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Professional Claims Only 

Select the Frequently Asked Question to view answer.
  1. What are the major changes for the 837P Professional transaction with HIPAA 5010?

    Line level claim balancing will be enforced. The sum of Third party payments, (delete space) adjustments, and patient responsibility amounts must equal the line item charge amount. Another item is that the place of service code at the 2400 line level must be different than that at the 2300 claim level.

  2. How should an Atypical Provider submit a claim when not eligible for enumeration (has no NPI)?
    An Atypical provider will still submit the Billing Provider loop (2010AA) without submitting the NM108 and NM109 values. The HFS Provider Number must be submitted in the 2010BB Payer loop using the Billing Provider Secondary Identification REF segment with a reference indicator of G2, which identifies the Provider Commercial Number. Please see 837P Companion Guide for further information.
  3. Does the NTE Segment on a transportation claim still require the pick-up and drop off address information in a 5010 transportation 837 professional transaction?
    No. A 5010 transaction has segments defined for the pick-up address and drop off address for transportation claims. HFS expects those values to be used to report the pick-up and drop-off address. Please see 837P Companion Guide for further information regarding the NTE segment for transportation claims.