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 |
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This should be the billing address for the agency, (the location to which vouchers/checks will be mailed) |
N4 |
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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. Although the XX qualifier is not required in this loop, if you do enter the XX qualifier you must include the Agency NPI number in the NM109 field.
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 |
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This should be the address where services for this claim were rendered. |
N4 |
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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: |
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NM1*82 |
NM108 = XX |
NM109 = Agency’s NPI |
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PRV |
PRV02 = ZZ |
PRV03 = Taxonomy for the rendering practitioner |
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