General Business Requirements for the 837 Institutional 5010A2 Claims Submission Process (Health Partners Claims)
These mapping guidelines will address a variety of issues that will facilitate the Electronic Media Claims Processing for the 837 Institutional (005010X223A2).
- Use most recent ICD-9, CPT, HCPC, and Revenue codes.
- Always check for 4th and 5th digit code requirements.
- An electronic claim cannot span two (2) separate calendar years. Charges must be filed for the previous year separately from the current year.
- No more than 5,000 claims will be accepted for any provider at one time.
- The maximum number of characters to be submitted in the dollar amount field is seven (7) characters.
- You may send up to sixteen (16) diagnosis codes per claim; however, the last twelve (12) diagnosis codes will not be considered in processing.
- Submitters must use the entire alphanumeric or numeric identification code for the Subscriber Identifier (Loop 2010BA, NM109), as it appears on the member’s identification card.
- Health Partners Plans (Medicaid) members have a nine (9) digit numeric member ID number
- Kidz Partners (CHIP) members have a ten (10) digit numeric member ID number
- Health Partners Plans (Medicare) members have a seven (7) digit numeric member ID number
Health Partners will accept the following provider identifiers:
- NPI Only (2010AA Loop, NM108 with the XX qualifier)
- NPI Only (2310B Loop, NM108 with the XX qualifier).
To learn more about HIPAA EDI mapping guidelines and become a certified EDI Professional please visit our course schedule page.