Box 17a. – Other ID#

The Other ID number of the referring, ordering, or supervising provider is reported in 17a in the shaded area. The qualifier indicating what the number represents is reported in the qualifier field to the immediate right of 17a.

 

The NUCC defines the following qualifiers used in 5010A1:

 

0B State License Number

1G Provider UPIN Number

G2 Provider Commercial Number

LU Location Number (This qualifier is used for Supervising Provider only.)

 

(The non-NPI ID number of the referring, ordering, or supervising provider is the unique identifier of the professional or provider designated taxonomy code.)

 

Note - Medicare: Leave blank.

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Go to:             patient/case/billing referral/open/PIN's tab

 File|Database Tables|Referral Sources, select and open, PIN's tab.

 

Referral 17a (see Expected ID from referral on Payer)

 

Expected ID

17a1, 21

Medicare

1C REFFERAL-MED

Medicaid

1D REFFERAL-MCD11,15

Blue Shield

1B REFFERAL-BS12

Commercial

G2 REFFERAL-COM

HMO

   REFFERAL-HMO

Blue Cross

1A REFFERAL-BC

UPIN

1G REFFERAL-UPIN

Emp TIN

EI REFFERAL-E TIN

State License

OB REFFERAL-Referral State Lic19

Taxonomy

ZZ REFFERAL-TAXONOMY11, 13, 14, 15, 17,20,21

MediPass

9F REFFERAL MediPass AUTH# 16

 

1If using “Print assigned provider as referral”, (the assigned provider on the case screen); ONLY PROV-UPIN will populate box regardless of what is expected – the  Qualifier is controlled by source of payment. 4/16/07 and above – correct qualifier of 1G for UPIN.

115/7/07 Added a pin type of  Taxonomy for NC Medicaid (works in KY box 24J only). 5/24/07 – FL, MN added 13  6/18/07 – Box 33 in KY also added. 7/25/07 – Removed space between qual & ID# FL Mcaid. (ZZ only in these states)

12 8/3/07 – BCBS MI = State Lic. (0B if present in 24j) and State Lic ONLY for referral in 17a.

139/14/07 – FL Medicaid will only print NPI + Legacy ID’s; no ZZ anymore except 17a if  assigned is referral.

 

146/5/08 – FL, IN, MN, NC, TX  Medicaid and IL, PA BCBS will print ZZ Taxonomy code on CMS 1500 and PrtCap. (Do not have to set it “Expected ID from referring provider” & is NPI only) (may have to turn on qualifiers for payer).

1510/31/08 – NC Medicaid (see also box 24j, 32b & 33b): [MPN=Medicaid Provider Number]

With MPN - (must turn off restore Legacy ID’s in cfg & must have a “Medicaid” pin type on provider screen) =

populates with 1D Referral-MCD (Paper only)

With out MPN – (must not have a “Medicaid” pin type on provider screen) = blank (Paper & PrtCap).

1611/17/09  – Medicaid FL; On Payer, “Expected ID from referring provider” set to MediPass. On the Cond|Auth screen,

            create an active authorization  with the nine digit MediPass referral number and link to a referral. (must  be NPI only and

turn on qualifiers) (Only requirement is that authorization be active)(works on paper & PrtCap).

1711/18/10  –  Medicaid/Medicare GA. When the provider degree type is PT and the payer is NPI only (CFG or override on payer), the referral PIN type of ‘Taxonomy’ will print in 17a. Need to turn on qualifiers.

1812/20/11  – WI Medicaid; the Provider PIN type of ‘Taxonomy’ will print in 24j shaded  (PIN type of ‘Medicaid’ will print in

    33b). NPI only & turn on qualifiers for ZZ in   24i & 33b. PPBID will override. (need to be on 1/23/12 and above to be able

   to turn off 24i & 24j completely from Printed claims options tab). (Paper only. ZZ taxonomy in 24& 33B in PrtCap)

19 5/28/14 – Note - Texas Workers Comp: Must assign a Referral source on case screen (do NOT assign provider as referral source

     on printed claims options tab [causes a 1G in 17a]) Need State License & NPI. On Payer, select State Lic as expected ID from

    Referral source. Need a TX employer on the case screen. (Legacy ID's must be on, turn on qualifiers & NPI only on printed

    Claims options tab is unchecked.) (If doing ANSI & you just turned on legacy ID's, every payer going ECS needs NPI only checked.)

206/XX/14 – NY for Excellus BCBS: Need Taxonomy code (17a = ZZ Taxonomy) Legacy ID’s are on, NPI only is unchecked,

      Payer ID MUST be 00806, Print qualifiers are on, Expected ID from referral is set to Taxonomy. A referral MUST be assigned

     on case screen & referral also needs a pin type of Taxonomy. (See Excellus BCBS Tips for set up)

213/29/17 – ZZ Taxonomy. For ALL states and ALL ‘Source of payment’. (All above settings still work after upgrade, but follow these settings

               3/29/17 and above). Legacy ID’s = off OR On the ‘Printed Claim Options’ tab – ‘NPI only’  = checked. Also on ‘Printed

               Claim Options’ tab ‘Print provider’s id# (08/05 box 24J)’ =  checked. ‘Print qualifiers for PINs in 17a, 24j, 32b, and 33b

           on 1500 form’ = checked. ‘Always insert taxonomy code as applicable in CMS-1500 boxes 17, 24 & 33’ = Checked. PPBID

           overrides Provider PINs. Also works in PrtCap.  (See box 24J and 33B). [If this ‘NEW’ way doesn’t work for you, chk

            to see if there is an old way that it worked on. May have to use it].

 

Note - See Box 17 and 17b.

1). check the box "include this referral source on claims" on the referrals personal screen

2). If referral has an NPI, it will also populate box 17b.

3). Can use assigned provider as billing referral on printed claims options tab.

Note - NJ if the treating Dr. for the case is a PT, and you click Medicare tab on the condition screen and the box checked for last seen on; Box 17 and 17a will be populated with the referring Dr. on the case screen. "Last seen date" prints in Box 19. If a supervising Dr. is assigned, his his selected PIN type (You must have a PIN types that matches the Expected ID from referring provider on the Edit Payer Information, General tab) prints after the "Last seen date" in Box 19.

Note - Over-ride for charges at service entry: Must have Plus or Advanced; in the Configuration, on the advanced Tab, check Generate seperate bills for patients REFERRED by multiple providers. The referring Dr. on the service will populate 17, 17a. If a supervising Dr. is assigned, his ID prints after the "Last seen date" in Box 19.

Note - If you have a UPIN AND an NPI on the PIN's tab, both will print (the NPI in 17b).

Note - When using the assigned provider as referal source, only pulls UPIN from the provider screen. If need a different number, create a provider/payer billing ID with a label of UPIN and the number you want.

Note - Can also assign referral at time of service entry. Label must match the expected ID from referral source.

Note - v10 - 2/13/07 and above: The Printed Claim Options tab for each payer now offers the ability to: Print qualifiers in 17a, 24j, 32b, and 33b on 08/05 form automatically.Three conditions must be met:

1 - Can NOT have a Service Line PIN assigned for the provider.
2 - Payer source of payment must be correct.
3 - A PIN exists for the provider for that source of payment (i.e. source of payment = Medicare, the provider needs to have a PIN's type of Medicare).