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Provider Bulletin H-200-11-01
- Form Locator 76 - Attending Provider Name and Identifiers. The Name and NPI of the attending provider will be required on all claims. Previously, the department did not require this field for outpatient renal dialysis (category of service 25).
- Form Locators 78 and 79 – Other Provider Names and Identifiers. Previously, the department had required these fields for outpatient renal dialysis and outpatient physical rehabilitation claims. These fields are situational. If a provider utilizes these fields, it must designate a two-digit Provider Type Qualifier Code in conjunction with the NPI.
To: Participating Hospitals: Chief Executive Officers, Chief Financial Officers, Patient Accounts Managers; Renal Dialysis Providers; and Ambulatory Surgical Treatment Centers (ASTCs)
Date: June 27, 2011
Re: Revisions to Billing Requirements for Reporting the Attending and Other Provider NPIs
Effective with all claims received August 1, 2011, and after, the department is implementing the following billing changes for provider identification:
These same reporting requirements apply to the X12 4010A1 837I claim transaction, Loop IDs 2310A and 2310C; upon implementation, the X12 5010 837I claim transaction, Loop IDs 2310A, 2310C, 2310D, and 2310F; and Direct Data Entry (DDE) – Physician Info Tab. The HIPAA 837I version 4010 and 5010 Companion Guides are available on the department's Web site.
New Error Codes Associated with These Billing Requirements:
G33 – Missing/Invalid Qualifier. For UB-04 only. If there is an NPI entry in either FL 78 or 79 but the Provider Type Qualifier Code is missing or invalid, the claim will be rejected.
H45 – Missing/Invalid Other Operating Physician NPI. If the "ZZ" Other Operating Physician Qualifier Code is present, but the corresponding NPI is missing or invalid, the claim will be rejected.
H55 – Missing/Invalid Rendering Provider NPI. If the "82" Rendering Provider Type Qualifier Code is present, but the corresponding NPI is missing or invalid, the claim will be rejected.
H56 – Missing/Invalid Referring Provider NPI. If the "DN" Provider Type Qualifier Code for the Referring Provider is present, but the corresponding NPI is missing or invalid, the claim will be rejected.
Hospitals and renal dialysis providers should use the billing guidelines in the Handbook for Hospitals Services, Appendix H-2, in conjunction with the UB-04 Data Specifications Manual. To become a UB-04 Subscriber, refer to the National Uniform Billing Committee (NUBC) Web site.
Appendix H-2 in the Handbook for Hospital Services has been updated and is available on the department's Web site. Printed copies of this bulletin and replacement pages for the handbook are available upon written request. To ensure delivery, specify a physical street address when making a request for a paper copy. Submit your written request or fax to:
Illinois Department of Healthcare and Family Services
Provider Participation Unit
Post Office Box 19114
Springfield, Illinois 62794-9114
Fax Number (217) 557-8800
Email the Provider Participation Unit
ASTCs should use the information in this notice in conjunction with the October 21, 2010 ASTC notice and billing guide on the department's Web site. Form Locators 78 and 79 are conditionally required for claims for this provider type. This billing information will be incorporated into a revision of the Handbook for ASTCs.
Any questions regarding this bulletin should be directed to your facility's medical assistance consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565.
Instructions for updating the Handbook for Hospital Services:
Remove Appendix pages H-2a (5/6, 7/8); H-2b (5/6, 7/8); and H-2c (5/6) and insert updated pages H-2a (5/6); H-2b (5/6); and H-2c (5/6) with effective date August 2011.