Reminder for Providers Billing on UB-04 and 837I Claims, CR 107682

Jun 16, 2022

Effective June 30, 2022, UB-04 and 837I claims submitted without an attending provider will be denied.

Providers who bill on UB-04 or 837I claims must include an Attending Physician Name, including secondary identifiers, when submitting claims in MIHMS. Form Locator 76 is a required field and will be used to validate that your attending physician is enrolled with MaineCare. The attending provider is the individual who has overall responsibility for the patient’s medical care and treatment. There are only a few services that do not require a National Provider Identifier (NPI) in the Attending Provider field.

Services that do not require an NPI in the Attending Provider field:

1. Emergency ambulance trips

• Emergency transportation services when they are the only services on the claim. Service codes identified: A0021, A0225, A0420, A0424, A0425, A0427, A0429, A0430, A0431, A0432, A0433, A0434, A0435, A0436, A0998, and A0999 (to also include A0428 when billed with modifier QL)
• Revenue code 0540

2. Singular or roster billing of Influenza or Pneumococcal Vaccinations and their administrations when these are billed as the only services on the claims. Administration codes are:

• Influenza G0008
• Pneumococcal G0009
• If all UB-04/837I billers are using the above admin codes, Revenue Code 0771

3. Vaccines

• Influenza 90655, 90656, 90657, 90658, 90660, 90673, 90685, 90686, 90688
• Pneumococcal 90670
• Revenue Code 0636

Type 1 vs. Type 2 NPI

Providers are required use a Type 1 NPI unless a self-referred screening mammography is the only service billed on the claim. As a reminder, Private Non-Medical Institutions (PNMI) are required to use a Type I NPI once you have completed the full enrollment revalidation process. See the e-message from April 12, 2021 for more detail.

When screening mammography services are self-referred, and as a result an attending physician NPI is not available, use the facility Type 2 NPI in the attending physician identifier field on the claim. For the self-referred mammography screenings, Type 2 NPIs are allowed.

• 77057, Screening mammography, bilateral (2-view film study of each breast)
• G0202, Screening mammography, producing direct digital image, bilateral, all views
• 77063, Screening digital breast tomosynthesis, bilateral (List separately in addition to the code for primary procedure)
• 77052, CAD screening mammography

In addition to including the attending physician’s NPI, you must also include a secondary identifier qualifier, as listed below.

UB-04: Secondary Identifier Qualifiers

• 0B - State License Number
• 1G - Provider UPIN Number
• G2 - Provider Commercial Number

837I: Secondary Identifier Qualifier

This is based on the provider’s NPI or Atypical Provider Identifier (API) number(s). If the provider enrolled with an NPI, then use “EI” and the NPI number as in the example below.

NPI Example:

NM1*71*1*LastName*FirstName****XX*9999999999~

REF*EI*111111111~

If the provider enrolled with an API then use “1D” and the Employer Identification Number (EIN) number as in the example below.

API Example:

NM1*71*1*LastName*FirstName****24*111111111~

REF*1D*A#########~

Health PAS Online Portal

When entering claims in the portal, you will enter the NPI only in the attending provider field. Do not enter the provider’s name, as the portal will not translate that information to MIHMS at this time.

Please call Provider Services with questions at: 1-866-690-5585.