2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Claims and PaymentThe data format is• A1C nnn ccyymmdd – nnn is the testresult and ccyymmdd is the date of thetest• Example: A1C 055 20041028Requirement for 837 Institutional, ExcludingAvaility ®This information pertains to claims submitted byproviders to the clearinghouse in the 837institutional format, excluding Availity ® .• A1C nnn ccyymmdd – nnn is the testresult and ccyymmdd is the date of thetest• Examples:• A1C 055• 20041028 A1C 042• 20041029For Paper ClaimsFor CMS 1500 (02-12) ClaimsPlace the A1C data in the PWK07 segment of the2300 loop with the code qualifier of OZ and PWK02of AAOne test result per PWK segment, which can occurup to 10 timesThe data format is• A1C nnn ccyymmdd – nnn is the testresult and ccyymmdd is the date of thetestFor UB-04 Paper Claims• Example: A1C 055 20041028Requirement for 837 Institutional for Availity ®This information pertains to claims submitted byproviders to Availity ® in the 837 institutionalformats.Place the A1C data in the PWK07 segment of the2300 loop with the code qualifier of OZ and PWK02of AAUp to four test results per PWK segment, which canoccur onceThe data format isUnderstanding the National Drug CodeThe National Drug Code (NDC) is found on thelabel of a prescription drug item and certainsupplies. It must be included on paper andelectronic claim transactions. The NDC is auniversal number that identifies a drug or relateditem. A complete NDC number consists of 11 digitswith hyphens separating the number into threesegments in a 5-4-2 format such as “12345-1234-12.”However, sometimes the NDC as printed on a drugitem omits a leading zero in one of the segments,18-62014 Practitioner and Provider Manual - Ver. 3