ANSI 837 - Florida Blue - BCBSF

Florida Blue 837 P Companion Guide 2012Req #Loop ID – Segment Description& Element NameTR3 DataElementTR3 Page(s)Plan Requirementthis field.B14 2300 - Claim Information /2400 - Service Line NumberMonetary AmountCLM02SV102159354The total claim charge amount must equal the sumof all submitted line items. Failure to do so willresult in claims being returned as a providercorrectable error and must be corrected andelectronically resubmitted.Line Item Charge AmountNote: If the whole dollar amounts are sent inmonetary elements, do not include the decimal ortrailing zero (E.g. $30 = 30).When indicating the dollars & cents, the decimalmust be indicated (E.g. $30.12 = 30.12).B15B16B172300 – Claim InformationClaim Frequency Type Code2300 - Claim InformationHealth Care Diagnosis Code2310B – Rendering Provider NPIRendering Provider Identifier16CLM05-3 159 Florida Blue will accept only the following codes:0 =Non-Payment/Zero1 =Admit Through Discharge Claim7 = Replacement Of Prior Claim8 = Void/Cancel Of Prior ClaimNote: When submitting the corrected claim, theoriginal Reference Number (ICN/DCN) also knownas the Original Claim Number is required to besent in loop 2300 REF. (REF01= F8 qualifier forOriginal Reference Number, REF02 = Original ClaimNumber) .HI 226 Florida Blue requires that you do not transmit thedecimal points in the diagnosis codes. The decimalpoint is assumed.NM109 264 When Rendering Provider is submitted, therendering provider’s NPI is required on all claims.Invalid or missing NPI will result in claims beingreturned as a provider correctable error and mustbe corrected and resubmitted.Exception: When a facility/group provider type bycontract does not require an individual rendering1 Availity, LLC Is a multi-payer joint venture company. For more information or to register, visit Availity’s website atwww.availity.com.900-3398-1112005010X222A1Florida Blue December 2012