Sunday, 25 September 2016

Filing Claims with NPIs

Your NPI is used for claims processing and internal reporting. Claim payments are reported to the Internal Revenue Service (IRS) using your tax identification number (TIN). To appropriately indicate your NPI and TIN on UB-04 and CMS 1500 claim forms, follow the corresponding instructions for each form included in this manual. Remember, claims processing cannot be guaranteed if you have not notified Blue Cross of your NPI, by using one of the methods above, prior to filing claims. See the first part of this section for more details on how to submit claims to Blue Cross.

For more information, including whom should apply for an NPI and how to obtain your NPI, visit our website or CMS’ site at If you have any questions about the NPI relating to your Blue Cross participation, please contact us at 1-800-716-2299, option 3.

National Provider Identifier (NPI)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the adoption of a standard unique identifier for healthcare providers. The Centers for Medicare and Medicaid Services (CMS) has assigned national provider identifiers (NPIs) to comply with this requirement. NPIs are issued by the National Plan and Provider Enumeration System (NPPES). This one unique number is to be used when filing claims with Blue Cross as well as with federal and state agencies, thus eliminating the need for you to use different identification numbers for each agency or health plan.
To comply with the legislation mentioned above, all covered entities must use their NPI and corresponding taxonomy code, where applicable, when filing claims. All providers who are being credentialed or who are undergoing recredentialing, regardless of network participation, must include their NPI(s) on their application. Claims processing cannot be guaranteed unless you notify Blue Cross of your NPI(s) prior to filing claims using your NPI(s).

Notifying Blue Cross of your NPI

Once you have been assigned an NPI, please notify us as soon as possible. To do so, you may use one of the following ways:

1. Include it on your Louisiana Standardized Credentialing Application (LSCA), Health Delivery Organization (HDO) Application or Blue Cross recredentialing application.

2. Include it on the online Provider Update Form at >Forms for Providers.

3. Submit it along with your name and tax-ID or social security number printed on your office letterhead by fax to 225-297-2750 or by mail to Blue Cross and Blue Shield of Louisiana; Attn.
Network Administration; P.O. Box 98029; Baton Rouge, LA 70898-9029.

Referring Physician NPIs

Referring physician NPIs are required on all applicable claims filed with Blue Cross and HMO Louisiana. Place the NPI in the indicated blocks of the referenced claim forms:

• CMS -1500: Block 17a
• UB-04: Block 78
• 837P: 2310A loop, using the NM1 segment ad the qualifier of DN in the NM101 element
• 837I: 2310D loop, segment NM1 with the qualifier of DN in the NM101 element
For more information on NPIs, visit >NPI.

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