Last Modified: 10/15/2018 Location: FL, PR, USVI Business: Part B
Indication of rendering physician billing number FAQ
A: If the practitioner rendering the service is part of a billing group, report the individual practitioner’s National Provider Identifier (NPI) in the Rendering Physician # area (2310B loop, segments NM108 [XX] and NM109 [NPI], of the 837P electronic claim or Item 24J of the CMS-1500 paper claim form).
• NPI is required for all rendering providers. If the NPI is missing, invalid, or submitted in the wrong area (e.g., valid NPI submitted in the upper, shaded portion of Item 24J), your claims will be returned as unprocessable.
• Note: If submitting claims on the CMS-1500 paper claim form, report the NPI of the individual practitioner in the lower, non-shaded portion of Item 24J. Place no information in the upper, shaded portion of Item 24J or your claim will be returned to you as unprocessable.
If the rendering provider is an independent lab, ambulatory surgical center (ASC), independent diagnostic testing facility (IDTF), ambulance supplier, or a solo practitioner not associated with a billing group, a rendering provider identifier is not required in the Rendering Physician # area. Report the NPI of these types of providers in the 837P 2010AA Billing Provider loop, segments NM 108 (XX) and NM109 (NPI) of the electronic claim or Item 33a of the paper claim form.
• See the Indication of billing entity provider number FAQ on the First Coast provider website for additional guidance on completing the billing provider on your claim.
Source: CMS internet-only manual (IOM) publication 100-04 Medicare Claims Processing Manual, chapter 26 section 10.4
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