November 2009 Newsletter
Qualifying the Qualifiers
When the UB-04 was designed and implemented, a new concept was introduced in relation to the Physician fields. On the UB-92, you entered a Physician Name and associated Physician ID. The ID could have been a NPI, UPIN, Tax ID, Payer assigned ID, etc. When the UB-04 was introduced, the Physician fields changed, and Blocks 76 (Attending) and 77 (Operating) were broken up into several fields. Now that it is mandated for nearly all payers, the NPI is the most-used identifier. However, there are still some payers out there that expect to see a legacy Provider Number either in addition to the NPI or as the only ID reported.
When reporting a legacy Provider ID, it is imperative to use the correct associated qualifier. For a legacy Provider ID, enter one of the following qualifiers in both blocks 76B and 77B:
0B - State License Number (Note: The first character is zero, not the letter O.)
1G – Provider UPIN Number
G2 – Provider Commercial Number
Blocks 78 (Other Physician 1) and 79 (Other Physician 2) have been divided even further. Both blocks have two qualifiers. The first one is used to define the NPI when it is entered in each block. The appropriate NPI qualifiers are:
DN – Referring Physician
ZZ – Other Operating Physician
82 – Rendering Provider
The second qualifier pertains to the legacy Provider ID (if entered). This is exactly like Blocks 76 and 77, using the same qualifiers listed above.
When a Physician ID is entered in Blocks 76 through 79, whether it is the NPI or a legacy provider number, the Physician First and Last Name must also be present. This information is required to complete the appropriate ANSI 837 segments. To add to the confusion, the Physician fields (Block 79) that were added to the UB-04 are currently not reportable in the ANSI 837 4010A1 format. Once the ANSI 5010 format has been implemented, there will be a loop/segment designated for sending this information.
The current ANSI 837 4010A1 loops/segments used to report Physician information are:
- NM1*71 (Attending – Loop 2310A)
- NM1*72 (Operating – Loop 2310B)
- NM1*73 (Other Physician – Loop 2310C)
In the upcoming ANSI 837 5010 format, they will be:
- NM1*71 (Attending – Loop 2310A)
- NM1*72 (Operating – Loop 2310B)
- NM1*ZZ (Other Operating – Loop 2310C)
- NM1*82 (Rendering – Loop 2310D).
Hopefully, this article qualifies as good information to help clear up the qualifying qualifiers!