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Magellan Behavioral Health 837 Professional Companion GuideREFRendering Provider SecondaryIdentificationPos: 525 Max: 5Detail - OptionalLoop: 2420A 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 39
Magellan Behavioral Health 837 Professional Companion GuideChange SummaryChange history of this documentRevision Date Version # Change Description Author7/31/03 1 Added Change Summary Section Al Howlett9/15/03 2 Added 2000B and 2000C Loop 2400 SV1-01-3 Business Al HowlettRules10/3/03 3 Language modification to 2400 SV1-01-3 business rule. Al Howlett12/16/03 4 Removed or modified REF segments and their respective Al Howlettloops03/17/04 5 Modified several REF, NM1, SV1 and N3 segments: Al Howlett• Remove MIS# requirement for all providers• Add note defining specific accounts and provider IDrequirements for adjudication• Changed PO Box submittal requirement: If it is notsent in Payer address, it must be sent in PayerSecondary ID REF segment• Allow only one rendering provider per claim4/21/04 6 Revised wording for Magellan Note: MIS# and otherprovider ID requirement2/14/08 7 Revised National Provider Identifier (NPI) and itsassociated qualifier requirements (NM108, NM109) and therequirement for the dual usage of an NPI primary identifierwith a TIN (REF02 using an ‘EI’ qualifier) and/or a SSN(REF02 using an ‘SY’ qualifier in their respectivesecondary identifier REF segments for the followingprovider loops:• 2010AA Billing Provider• 2010AB Pay-To Provider• 2310B Rendering Provider• 2420A Rendering ProviderHHHusmannNicole Stephens_________________________________________________________________________________________________________________________Revised: February 14, 2008 HIPAA X12 837p (004010X098A1) Version 7 40
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