Provider ID Set-up

Provider ID Set-up (VA Guidelines)

During Provider ID Set-up payers require the use of a variety of provider identifiers on claims submitted for adjudication. Printed claim forms have boxes where these IDs can be printed. The general term, Provider ID, can refer to an ID that belongs to a human being such as an Attending physician or it can refer to an ID that belongs to an organization that provides healthcare services to a veteran such as a VAMC or an outside laboratory.

Both VA and non-VA people and organizations have IDs. IDs have qualifiers that identify what type of ID is being transmitted. For example, a Blue Cross ID is transmitted with a qualifier (1A) which indicates that this number is a Blue Cross number.

The NPI (National Provider Identifier) is a HIPAA requirement with a usage requirement date beginning May 23, 2007. It is transmitted on 837 records along with treating specialty taxonomies from the National Uniform Claims Committee (NUCC) published code list. Patch IB*2.0*343 added the ability to define the NPI and Taxonomy Codes for the VAMC, Non-VA facilities and both VA and Non-VA human providers.

Patches IB*2.0*348 and 349 added the ability to print the NPI on the new UB-04 and CMS-1500 claim forms. After Patch IB*2*436, old claims can be reprinted locally for legal purposes and sent to Regional Counsel even though the original claim was created prior to the requirement for providers to have an assigned NPI.

A legal claim is defined as having a Billing Rate Type of “NO FAULT INS”, “WORKERS’ COMP”, or “TORT FEASOR”. When Patch IB*2.0*432 is loaded, the Social Security Number (SSN) will no longer be transmitted in the 837 records as a human providers Primary ID. The NPI will be transmitted in the 837 Health Care Claim transmission as the Primary ID for both human providers and organizational providers such as the Billing Provider.

The HIPAA 837 transaction set includes a number of segments in which to transmit multiple IDs and qualifiers for a single claim. The list below indicates the VistA record name, the type of information being transmitted, the maximum number of IDs that can go in that record for one claim and if the IDs will print on a paper claim (P), transmit electronically (T), or do both (B).

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