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Effective August 31, 2020, Billing Provider Information Must Not Match Attending or Rendering Provider Information

Last updated on 8/27/2020

Effective August 31, 2020, the following changes will be made to Long-Term Care (LTC) Institutional Claims:

Institutional claim-Provider Tab

The following field will be added to the Attending Provider section:

  • Taxonomy

A new section will be added for Rendering Provider, with thefollowing new fields added:

  • National Provider Identifier (NPI)/Atypical Provider Identifier (API)
  • First Name
  • Last Name
  • Middle Initial
  • Suffix

Institutional claim-Details Tab

The following changes will be made:

  • Attending Provider section will be modified to display Rendering Provider label instead (Attending Provider information will not be entered in the Detail tab).
  • Existing NPI/API, First Name, Last Name, Middle Initial, and Suffix fields will be repurposed to allow the user to enter Rendering Provider NPI/API, First Name, Last Name, Middle Initial, and Suffix.
  • Attending Provider information saved in the Details tab of a draft, individual template, or group template prior to August 31, 2020, will not automatically convert to Rendering Provider information. The information must be updated manually.

Claims submitted with one or more of the following combinations will be rejected:

  • Same information for Billing Provider NPI/API and Attending Provider NPI/API on the Institutional claim.
  • Same information for Billing Provider NPI/API and Rendering Provider NPI/API (Provider tab or Details tab) on the Institutional claim.
  • Same information for Attending Provider NPI/API and Rendering Provider NPI/API (Provider tab or Details tab) on the Institutional claim.

Note: Rendering Provider is only required to be submitted if it is different from the Attending Provider.

  • Same information for Rendering Provider NPI/API (Provider tab) and Rendering Provider NPI/API (Details tab) on the Institutional claim.
  • Attending Provider NPI/API, Last Name, and First Name fields are required fields. If one of these fields is submitted without data, the claim will be rejected.
  • Rendering Provider fields are optional in both the Provider and Details tabs, but once data is entered in one of the fields (NPI/API, Last Name, or First Name) the other two fields become required, and data must be submitted in all of these fields to avoid a rejected claim.

Error Messages:

Users that employ the same NPI/API for the Attending or Rendering Provider as the Billing Provider will see the following error messages:

  • Attending provider NPI/API cannot be the same as the Billing provider NPI/API.
  • Rendering provider NPI/API cannot be the same as the Billing provider NPI/API.

Users that employ the same NPI/API for the Attending Provider as the Rendering Provider will see the following error messages:

  • Header Rendering Provider was found but not expected because it is the same as the Attending Provider. 
  • Detail Rendering Provider was found but not expected because it is the same as the Attending Provider.

Users that employ the same NPI/API for the Details tab Rendering Provider NPI/API as the Provider tab Rendering Provider NPI/API will see the following error message:

  • The Rendering Provider must be different from claim level Rendering Provider.

Users will need to correct the information in the Billing Provider, Attending Provider, or Rendering Provider fields before continuing. These changes will also apply for LTC Institutional claims (837I) received from third-party/EDI submitters. 

The updated EDI Companion Guide will be provided later to assist those who are submitting these types of claims.

For more information, call the TMHP LTC Help Desk at 800-626-4117, Option 1.