported in the Pay-To Loop, 2010AB. This scenario would apply to only 837P claims when the Rendering and Billing Provider Loops are required.

Direct Data Entry (DDE)

  1. A claim was submitted with a one-digit payee code and no Payee NPI was reported.
  2. A claim was submitted with a FEIN and no Payee NPI was reported.

I49 Payee NPI Invalid

Conditions when this message will be sent:

837P Electronic Claim Submittals

  1. A claim was submitted with a Payee NPI and a one-digit payee code in the Pay-To Loop, 2010AB. The Payee NPI reported was not registered to a 16-digit payee number.
  2. A claim was submitted with a Payee NPI in the Pay-To Loop, 2010AB and no one-digit payee code was reported. The Payee NPI reported was not registered to a 16-digit payee number.

Direct Data Entry (DDE)

  1. A claim was submitted with a Payee NPI and a one-digit payee code. The Payee NPI reported was not registered to a 16-digit payee number.
  2. A claim was submitted with a Payee NPI and no one-digit payee code was reported. The Payee NPI reported was not registered to a 16-digit payee number.

H49 Payee NPI Invalid

Conditions when this message will be sent:

837I Electronic Claim Submittals

  1. A claim was submitted with a Payee NPI and a one-digit payee code in the Pay-To Loop, 2010AB. The Payee NPI reported was not registered to a 16-digit payee number.
  2. A claim was submitted with a Payee NPI and no one-digit payee code in the Pay-To Loop, 2010AB. The Payee NPI reported was not registered to a 16-digit payee number.

UB04 Paper Claim Form

  1. A claim was submitted with a Payee NPI reported in Form Locator 02, Line 4 and a one-digit payee code was reported in Form Locator 02, Line 1. The Payee NPI reported was not registered to a 16-digit payee number.
  2. A claim was submitted with a Payee NPI reported in Form Locator 02, Line 4 and no one-digit payee code was reported in Form Locator 02, Line 1. The Payee NPI reported was not registered to a 16-digit payee number.

Direct Data Entry (DDE)

  1. A claim was submitted with a Payee NPI and a one-digit payee code. The Payee NPI reported was not registered to a 16-digit payee number.
  2. A claim was submitted with a Payee NPI and no one-digit payee code. The Payee NPI reported was not registered to a 16-digit payee number.

H54 Payee NPI Required

Conditions when this message will be sent:

837I Electronic Claim Submittals

  1. A claim was submitted with a one-digit payee code in the Pay-To Loop, 2010AB and no Payee NPI was reported.
  2. A claim was submitted with a SSN or FEIN in the Pay-To Loop, 2010AB and no Payee NPI was reported.

UB04 Paper Claim Form

  1. A claim was submitted with a one-digit payee code reported in Form Locator 02, Line 1 and no Payee NPI was reported

Direct Data Entry (DDE)

  1. A claim was submitted with a one-digit payee code and no Payee NPI was reported.
  2. A claim was submitted with a SSN or FEIN and no Payee NPI was reported.

837P Electronic Claim Submittals

The Rendering Provider Loop is mandated when the Rendering Provider is different from the Billing Provider. For HFS, the Billing Provider and the Pay-To Provider will be the same.

 

Loop 2010AA – Billing Provider Name

Group Practice, FQHC, RHC, ERC, Hospital, etc. & NPI

Loop 2310B – Rendering Provider Name

Individual practitioner/physician’s name & NPI

Loop 2010AB – Pay-To Provider Name

Not Required for HFS

837I Electronic Claim Submittals

The Billing Provider Loop, Billing Provider Name and NPI, will be used to identify the Billing Provider and the Pay-To Provider. The Pay-To Provider Loop will be required if the Pay-To Provider NPI is different than the Billing Provider NPI.

 

Loop 2010AA – Billing Provider Name

Hospital Name & NPI

Loop 2010AB – Pay-To Provider Name

Hospital Name & NPI if different than the Billing Provider Name & NPI

837I Electronic Claim Submittals

The Billing Provider Loop, Billing Provider Name and NPI, will be used to identify the Billing Provider and the Pay-To Provider. The Pay-To Provider Loop will be required if the Pay-To Provider NPI is different than the Billing Provider NPI.

 

Loop 2010AA – Billing Provider Name

Hospital Name & NPI

Loop 2010AB – Pay-To Provider Name

Hospital Name & NPI if different than the Billing Provider Name & NPI

UB04 Paper Claims

The Payee NPI will be reported in Form Locator 02, Line 4.

Questions regarding this notice should be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

 

Theresa A. Eagleson, Administrator
Division of Medical Program