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Updated Reminder: UB-04 Institutional Claim Edit

NCDHHS has issued updated guidance regarding the use of individual and organizational data in the attending fields on institutional claims. This reminder is being re-issued to reflect the updated guidance, which is different than what has been posted previously.

In accordance with the ASC x12 Companion Guide, correct billing practices require that the attending NPI information on an Institutional/ UB-04 claim is required to be an individual NPI. ACS will no longer allow errors to pass through the system. Currently, some providers are incorrectly affixing an organizational billing NPI and organizational billing taxonomy in these fields. Please also reference NCDHHS Clinical Coverage Policies for the services rendered for additional information about these requirements.

Effective with claims received on and after June 1, 2023,, all institutional claims need to include an individual attending physician NPI, individual attending physician taxonomy, attending physician first and last name. Claims noncompliant with this requirement will be denied for reason 214: invalid or incomplete attending provider submission. These claims should be resubmitted with an individual NPI, taxonomy and attending name.

Please submit any questions you may have to [email protected].

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