General inquiries: 828-225-2784
Provider questions: Call 1-866-990-9712, contact your account specialist or email
Confidential Compliance Hotline for suspected fraud and abuse: Report online or call 1-866-916-4255
AlphaMCS technical support: 828-225-2784, ext. 1500, 8:30 a.m. to 5 p.m. M-F
Connect with us on LinkedIn and Facebook
|
|
|
Correctly reporting address and provider information on 837 files
Beginning in March, Smoky Mountain MCO (Smoky) will implement claims edits in AlphaMCS to verify the correct submission of site information on 837 electronic claims files. Providers must appropriately identify the enrolled site location responsible for the service billed as the Billing Provider in accordance with national regulations for electronic healthcare claims.
Although many providers currently submit agency site location information correctly, providers that have not updated their billing practices may experience an increase in denied claims as a result of the new edits.
Provider agencies that deliver services from multiple credentialed locations are required to identify the agency's specific site information on the claim, including 9-digit code and associated National Provider Identifier (NPI) for the location where the service was based and/or delivered. Providers must ensure that information on the 837 claim file is presented in the appropriate data fields in compliance with ANSI ASC X12N 837 version 5010 standard requirements described below.
On 837 electronic claim files, the provider's facility or site location information is reported as the Billing Provider data (837 Loop 2010AA). Alpha MCS edits will ignore information presented as the Service Facility in 837 Loop 2310C when determining the location credentialed and/or authorized to provide the service.
Please Note: The 837 Service Facility Location Loop 2310C is reserved for reporting ONLY when services were provided at a health care facility that is NOT owned by the billing provider (for example, an independent practitioner or a group practice billing services for a patient located at a hospital or skilled nursing facility).
The provider's billing or administrative office address should NOT be reported in the Billing Provider Loop unless it is the same address where the service was rendered or based.
Correctly Reporting Billing Provider Data on the 837 file
To avoid denials on valid services, the following elements must be correctly reported in the 837 file Billing Provider Loop 2010AA to successfully identify a valid enrolled provider location:
Billing Provider NPI number, reported in the 837 file's Billing Provider Loop 2010AA, segment NM109, MUST match the NPI registered with Smoky and recorded in Alpha MCS system as associated with the provider agency's specific site location; credentialed and/or authorized to perform the service where it was rendered. Many services are authorized to a specific physical address.
Billing Provider's Location Address is identified by the 9-digit ZIP code (ZIP+4) reported in 837 Loop 2010AA, segment N403. The ZIP+4 on the claim must be associated with the NPI submitted for the Billing Provider and match the physical address on file for the provider location responsible for services billed. It is important that the provider's NPI numbers and associated addresses are correctly recorded in both the AlphaMCS system and the State's NCTracks system.
|
 |
|
Please see the ANSI ASC X12N 837 version 5010 standards regarding correct use of the Billing Provider and Service Facility Location Loops cited below:
Loop 2010 AA - BILLING PROVIDER NAME LOOP - SUBPARTS
When the Billing Provider is an organization health care provider, the NPI of the organization health care provider or its subpart is reported in Segment NM109. When an organization health care provider has determined a need to enumerate subparts, it is required that a subpart's NPI be reported as the Billing Provider. The subpart reported as the Billing Provider MUST always represent the most detailed level of enumeration and MUST be the same identifier sent to any trading partner.
Loop 2310C - SERVICE FACILITY LOCATION NAME
When an organization health care provider's NPI is provided to identify the Service Location, the organization health care provider must be external to the entity identified as the Billing Provider (for example, reference lab). It is not permissible to report an organization health care provider NPI as the Service Location if the entity being identified is a component (for example, subpart) of the Billing Provider. In that case, the subpart must be the Billing Provider.
|
|
About provider email alerts
You are receiving this alert because you are a member of the Smoky provider network or have signed up for our Provider Network Bulletin. Smoky issues email alerts to convey critical information as soon as possible. Please note that if you unsubscribe from these alerts, you will also be removed from the Provider Network Bulletin mailing list and may miss out on important information. unencrypt |
|
|
Smoky Mountain LME/MCO | 200 Ridgefield Court, Suite 206 | Asheville, NC 28806
|
Smoky Mountain LME/MCO manages publicly funded services for mental health, substance use and intellectual/developmental disabilities in Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes and Yancey counties in North Carolina. For immediate help or information about services, call 1-800-849-6127, 24 hours a day (TTY: Relay NC 711). Visit us at www.smokymountaincenter.com.
|
|
|
|
|
