VERSION 004010X098A1 - Magellan Provider's Home Page

More documents

Recommendations

Info

Magellan Behavioral Health 837 Professional Companion GuideREFRendering Provider SecondaryIdentificationPos: 271 Max: 5Detail - OptionalLoop: 2310B Elements: 0Magellan Specific Note:Provider Primary Id:Magellan will accept a National Provider Identifier (NPI) and its associated qualifier (NM109 using an ‘XX’ qualifier), butMagellan is requiring a dual usage of an NPI as the primary identifier with a federal tax ID (TIN) (REF02 using an ‘EI’qualifier) and/or a social security number (SSN) (REF02 using an ‘SY’ qualifier) in their respective secondary identifierREF segments for the following provider loops:• 2010AA Billing Provider• 2010AB Pay-To Provider• 2310B Rendering Provider• 2420A Rendering ProviderIf an NPI is used for the above provider types without a TIN (REF02 using an ‘EI’ qualifier) and/or SSN (REF02 using an‘SY’ qualifier) for a secondary identifier, claim will be rejected in a 997 or 277U.To comply with HIPAA regulations, Magellan will require NPI usage for provider primary identifiers after May 22, 2008.MIS# will no longer be accepted after this date.Secondary Ids2010AA REF-02; 2010AB REF-02; 2310B REF-02; 2420A REF-02 should be sent as outlined in the rules noted below:• In REF-01 use qualifier "G2" Commercial Identifier to report the MIS# and "SY" SSN to report the Social SecurityNumber.• The Magellan Provider Identifier (MIS#) is required for TennCare. (This is for PO Boxes 12700, 12400)• Roster providers for TennCare also require a Social Security Number along with the MIS#. (This is for PO Boxes12700, 12400)• All other accounts: The Magellan Provider Identifier (MIS#) is requested for all providers. Use qualifier "G2"Commercial Number to report the MIS#.• In the future, the MIS# will be required for all non-Medicaid claims.Magellan Specific Note:If more than one Rendering Provider (based on Primary ID match) is submitted on a claim, the claim will not load to thehost adjudication system and a negative response will be returned.Rendering Provider is required on TennCare Caserate claims.MIS# will no longer be accepted after May 22, 2008._________________________________________________________________________________________________________________________Revised: February 14, 2008 HIPAA X12 837p (004010X098A1) Version 7 27
Magellan Behavioral Health 837 Professional Companion GuideREFRendering Provider SecondaryIdentificationPos: 271 Max: 5Detail - OptionalLoop: 2310B Elements: 0Element Summary:Ref Id Element Name Req Type Min/Max UsageREF01 128 Reference Identification QualifierM ID 2/3 RequiredDescription: Code qualifying the ReferenceIdentification0B - State License Number1A - Blue Cross Provider Number1B - Blue Shield Provider Number1C - Medicare Provider Number1D - Medicaid Provider Number1G - Provider UPIN Number1H - CHAMPUS Identification Number1J - Facility ID NumberB3 - Preferred Provider Organization NumberBQ - Health Maintenance Organization CodeNumberEI - Employer’s Identification NumberFH - Clinic NumberG2 - Provider Commercial NumberG5 - Provider Site NumberLU - Location NumberSY - Social Security Number – may not be used formedicareU3 - Unique Supplier Identification Number (USIN)X5 - State Industrial Accident Provider NumberREF02 127 Reference IdentificationM AN 1/30 RequiredDescription: Reference information as defined for aparticular Transaction Set or as specified by theReference Identification Qualifier_________________________________________________________________________________________________________________________Revised: February 14, 2008 HIPAA X12 837p (004010X098A1) Version 7 28
Page 3 and 4: Magellan Behavioral Health 837 Prof
Page 27: Magellan Behavioral Health 837 Prof
Page 41: Magellan Behavioral Health 837 Prof

VERSION 004010X098A1 - Magellan Provider's Home Page

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?