Correction to Paper Claims Instructions Bulletin Article

This is a correction to a bulletin article that was published in the May/June 2008 Texas Medicaid Bulletin No. 215 entitled “National Provider Identifier Implemented May 23, 2008”. Under the “Paper Claims” subheading, the instructions for fields 76, 78 and 79 of the UB-04 CMS-1450 Claim Form contained incorrect information. Paper claims require a Texas Provider Identifier (TPI) in addition to the National Provider Identifier (NPI) only for the billing and performing providers. All other provider fields on the claim forms (referring, facility, admitting, other A or B, and operating) require only the NPI. Click on the title for the complete article.

UB-04 CMS-1450 Claim Form

Block No.

Description

Guidelines

Attending provider

Enter the attending provider’s name and NPI.

For inpatient claims, enter the physician’s NPI of the provider who performed the service/procedure and/or is responsible for the treatment and plan of care.

Procedures are defined as those listed in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding manual, volume 3, which includes surgical, diagnostic, and medical procedures.

For outpatient claims, enter the NPI of the physician who referred the patient to the hospital.

78-79

Other (A or B) provider

Enter the other provider’s name and NPI.

For outpatient claims, enter the NPI for the following:

· The ordering physician for all laboratory and radiology services. (If a different physician ordered laboratory or radiology services, enter his or her NPI in Block 76, and enter the referring/attending physician’s NPI n this block.)

· The designated physician for a limited client when the physician performed or authorized nonemergency care.

· Referring provider—The provider who sent the patient to another provider for services. Required on an outpatient claim when the referring provider is different than the attending physician.

Note: If the referring physician is a resident, Blocks 76 and 78 must identify the physician who is supervising the resident.

· Other operating physician—An individual performing a secondary surgical procedure or assisting the operating physician. Required when another operating physician is involved.

· Rendering provider—The health-care professional who performed, delivered, or completed a particular medical service or nonsurgical procedure.