Date: July 18, 2019
To: Enrolled Hospitals: Chief Executive Officers; Chief Financial Officers; and Patient Accounts Managers
Re: Correction - Hospital Outpatient Claims Referring Provider Requirements for
October 1, 2019
The earlier notice instructed hospitals to use Provider Type Qualifier Code DN followed by the Referring Provider NPI on all outpatient claims except when a claim contains Emergency Room Revenue Code 0450, 0451, or 0456. Per the UB-04 Data Specifications Manual and the 837I Implementation Guide, Provider Type Qualifier Code DN followed by the Referring Provider NPI is required on outpatient claims only when the Referring Provider NPI is different from the Attending Provider NPI. The Department will follow that billing policy outlined in the UB-04 Data Specifications Manual and the 837I Implementation Guide.
If a Referring Provider NPI is present, the Department already edits claims to ensure the Referring Provider NPI is valid. As stated in the June 25, 2019 Informational Notice, effective with dates of service on and after October 1, 2019, the Department will reject claims if the Referring Provider is not enrolled with the Department. Any provider not enrolled must go to the IMPACT webpage to start the enrollment process.
Questions regarding this notice may be directed to the Bureau of Hospital and Provider Services at 877-782-5565.