Blue Cross

 

March 2008

Subject: New NPI informational edits and new EDI front-end edits

Dear submitter:

Effective March 28, 2008, BCBSM EDI will start returning informational edits to providers who send dual submissions (NPI and PIN). The informational edits will be returned in a U277 report which will be separate from current rejected U277 data. The reports are called, U227Q – Professional Warning, U277R – Institutional Warning and U277S – Dental Warning.

Informational edits will be 'warning' messages that alert you to a problem with the NPI/PIN numbers reported; however you should know that the claim has been accepted and will be processed. Informational edits are generated when the provider codes (NPI and PIN) on the claim do not agree with our corporate NPI crosswalk table or the EDI authorization table. Informational edits should be reviewed and appropriate actions taken to resolve these discrepancies to ensure the appropriate NPI has been registered and is used for billing.

At a future date the informational edits will become front-end edits which will require you to correct and resubmit the claim.

Edits will apply to 'BL' (Blue Cross Blue Shield), 'HM' (Blue Care Network) 'OF' and 'FI' (FEP) Source of Payments on professional, institutional and dental claims shown below:

NEW INFORMATIONAL EDITS:

Professional informational edits

Edit
Code

Report Error Description

U277 Transaction
Codes

Transaction
Description

Source of
Pay

P525

Billing NPI Unauthorized for Electronic
Billing – Not registered with EDI

A3 - 153 - 85

Entity's ID Number

BL, OF, HM

P526

Billing Provider NPI Missing from the 837

A3 - 153 - 85

Entity's ID Number

BL, OF, HM

P527

Billing NPI not found on crosswalk – Not
registered with Provider Enrollment

A3 - 153 - 85

Entity's ID Number

BL, OF, HM

P528

Billing PIN/NPI does not match crosswalk

A3 - 153 - 85

Entity's ID Number

BL, OF

P529

Billing PIN/NPI crosswalk invalid/missing
taxonomy

A3 - 153 - 85

Entity's ID Number

BL, OF

P530

Billing PIN/NPI crosswalk error – PINs under
this tax ID lack an NPI.

A3 - 153 - 85

Entity's ID Number

BL, OF

P534

Billing NPI & Rendering does not match
Crosswalk

A3 - 153 - 85

Entity's ID Number

HM only

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Institutional informational edits

Edit
Code

Report Error Description

U277 Transaction
Codes

Transaction
Description

Source of
Pay

F526

Billing Provider NPI Missing

A3 - 153 - 85

Entity's ID Number

BL, OF, HM

F527

Billing NPI not found on corporate crosswalk

A3 - 153 - 85

Entity's ID Number

BL, OF, HM

F528

Billing PIN/NPI does not match corporate
crosswalk

A3 - 153 - 85

Entity's ID Number

BL, OF

F529

Billing PIN/NPI crosswalk invalid/missing
taxonomy

A3 - 153 - 85

Entity's ID Number

BL, OF

Dental informational edits

Edit
Code

Report Error Description

U277 Transaction
Codes

Transaction
Description

Source of
Pay

D526

Billing Provider NPI Missing

A3 - 153 - 85

Entity's ID Number

BL, FI

D527

Billing NPI not found on corporate crosswalk

A3 - 153 - 85

Entity's ID Number

BL, FI

D528

Billing PIN/NPI does not match corporate
crosswalk

A3 - 153 - 85

Entity's ID Number

BL, FI

D530

Billing PIN/NPI crosswalk error not fully
registered

A3 - 153 - 85

Entity's ID Number

BL, FI

BCBSM EDI will begin returning new front-end edits for NPI submitted data. The new edits will be returned using the current U277 front-end edit process and claims must be corrected and resubmitted.

NEW EDI FRONT-END EDITS:

Professional NPI only front-end edits

Edit
Code

Report Error Description

U277 Transaction
Codes

Transaction
Description

Source of Pay

P531

Billing NPI not present on corporate crosswalk

A3 - 562 - 85

Entity's National
Prov ID

BL, OF

P532

Billing NPI crosswalk error invalid/missing
taxonomy

A3 - 562 - 85

Entity's National
Prov ID

BL, OF

P533

Billing PIN/NPI crosswalk error – PINs under
this tax ID lack and (spelling) NPI

 A3 - 562 - 85

Entity's National
Prov ID

BL, OF

Institutional NPI only front-end edits

Edit
Code

Report Error Description

U277 Transaction
Codes

Transaction
Description

Source of
Pay

F531

Billing NPI not present on corporate crosswalk

A3 - 562 - 85

Entity's National
Prov ID

BL, OF

F533

Billing NPI crosswalk error not fully registered

A3 - 562 - 85

Entity's National
Prov ID

BL, OF

As a reminder, if you have not registered your NPI for electronic billing, please do so. Instructions on how to update your provider authorization are on our web site at http://editest.bcbsm.com/tpalogon.html.

If you have questions regarding this information, please call the EDI help desk at 800-542-0945, prompt 5.

Sincerely,

Wanda Brideau
Manager, Electronic Trading Partner Service and Support
(EDI Business Team)  


John Bialowicz
Manager, ETP Contracting and Relations
e-Business Interchange Group

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