Pay-to Provider IDs

Defining Pay-to Provider IDs  On Billing Forms

The Pay-to Provider NPI is not entered or maintained by Billing personnel. The Pay-to Provider NPI is retrieved from the Institution file (#4). Beginning with Patch IB*2*432, the Pay-to Provider Primary ID is the NPI number of the site defined as the Pay-to Provider. The Federal Tax Number is defined when the Pay-to Provider is defined, but will no longer be used as the Primary ID.

  1. Define the Pay-to Provider Secondary IDs With Patch IB*2*400, the CI1B segment was added to the outbound 837 claim transmission map to transmit Pay-to Provider Secondary IDs if the need should arise in the future. The CI1B segment was removed with Patch IB*2*432.
  2. Billing Provider IDs The Billing Provider Primary ID and the Billing Provider Secondary IDs are IDs that identify the facility at which the patient service was provided. This is a facility with a physical location (street address). The Billing Provider on a claim must be one of the following Facility Types that have been assigned NPI numbers:
    • CBOC – Community Based Outpatient Clinic
    • HCS – Health Care System
    • M&ROC – Medical and Regional Office Center
    • OC – Outpatient Clinic (Independent)
    • OPC – Out Patient Clinic
    • PHARM – Pharmacy
    • VAMC – VA Medical Center
    • RO-OC – Regional Office – Outpatient Clinic
  3. When care is provided at any other facility type (i.e. a mobile unit), the Billing Provider becomes the Parent facility as defined in the Institution file (#4) and the mobile unit becomes the Service Facility. With Patch IB*2*432, the name for the Billing Provider on a claim is extracted from the new Billing Facility Name field (#200) of the Institution file (#4). If this field is not populated, the IB software continues to extract the name from the .01 field of the Institution file.
  4. Define the Billing Provider Primary ID/NPI For all claims generated by the VA, the Billing Provider Secondary ID is the Federal Tax Number of the site. Once defined, the IB software will automatically assign this ID to a claim. The Billing Provider NPI is the Billing Provider Primary ID. The Billing Provider NPI is defined in the Institution file. Once defined, the IB software automatically assigns this ID to a claim. The VA Billing Provider NPI and Taxonomy Code will not be entered or maintained by Billing personnel. Users may change the default Billing Provider taxonomy code for a claim but users cannot change the Billing Provider NPI.
  5. Define the Billing Provider Secondary IDs The Billing Provider Secondary IDs are IDs and Qualifiers that are provided to a site by the insurance company. There can be a total of eight Billing Provider Secondary IDs per claim. The first ID is calculated by the system and used by the clearinghouse to sort claims. The second ID is always the site’s Federal Tax ID, and the remaining six IDs must be defined by the IB staff if required. Users can define one Billing Provider Secondary ID for a CMS-1500, and another for a UB-04 for the main division. If no other Billing Provider Secondary IDs are defined, these two IDs become the default IDs for all claims. At this time, there will not be any Billing Provider secondary IDs for Dental claims. Billing Provider Secondary IDs can be defined by Division, Form Type, and Care Unit.
  6. Define Billing Provider Secondary IDs by Division and Form Type If an insurance company requires different Billing Provider Secondary IDs for each division, then users must define more than just the default IDs.
  7. Define Billing Provider Secondary IDs by Division, Form Type and Care Unit If an insurance company requires different Billing Provider Secondary IDs for services provided by particular Care Units, users can define them by Division, Form Type, and Care Unit.
  8. Define Additional Billing Provider Secondary IDs by Division and Form Type In addition to the Billing Provider Secondary ID that appears on Billing Screen 3 for each insurance company on the bill, there can be five additional Billing Provider Secondary IDs that will be transmitted with claims for an insurance company. Prior to Patch IB*2.0*320, the IDs defined in IB Site Parameters, Section 14 and Provider ID Maintenance, Number 3, were transmitted with all claims to all payers. These options for defining IDs were removed with Patch IB*2.0*320. If an insurance company requires additional Billing Provider Secondary IDs, users can define them in Insurance Company Entry/Edit.

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