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MedAvant will implement the dual submission strategy being adopted by CMS. The dual submission strategy requires that both NPI and all legacy provider identifiers are submitted in the ANSI claim. Effective August 1, 2006; all ANSI 4010 A1 submitters can begin submitting claims containing both NPI and legacy identifiers. All claims containing NPI will be subject to a "check digit" edit and must contain the appropriate qualifiers. Claims not meeting these requirements will be rejected.
CMS has established October 2, 2006 through May 22, 2007
as the transition period. Claims submitted within this date range can include both NPI and legacy identifiers. Since the payers are implementing NPI on different timelines, MedAvant will submit your NPI data only to the payers ready to accept NPI. Your NPI information will not be forwarded to payers that cannot accept NPI. That is why it is critical during this transition period for all the claims to contain both the NPI and legacy identifiers.
ANSI submitters must follow the WPC Implementation guide for ANSI 4010X096A1 (Institutional) and ANSI 4010X098A1 (Professional) claims.
The following is an example of sending professional claims with dual identifiers:
When submitting claims containing NPI, the NPI must appear in the NM109 and the corresponding "XX" qualifier in the NM108 element of the applicable loops. Claims must also contain the provider legacy ID number and provider tax ID/SSN as ref segments in the applicable loops. Due to the CMS guidelines on submitting NPI during the transition period, MedAvant cannot accept claims that contain only NPI. Below are 2 examples of valid 837P transactions containing both NPI and legacy identifiers. One example with a 2420A loop and one is without a 2420 loop.
With a 2420A loop
ISA*00* *00* *ZZ*123456789 *ZZ*650202999 *060606*1220*U*00401*237204140*1*T*:
GS*HC*T0080169*610017*20060606*1220*237204141*X*004010X098A1
ST*837*000000001
BHT*0019*00*1124986837773*20060606 *1220*CH
REF*87*004010X098A1
NM1*41*2*GENERAL PRACTICE*****46*123456789
PER*IC*GENERAL PRACITCE OFFICE*TE*9999999999
NM1*40*2*MEDAVANT*****46*650202999
HL*1**20*1
NM1*85*2*GENERAL PRACTICE*****XX*1234567890
N3*3333 PRACTICE PARKWAY SUITE 333
N4*GENERAL*GA*666666
REF*EI*123456789
REF*1B*11111111
PER*IC*JANE DOE*TE*9999999999
NM1*87*1*PRACTICE*GENERAL****XX*1234567890
N3*P.O. BOX 111
N4*GENERAL*GA*666666
REF*EI*123456789
REF*1B*11111111
PER*IC*JANE DOE*TE*9999999999
HL*2*1*22*0
SBR*P*18*******BL
NM1*IL*1*JOHN*WAYNE****MI*2222222222222
N3*1111 YELLOW BRICK RD
N4*YELLOWBRICK*RI*22222
DMG*D8*197780606*M
NM1*PR*2*BLUE SHIELD*****PI*BS021
CLM*295013*80***23::1*Y*A*Y*Y*B
DTP*431*D8*20060606
REF*D9*555555555555555
HI*BK:3739
NM1*DN*1*REFERRAL*DOE****XX*6666666666
REF*EI*123456789
REF*1B*33333333
NM1*82*1*JAMES*DOE****XX*5555555555
REF*EI*123456789
REF*1B*000008888
NM1*FA*2*YELLOWBRICK COMMUNITY HOSPITAL*****XX*0123456789
REF*TJ*123456789
REF*1B*0000007777
N3*1000 BRICK AVENUE
N4*YELLOWBRICK*RI*22222
LX*1
SV1*HC:99990*70*UN*1*23**1**Y
DTP*472*D8*20060606
REF*6R*0015005901
NM1*82*1*JAMES*DOE****XX*5555555555
REF*EI*123456789
REF*1B*000008888
LX*2
SV1*HC:99999*10*UN*1*23**1**Y
DTP*472*D8*20060606
REF*6R*0015006002
NM1*82*1*JAMES*DOE****XX*5555555555
REF*EI*123456789
REF*1B*000008888
SE*39*000000001
GE*1*237204141
IEA*1*237204140
Without a 2420A loop
ISA*00* *00* *ZZ*123456789 *ZZ*650202999 *060606*1220*U*00401*237204140*1*T*:
GS*HC*T0080169*610017*20060606*1220*237204141*X*004010X098A1
ST*837*000000001
BHT*0019*00*1124986837773*20060606 *1220*CH
REF*87*004010X098A1
NM1*41*2*GENERAL PRACTICE*****46*123456789
PER*IC*GENERAL PRACITCE OFFICE*TE*9999999999
NM1*40*2*MEDAVANT*****46*650202999
HL*1**20*1
NM1*85*2*GENERAL PRACTICE*****XX*1234567890
N3*3333 PRACTICE PARKWAY SUITE 333
N4*GENERAL*GA*666666
REF*EI*123456789
REF*1B*11111111
PER*IC*JANE DOE*TE*9999999999
NM1*87*1*PRACTICE*GENERAL****XX*1234567890
N3*P.O. BOX 111
N4*GENERAL*GA*666666
REF*EI*123456789
REF*1B*11111111
PER*IC*JANE DOE*TE*9999999999
HL*2*1*22*0
SBR*P*18*******BL
NM1*IL*1*JOHN*WAYNE****MI*2222222222222
N3*1111 YELLOW BRICK RD
N4*YELLOWBRICK*RI*22222
DMG*D8*197780606*M
NM1*PR*2*BLUE SHIELD*****PI*BS021
CLM*295013*80***23::1*Y*A*Y*Y*B
DTP*431*D8*20060606
REF*D9*555555555555555
HI*BK:3739
NM1*DN*1*REFERRAL*DOE****XX*6666666666
REF*EI*123456789
REF*1B*33333333
NM1*82*1*JAMES*DOE****XX*5555555555
REF*EI*123456789
REF*1B*000008888
NM1*FA*2*YELLOWBRICK COMMUNITY HOSPITAL*****XX*0123456789
REF*TJ*123456789
REF*1B*0000007777
N3*1000 BRICK AVENUE
N4*YELLOWBRICK*RI*22222
LX*1
SV1*HC:99990*70*UN*1*23**1**Y
DTP*472*D8*20060606
REF*6R*0015005901
LX*2
SV1*HC:99999*10*UN*1*23**1**Y
DTP*472*D8*20060606
REF*6R*0015006002
SE*39*000000001
GE*1*237204141
IEA*1*237204140
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