Claim Billing Information For BUCKEYE COMMUNITY HEALTH PLAN Partnering Parties
Claim Billing information for BUCKEYE COMMUNITY HEALTH PLAN health care claims goes under HIPAA requirements. HIPAA specifies the electronic standards that must be followed when certain health care information is exchanged. These standards are published in National Electronic Data Interchange Transaction Set Implementation Guides. They are commonly called Implementation Guides (IG) and often are referred to as IG. The following Claim Billing Information notes in the blog below illustrates the adopted standards and the related BUCKEYE COMMUNITY HEALTH PLAN business categories as for Provider Number Billing Information.
Medicaid Provider Number X12 location and selection process
If there are different providers that rendered the services evident at the service lines of the claim, the Medicaid provider number must be in Loop 2420A, in REF02, using “1D” as the qualifier in REF01. If there are no REF segments containing the “1D” qualifier, an attempt will be made to select the correct values from REF segments containing the following qualifiers “G2” or “N5” in this order. If a single provider that rendered all of the services on the claim is listed on the claim and the provider is not the same as the billing provider, in Loop 2310B, REF02, the Medicaid provider number must be present. The qualifier in REF01 must be “1D”. If there are no REF segments containing the “1D” qualifier, an attempt will be made to select the correct values from REF segments containing the following qualifiers “G2” or “N5” in this order. If the Billing provider on the claim is also the rendering provider, and the Rendering provider information is not at the service level or claim level, the provider number is required in Loop 2010AA, REF02. The qualifier in REF01 must be “1D”. If there are no REF segments containing the “1D” qualifier, an attempt will be made to select the correct values from REF segments containing the following qualifiers “G2” or “N5” in this order.