New KY MMIS 837P Companion Guide - Kymmis.com

Commonwealth of Kentucky – MMISNew KY MMIS 837P Companion GuideRendering Provider Name for Atypical Providers using KY Provider numbersRendering/Individual Information: (This is the Individual Provider Number)This loop is only valid for Atypical providers.This loop is required when the Rendering Provider’s ID number is different than the Billing Provider’s ID.292 2310B NM1 NM108 - Identification CodeQualifier‘24’ – Employer’sIdentification number or‘34’ – Social Securitynumber for Atypicalprovider292 2310B NM1 NM109 - Identification Code ‘10 digit’ EmployeeIdentification number orSocial Security number ofthe provider.296 2310B REF REF01 - Reference IdentificationQualifier‘1D’ – Medicaid ProviderNumber297 2310B REF REF02 - Reference Identification ‘10 digit’ KentuckyIndividual Provider NumberOther Subscriber Information327-330 2320 CAS CAS02 – Adjustment ReasonCodeAlsoCAS05, CAS08, CAS 11,CAS14, CAS17All external code sourcevalues from code source139 are allowed.For Encountersrecommend values are 1,2, 3, 24, and 107When 24 or 107 are usedMonetary Amounts equal0.320 2320 SBR SBR03 – ReferenceIdentificationGroup or Policy NumberMB = Medicare part B320 2320 SBR SBR05 – Insurance Type Code Insurance type codeMB = Medicare part B332 2320 AMT AMT01 - Amount Qualifier Code ‘D’ – Payer Amount Paid332 2320 AMT AMT02 - Payer Paid Amount Other Payer Amount Paid(TPL, MCO and Medicare)Used for Fee-for-Serviceand Encounters334 2320 AMT AMT01 - Amount Qualifier Code ‘B6’ – Payer AllowedAmount334 2320 AMT AMT02 - Payer Paid Amount Other Payer AllowedAmount Paid (TPL, MCOand Medicare)Used for Fee-for-Serviceand Encounters3-1