Billing - General Questions
- Is there a generic NPI for referring physicians to be used when submitting our claim?
- With regard to value codes, what do we bill on electronic claims for VC A1, A2, A7, etc
- How will you know about Value Code 44 if we do not report it?
- Do I need the physician’s NPI? What if the physician is an outside physician?
- Are we required to bill with the other physicians taxonomy code?
- I am a Direct Date Entry (DDE) provider, will the FISS screens change?
- Will we still key the 0001 line in Field Locator 42? What do we key in ‘totals’ in line number 23?
- We use PC ACE, who do we contact for EDI information?
- How many characters are allowed in field locator 50A in FISS?
- We bill paper claims to HMO. Are they changing to UB04?
- What phone number should we call for EDI questions and can our software provider call them?
- Field locator 51A appears to be where we would put our Oscar provider number. Do we key our provider number?
- How do we bill our covered days and co insurance days?
- If FISS is transparent now, do you anticipate the system changing to match the UB04?
- On the new UB04, FL 56 requires our NPI, does our Medicare legacy number go in FL 57?
- Can I send a dash in the patient control number?
- On an electronic bill do I use the new value codes and report days differently that are non-covered?
- Are the new value codes 80-83 for paper only?
- What changes do we need to make as an electronic biller?
- If we are entering claim information in the UB-92 format, when the UB-04 format is required, how will that impact any compliance audits?
- What is FL 8 for?
- What changes do we need to make for PCACE? Will PCACE print the UB-04?
- How many characters do we need to enter for the diagnosis?
- How many diagnosis fields are allowed in FISS?
- If we cannot obtain an attending or referring physician/provider NPI number, can we use ours?
- I noticed on the UB-04 there is no place for signature?
- It appears the font size is smaller on the UB-04, is it?
- Are there any changes for the 837-I format?
- What FL are the new value codes 81-83 located?
- Are both the attending NPI and UPIN numbers required on our claims?
- What would we report in FL 70, patient reason DX?
- What can Highmark Medicare Services tell us with regards to the release of the providers NPI numbers? When will a list or web site be released for facilities to reference when we cannot obtain a provider’s NPI number?
- Is the attending provider NPI number required for electronic billing?
- Are there any new specifications for electronic billers?
- When we have an individual NPI and a group NPI, where does the group NPI go?
- For multi discipline providers such as PT,OT, SLP do we submit separately for attending physician?
- On multiple page claims, do we enter a total on line 23 for each page?
- Where do we enter the attending physician as well as the prescribing physician?
- How do we enter the days with the new value codes 80 – 83?
- Where do we enter the dollar amount for a primary payment?
Is there a generic NPI for referring physicians to be used when submitting our claim?
There is no generic NPI number. You are required to obtain the referring physicians NPI number.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
With regard to value codes, what do we bill on electronic claims for VC A1, A2, A7, etc
Incorrect usages or reporting of Value Code 44 is usually determined through the annual or bi-annual Medicare Secondary Payer (MSP) Audit conducted by the Fiscal Intermediary. There is no change to Value Codes, other than what is reported in CR 5411, which relates to A1, A2, A7, B1, etc …….
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
How will you know about Value Code 44 if we do not report it?
There is no change to Value Codes, other than what is reported in CR 5411, which relates to A1, A2, A7, B1, etc …….
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
Do I need the physician’s NPI? What if the physician is an outside physician?
Yes you need the referring, ordering and/or attending NPI number. The rules are not changing, just the number.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
Are we required to bill with the other physicians taxonomy code?
You are not required to bill with the other physicians taxonomy code, only the NPI number.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
I am a Direct Date Entry (DDE) provider, will the FISS screens change?
There are no changes to the Fiscal Intermediary Shared System (FISS). Changes will be transparent. Data will be converted to UB04.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
Will we still key the 0001 line in Field Locator 42? What do we key in ‘totals’ in line number 23?
Yes, you will still key your 0001 total line at the end of your charges. If you have multiple pages, you will key the total in the 'totals' line number 23 and revenue code 0001 on the last page.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
We use PC ACE, who do we contact for EDI information?
EDI services at 1-866-488-0546
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
How many characters are allowed in field locator 50A in FISS?
In FL 50A the UB04 allows 23 characters, FISS characters remain the same.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
We bill paper claims to HMO. Are they changing to UB04?
Yes. All insurers that utilize the UB-92 will be required to use the UB-04.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
What phone number should we call for EDI questions and can our software provider call them?
Yes, the software vendor may call EDI services at 1-866-488-0546.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
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Key your Medicare Oscar provider number in FL 51A, when Medicare is the primary payer.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
How do we bill our covered days and co insurance days?
Effective July 1, 2007, in accordance with CR 5411/Transmittal 261 entitled, Institutional Value Code Changes: The National Uniform Billing Committee (NUBC) has restricted the use of value codes A1, A2, A7, B1, B2, B7, C1, C2, and C7 to paper claims. These value codes are no longer available for use on the X12N 837 institutional claim transaction.
The FISS will recognize Value Code (VC) 80 and amount as covered days, VC 81 and amount as non-covered days, and VC 82 and amount as coinsurance days.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
If FISS is transparent now, do you anticipate the system changing to match the UB04?
We do not know, at this time, if there will be FISS changes in the near future.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
On the new UB04, FL 56 requires our NPI, does our Medicare legacy number go in FL 57?
By definition, FL57 is used to report other provider identifiers as assigned by a health plan (as indicated in FL50), prior to May 23, 2007. This number can be your Medicare legacy number.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
Can I send a dash in the patient control number?
Yes, the basic character set allows for a dash.Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
On an electronic bill do I use the new value codes and report days differently that are non-covered?
Yes, see answer to question 14.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
Are the new value codes 80-83 for paper only?
No.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
What changes do we need to make as an electronic biller?
Changes for electronic submitters should be transparent. Your software vendor will handle any changes to the electronic specifications.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
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There will be no impact from a Medicare initiated audit.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
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Patient's Name and patient Identifier if different than the subscriber's/insured's ID. This is 1 field with 2 lines and 2 subfields. Subfield A is for the patient identifier (19 positions) and subfield b is for patient name (29 positions). Use a comma to separate the last and first names.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
What changes do we need to make for PCACE? Will PCACE print the UB-04?
Please reference the PC-ACE Pro32 January 2007 Release Newsletter for specific information. You do NOT have to upgrade your current UB92 print-image import to support NPI, as there is no "NPI requirement" within PC-ACE Pro32 for you to switch import formats from UB92 to UB04. PC-ACE Pro32 provides storage for the NPI values in internal reference files, which are accessed by the legacy provider IDs on the print-image or NSF import files. System Designs, Inc. recommends that users continue to use the UB92 print-image files for import into PC-ACE Pro32 as long as this solution meets your other data needs. If a provider does convert to the UB04 format, a re-mapping will be required.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
How many characters do we need to enter for the diagnosis?
8 characters
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
How many diagnosis fields are allowed in FISS?
The principal and 8 other diagnosis codes (67A-67H) will be considered for adjudication and payment determination. (X12N 837 Institutional Companion Document)
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
If we cannot obtain an attending or referring physician/provider NPI number, can we use ours?
No, you are required to obtain and submit the attending or referring physicians NPI number on your Medicare Part A claim.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
I noticed on the UB-04 there is no place for signature?
Per the specifications of CR5072, this FL has been deleted.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
It appears the font size is smaller on the UB-04, is it?
The NUBC sets up the font size, you may need to adjust the size for your paper claims.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
Are there any changes for the 837-I format?
Yes, see answer for question 14.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
What FL are the new value codes 81-83 located?
The new Value Codes are located in FL 39-41.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
Are both the attending NPI and UPIN numbers required on our claims?
The NPI replaces all prior identifiers.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
What would we report in FL 70, patient reason DX?
Patient reason for visit is reported as a 'V' diagnosis code.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
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NPPES health care provider data that are disclosable under the Freedom of Information Act (FOIA) will be disclosed to the public by the Centers for Medicare & Medicaid Services (CMS). In accordance with the e-FOIA Amendments, CMS has disclosed these data via the Internet. Data is available in a query-only database, known as the NPI Registry, and a downloadable file.
CMS made FOIA-disclosable NPPES health care provider data available beginning Tuesday, September 4, 2007. The NPI Registry become operational on September 4th and CMS posted the downloadable file on September 12th.
Access to these files is availalbe through the following link: http://www.cms.hhs.gov/NationalProvIdentStand/06a_DataDissemination.asp
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
Is the attending provider NPI number required for electronic billing?
Yes, the NPI is required on all claims, electronic and paper, which includes the attending and/or referring physicians.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
Are there any new specifications for electronic billers?
At this time, there are no changes for electronic submitters billing Medicare Part A claims.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
When we have an individual NPI and a group NPI, where does the group NPI go?
The billing entity NPI will be entered in FL56 and the attending physician NPI can be entered into FL 76.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
For multi discipline providers such as PT,OT, SLP do we submit separately for attending physician?
Billing requirements have not changed with the implementation of the UB04. Continue following the same billing requirements that are in place at this time.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
On multiple page claims, do we enter a total on line 23 for each page?
According to the NUBC specifications manual, the total is only required on the last page. Remember that Medicare still requires your total to be entered with revenue code 0001.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
Where do we enter the attending physician as well as the prescribing physician?
Attending physician should be entered into FL76 and the prescribing physician can be entered into FL78 or FL79.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
How do we enter the days with the new value codes 80 – 83?
Enter the number of days as if you were entering a dollar amount. For example, 30 days should be entered as 30.00. If you simply key 30, FISS will populate the value code field with .30.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008
Where do we enter the dollar amount for a primary payment?
Enter the primary amount along with the appropriate value code just as you do now.
Date Posted: 03/19/2007, Date Reviewed/Revised: 12/19/2008