Know Your HIPAA Claims

HIPAA 837 Billing Instructions for all Providers

(For further instruction please see the 837 Companion Guide)

When using software other than EDI Claims Link for Windows:

LOOP 2010AA – Billing Provider Information

NM1*85
(85 indicates this is the billing provider information & is the only valid value)
NM108 = XX
(XX indicates this is NPI data)
NM109 = Agency’s NPI
(Your billing NPI number)
The agency’s NPI is required so that a valid match can be made against the information which you submitted to ValueOptions.

N3

 

 

This should be the billing address for the agency, (the location to which vouchers/checks will be mailed)
The address should match the address on the summary vouchers sent to you by ValueOptions.

N4

 

 

City, State Zip for the preceding address.

REF

REF01 = EI

REF02 = Agency Tax ID

Tax ID information is required for tax purposes.

Service Location must include the address where services were rendered.

LOOP 2310D – Service Facility Location

NM1*FA NM108 = XX
This is not required, but if it is supplied, the value MUST be “XX”
NM109 = Agency NPI
This is not required, but if it is supplied, the value MUST be the agency NPI
Only the Agency NPI is a valid value.
Tax ID or SSN values which might have been carried in this segment are no longer options

N3

 

 

This should be the address where services for this claim were rendered.

N4

 

 

City, State Zip for the preceding address.

Rendering Provider must include the Agency NPI, XX qualifier, and taxonomy code:

LOOP 2310B – Rendering Provider

NM1*82 NM103 – Rendering practitioner’s last name followed by a comma, followed by one space, then the licensure level  

This information is required to determine which fee schedule should be applied for the professional services contained on the claim.

EXAMPLE:
Smith, LCSW

NM1*82

NM108 = XX
Since NPI is mandatory, the value MUST be “XX”

NM109 = Agency’s NPI

 

PRV

PRV02 = ZZ

PRV03 = Taxonomy for the rendering practitioner