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July 2013

We’ll introduce new informational edits for electronic claims in August

In an ongoing effort to improve the quality and security of our electronic connections, Blue Cross Blue Shield of Michigan is modifying the controls used in the electronic data interchange enrollment process.

On Aug. 19, 2013, we’ll introduce new informational edits to ensure that a billing provider’s national provider identifier is associated with the submitter code on file for electronic 837 claim transactions. Initially, the new edits will be informational to alert trading partners of a mismatch when the NPI and submitter code combination used on the claim does not match the combination the provider used to enroll with the EDI clearinghouse.

The following informational edits will not cause a claim’s rejection, but they do require submitters to take action:

Professional – Returned on a 277CAX informational report

  • A2 24 85 P001i  BILLING NPI/SUB ID COMBO NOT AUTHORIZED FOR BCBSM/BCN
  • A2 24 85 P002i  BILLING NPI/SUB ID COMBO NOT AUTHORIZED FOR MEDB/MED ADV
  • A2 24 85 P003i BILLING NPI/SUB ID COMBO NOT AUTHORIZED FOR COMMERCIAL

Institutional – Returned on a 277CAZ informational report

  • A2 24 85 F001i BILLING NPI/SUB ID COMBO NOT AUTHORIZED

Note: These informational edits will only be returned on 277CAX and 277CAZ reports, not in 277CAP transactions.

If you receive any of these edits, we recommend you first double-check your claims to ensure you reported the correct billing provider NPI. If correct, you will need to update your Provider Authorization Form with the appropriate billing NPI and submitter code combination. Instructions on how to update the Provider Authorization Form are available at editest.bcbsm.com/tpalogon.html.

It’s critical that trading partners correct these inconsistencies by the end of 2013. In early 2014, the informational edits will convert to “hard edits” of P001, P002, P003 and F001, and claims will be rejected.

If you have questions about the new edits or the Provider Authorization Form process, call the EDI Helpdesk at
1-800-542-0945 or send an email to EDISupport@bcbsm.com and include “Trading Partner Agreement” or “TPA” in the subject line.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2012 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
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