New KY MMIS 837P Companion Guide - Kymmis.com

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Commonwealth of Kentucky – MMISNew KY MMIS 837P Companion Guide89 2010AA N4 N403 - Zip CodeN404 – Country Codethe provider.Billing Provider Zip Code +4 digit postal code.(Excluding punctuation andblanks.)‘1D’ – Medicaid ProviderNumber92 2010AA REF REF01 - Reference IdentificationQualifier92 2010AA REF REF02 - Reference Identification ‘10 digit’ Kentucky Groupor Individual ProviderNumber.3-3
Commonwealth of Kentucky – MMISNew KY MMIS 837P Companion GuideSubscriber HierarchicalNote: For Commonwealth of Kentucky, the subscriber is always the same as the patient(2000B SBR02=18, SBR09=MC).Claims containing data in the 2000C Patient Hierarchical Level (i.e. Dependent) may notprocess correctly.109 2000B HL HL04 - Hierarchical Child Code ‘0’ – No Subordinate HLSegment in thisHierarchical Structure110 2000B SBR SBR01 - Payer ResponsibilitySequence Number Code112 2000B SBR SBR09 - Claim Filing IndicatorCodeRefer to ImplementationGuide for Valid Values‘MC’ - MedicaidSubscriber Name118 2010BA NM1 NM102 - Entity Type Qualifier ‘1’ – Person119 2010BA NM1 NM108 - Identification CodeQualifier‘MI’ – MemberIdentification Number119 2010BA NM1 NM109 - Identification Code ’10 digit’ - KentuckyMedicaid MemberIdentification Number(MAID)Payer Name131 2010BB NM1 NM103 - Name Last orOrganization Name131 2010BB NM1 NM108 - Identification CodeQualifier‘KYMEDICAID’‘PI’ – Payer Identification131 2010BB NM1 NM109 - Identification Code ‘KYMEDICAID’Claim Information171 2300 CLM CLM01 - Claim Submitter’sIdentifier173 2300 CLM CLM05-3 - Claim FrequencyType Code228 2300 REF REF01 - ReferenceIdentification Qualifier228 2300 REF REF02 - ReferenceIdentificationPatient Control NumberLength allowed: 1 to 38.The value received will bereturned on the 835transaction.Refer to ImplementationGuide for Valid Values‘G1’ – Prior AuthorizationNumberAssigned PriorAuthorization Number3-1
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New KY MMIS 837P Companion Guide - Kymmis.com

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