How to Avoid Provider Identification Errors on Claims

Florida Blue recently made several changes to our claims processing system to comply with HIPAA 5010 requirements. In February 2012, process enhancements were made to ensure that a provider’s National Provider Identifier (NPI) and Tax ID number are matched appropriately.

We have seen an increase in the volume of provider correctable error codes that cause claim processing delays. Below are reminders to help you reduce the number of WEBV040 and WEBV042 claims processing errors displayed when claim data (or information) does not match information registered with Florida Blue

Billing Provider Section

This section is used to provide information regarding the billing provider for services rendered. It should match the name written on the check or electronic funds transfer from Florida Blue.

• OPTION 1: If you are registered as a group provider (PA, LLC, etc.) with Florida Blue and you want to bill as a group provider, enter the appropriate group name, Tax ID number and the group NPI (type 2).
− THE MATCH: Group Name matches Group NPI matches Group Tax ID

• OPTION 2: If you are registered as an individual provider with Florida Blue and you are billing as an individual provider, please enter your name, Social Security Number and your individual NPI (type 1).
− THE MATCH: Individual Name matches Individual NPI matches Individual Social Security Number

Rendering Provider Section
This section is used to provide information regarding who performed the services. It is the provider who actually sees the patient.

• OPTION 1: If you billed as an organization (PA, LLC, etc.) list the name of the rendering individual provider and the rendering individual NPI.

• OPTION 2: If you billed as an individual, do not list a rendering provider. This would be redundant as the billing individual would be the same as the rendering individual. Submitting redundant information can cause a different provider correctable error.

Attached is an example to assist you in understanding the appropriate entry of billing and rendering provider information to reduce the number of returned claims. Additional HIPAA 5010 reference information can be found on our website at www.floridablue.com under the Provider tab and by selecting “Get Ready for 5010.”

Please share this information with your technical support team, billing service or clearinghouse.

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