ANSI 837 - Florida Blue - BCBSF

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Florida Blue 837 P Companion Guide 2012V. PAYER – Definitions 9VI. 837P CONTROL SEGMENTS, ENVELOPES AND BUSINESS REQUIREMENTS 10Global Information 10Enveloping Information 12Business Requirements 14VII. BILLING REQUIREMENTS FOR ANCILLARY PROVIDERS 20Required Billing Information 20Appropriately Billing Provider Identifiers 20Specialty Pharmacy 21VIII. NPI Matrices 23NPI Attributes 23NPI TR3 Location Information 23IX.HELPFUL TIPS FOR AVOIDING PROVIDER IDENTIFIER ERRORS ONELECTRONIC CLAIMS24X. TIPS FOR SENDING COB INFORMATION ON ELECTRONIC CLAIMS 28XI. COMMUNICATION / CONNECTIVITY PROTOCOLS SUPPORTED 30XII. TRADING PARTNER AGREEMENT 3141 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
Florida Blue 837 P Companion Guide 2012837 Health Care Professional Claim Companion Guide (5010)I. IntroductionWhat is HIPAA 5010?The Health Insurance Portability and Accountability Act (HIPAA) requires the health care industry inthe United States to comply with the electronic data interchange (EDI) standards as established bythe Secretary of Health and Human Services. The ASC X12 005010X222A1 is the establishedstandard for Health Care Professional Claims (837P).What is NPI?The National Provider Identifier (NPI) is required wherever you identify a provider or providerorganization in any standard covered HIPAA-AS electronic transaction. The NPI must be valid and itmust be registered with Florida Blue.If you are a provider or provider organization who needs to obtain an NPI, please accessthe National Plan and Provider Enumeration System (NPPES)at https://nppes.cms.hhs.gov/NPPES/Welcome.do . To register your NPI with Florida Blue, pleaseaccess our NPI Notification Format http://www.bcbsfl.com/DocumentLibrary/Providers/Content/NPI_ProviderNotificationForm.pdf.What is a Taxonomy code, and is it required for Florida Blue?Taxonomy codes are administrative codes that identify the provider type and area of specializationfor health care providers. Each taxonomy code is a unique ten character alpha-numeric code thatenables providers to identify their specialty. Taxonomy codes are assigned at both the individualand organizational provider levels.Taxonomy codes have three distinct levels: Level I is provider type, Level II is classification, andLevel III is the area of specialization. A complete list of taxonomy codes can be found onthe National Uniform Claim Committee website at https://www.nucc.org.Taxonomy codes are required by Florida Blue under specific circumstances. Taxonomy is one ofseveral data elements used by Florida Blue to help determine the appropriate provider record forprocessing. In cases where the NPI is shared by multiple provider entities, specialties or locations,the taxonomy becomes a critical data element.51 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
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ANSI 837 - Florida Blue - BCBSF

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