National Provider Identifier Requirements (EmblemHealth Electronic Claims Submission)
National Provider Identifier (NPI) should be checked by vendor practice management system to ensure vendor software is capturing and correctly populating a National Provider Identifier (NPI) in electronic claims, otherwise claims will be rejected by EmblemHealth. Please note the following NPI requirements for electronic health care claim submissions:
Professional Provider Claim (837P) NPI Requirements
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Billing Provider 2010AA: An NPI is required for health care providers in the United States or its territories.
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Pay-To Address 2010AB: There is no NPI in the Pay-To Address loop. The purpose of Loop ID-2010AB has changed from previous versions. Loop ID-2010AB only contains address information when different from the Billing Provider Address.
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Rendering Provider 2310B: Only required when the Rendering Provider information is different from the information carried in Billing Provider Loop 2010AA. If this loop is sent, an NPI is required.
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Rendering Provider 2420A: Only required when the Rendering Provider information is different from the information carried in the 2310B or 2010AA loops. If this loop is sent, an NPI is required.
Institutional Claim (837I) NPI Requirements
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Billing Provider 2010AA: An NPI is required for health care providers in the United States or its territories.
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Pay-To Address 2010AB: There is no NPI in the Pay-To Address loop. The purpose of Loop ID-2010AB has changed from previous versions. Loop ID-2010AB only contains address information when different from the Billing Provider Address.
Dental Provider Claim (837D) NPI Requirements
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Billing Provider 2010AA: An NPI is required for health care providers in the United States or its territories.
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Pay-To Address 2010AB: There is no NPI in the Pay-To Address loop. The purpose of Loop ID-2010AB has changed from previous versions. Loop ID-2010AB only contains address information when different from the Billing Provider Address.
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Rendering Provider 2310B: Only required when the Rendering Provider information is different from the information carried in Billing Provider Loop 2010AA. If this loop is sent, an NPI is required.