Box 24j. - RENDERING PROVIDER ID. #

(See 24a for service line comments)

NEW YORK WORKERS COMPENSATION
You must be running a 1/16/2020 revised date or greater. During CMS-1500 generation, ECLIPSE determines that this is a NY WCB claim by verifying ALL of the following criteria:
1. Payment source for the primary payer is set to WC.
2. Condition work related box is checked.
3. NY is the current provider’s state.
4. Condition screen data was saved at some point (regardless of whether proper fields were filled out).

If the above criteria are met, ECLIPSE will automatically populate Box 24J with the provider's State License Number as well as NPI Number.

Note – Need to be on 5/01/07 or above to print "legacy" numbers (shaded boxes).

Note – v10, 5/29/07 and above:Can turn off "legacy" numbers (shaded boxes) at the payer level via check box on Printed Claims Options tab "Print NPI only. Override CMS deadline" (Check box = no legacy numbers).

Note – Medicare Advantage programs treat as Medicare. Source of payment should be Medicare.
________________________________________________________________________________

Souce of Payment

24J shaded7, 34,35

24J NPI8

Medicare

1C PROV-MED

ZZ PROV-Taxonomy 20, 34,35

PROV-NPI

Medicaid

1D PROV-MCAID9,11, 13, 19, 31

ZZ PROV-Taxonomy9,11, 15, 16, 17, 18, 19, 20, 24, 26, 30, 33, 34,35

PXC PROV-Taxonomy 23, 25, 26

PROV-NPI

 

Blue Cross Blue Shield

1B PROV-BS10, 12

0B State License10, 12

ZZ PROV-Taxonomy16, 21, 27, 29, 32, 34,35

PROV-NPI

Commercial

G2 PPBILID-SLP2 OR G2 PROV-COM2

ZZ PROV-Taxonomy 33,34,35

PROV-NPI

HMO

   PROV-HMO

PROV-NPI

Blue Cross

1A PROV-BC

PROV-NPI

 Workers Comp

X5 PPBILID-St.Ind Accident /X5 St.Ind Accident

ZZ PROV-Taxonomy22, 34’35 

0B State License28

PROV-NPI

 

2Can’t have Prov/Pay Bill ID SLP unless source of pay = commercial; the rendering providers 1G UPIN populate’s the box.

        If have SLP for any other source of pay will get a G2 PPBillID-SLP.  PPBID PIN may populate. Newer ver. of ECL – the

      PROV-COM will also populate box (or PPBID-COM).

7 Rendering provider - the provider who did the service. Same number (Label) in Prov/Pay Bill ID will take precedence (No

        Qualifiers – PPBID-SLP works on all). PPBID UPIN may populate box.

8 Not overwritten by Prov/Pay Bill ID - NPI. Only pulls the “Pin type’s” of NPI from the provider assigned to the

        service for  paper & PrtCap.

94/23/07 – to get 1D for Prov-Mcaid (but NOT in KY if have NPI.  If using NPI, get “ZZ Taxonomy” if enter a taxonomy code

       in Prov.Taxonomy override in KY only see 11). No Prov-Mcaid in KY with or without NPI.  5/7/07 – added NC in Prov.

    Taxonomy override.

104/24/07 – BCBS of IL = No spaces between qualifier and number in 32b and 33b & 4/30/07 24j get an 0B Prov-state License.

    8/3/07 – BCBS MI = State Lic. (0B) if present.

115/7/07 Added a pin type of  Taxonomy for NC Medicaid (works in KY box 24J only ) & need MCaid on provider PINs. If want

     ZZ in 33b, use taxonomy on PPBID to over-ride  the 1D).

   5/24/07 – FL, MN added 13 (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.

154/07/08 – IN Medicaid will print ZZ Taxonomy code.

166/5/08 – FL, IN, MN, NC, TX  Medicaid and IL, PA BCBS will print ZZ Taxonomy code on CMS 1500 and PrtCap (is NPI only)

        (may have to turn on qualifiers for payer).

178/29/08 –  SC Medicaid will print ZZ Taxonomy code on CMS 1500 and PrtCap (NPI only required)

1810/24/08 – WI Medicaid will print ZZ Taxonomy code on CMS 1500 and PrtCap (will pull from PIN of taxonomy [preferred

         method] OR taxonomy code o-ride if no PIN)

1910/31/08 – NC Medicaid (see also box 24j, 32b & 33b): [MPN=Medicaid Provider Number only… NO NPI]

With MPN - (must turn off restore Legacy ID’s in cfg or NPI only on payer& must have a “Medicaid” pin type on

provider screen) = populates with 1D Prov-MCAID (Paper only).

            With out MPN – (must turn off restore Legacy ID’s in cfg or NPI only on payer & must not have a “Medicaid” pin

            type on provider screen) = ZZ-Prov-TAX (Paper only. Blank in PrtCap).

2011/18/10  –  Medicaid/Medicare GA. When the provider degree type is PT and the payer is NPI only (CFG or override on payer),

          the Provider PIN type of ‘Taxonomy’ will print in 24j. Need to turn on qualifiers and 24j.

211/5/11  – NY BCBS; the Provider PIN type of ‘Taxonomy’ will print in 24j. Need to turn on qualifiers and 24j. Need to check

           box to turn on service line comments in box 24. Works paper & PrtCap. PPBID will override.

2212/19/11  – CA workers comp; the Provider PIN type of ‘Taxonomy’ will print in 24j shaded. NPI only & turn on qualifiers for

          ZZ in 24i & 33b.

2312/20/11  – 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 PXC 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).

    5/14/12 – KY Medicaid works just like WI Medicaid. (box 33b doesn’t work in PrtCap). (Need a Medicaid ID to turn on

         Taxonomy in 24J)

2410/03/12  – KY Medicaid was changed back to a ZZ qualifier for the taxonomy code in 24i and 33B. Legacy ID’s and Print

         Qualifiers must be turned on. 32b = 1D Medicaid ID. (KY - 33b has a 1D Medicaid ID in PrtCap (see 26).

2510/16/12  – KY Medicaid. MPN changed ZZ qualifier in 24i back to PXC (???). Everything else is same as 24 (see 26).

2611/15/12  – KY Medicaid. MPN changed PXC qualifier in 24i back to ZZ. Legacy ID’s and Print Qualifiers may not need to be

                turned on (try it first with them off) . PIN type of Taxonomy will populate box 33b with ZZ Taxonoy, PIN type of

            UPIN or SLP (use on PPBID) will populate box 24i with ZZ and 24J with the number in the PINs. Box 33b and 24J

            can have different numbers. OR PIN type of Medicaid will populate 24i with ZZ and 24J with Taxonomy PIN.

            Box 33B & 24J will have the same  number. (none of these work In PrtCap… Paper ONLY).

275/8/14  –  WA BCBS; the Provider PIN type of ‘Taxonomy’ will print in 24j. Legacy ID’s off or NPI only checked, need to

               turn on qualifiers and 24j.  33B will also have Taxonomy code. PPBID will  override. Works paper & PrtCap.

285/28/14 – TX: Workers Comp, Need to have a TX employer assigned on the case screen. (If treating = assigned, turn off 24J

               on the printed claims options tab Only need 24J to print if the treating provider is different than the assigned provider).

           Legacy ID’s  need to be on. Turn on Qualifiers. (Works in PrtCap). See the CMS 1500 form. (See box 17a & box 33b).

296/XX/14 – NY for Excellus BCBS: Need Taxonomy code (24I = ZZ) [should only be on when the provider bills as a Group.

               Legacy ID’s are on, NPI only is unchecked. Payer ID MUST be 00806, Print qualifiers is on, Provider entity type is

            set to Organization & need a pin type of Taxonomy. (See box 32B & 33B). (See also Excellus BCBS Tips for set up)

30XX/XX/13 – NE Medicaid: Legacy ID’s off or NPI only (If legacy ID’s are on & NPI only unchecked, get 24J shaded only).

                Need a PIN type of Medicaid with the desired taxonomy code in the PIN’s column. [Try this in the state you are in.

            If it works, notify Dave]

31TX Medicaid: As of Jan 2016, providers need Medicaid ID in 24j shaded & 33B. Legacy ID’s = Off, NPI only = don’t care,

              Print qualifiers = off. PIN type of Taxonomy needs to be their Medicaid ID.

32 NE BCBS - Effective December 1, 2015, BCBSNE will require that all medical providers must add taxonomy codes to all

              claims in Box 24J of the CMS 1500 for paper submissions. Legacy ID’s = on, NPI only off (to print on paper only. MUST

           be on for ANSI), print qualifiers = off, 24j = on, PPBID pin type of SLP (Service Line Pin) = Taxonomy code.

339/7/16 – KY  Aetna Betterhealth Medicaid: Box 33B ZZTaxonomy (no space). Legacy ID’s on, Print

              Qualifiers are on, do not need payer ID. (24I & 24J will be OK) (doesn’t work in PrtCap). 33B will have ZZ Taxonomy

           (will contain a space). OR Legacy ID’s off, Print Qualifiers are on or off, need payer ID of 128KY (24I & 24J will be OK).

           Prov PIN’s Taxonomy or PPBID Taxonomy Populate box 24J shaded, Medicaid ID populates 33B with ZZMedicaidID

           (no space). [SEE KY Note on box 33b]

 

Ambetter – If want a provider taxonomy code in 24j shaded. Legacy ID’s on, PPBID with a PIN type of ‘Commercial’

              & PIN has the ‘ZZtaxonomy’ code in it, qualifiers off.

343/29/17 – 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 17A 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].

35 XX/XX/XX – ZZ  Taxonomy. For ALL states and ALL ‘Source of payment’.

            Legacy ID’s = On. On the ‘Printed Claim Options’ tab – ‘NPI only’  = unchecked. 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.

             Need a PIN type of Group with ZZTaxonomy (desired taxonomy code in 33b) & PIN type of Taxonomy (taxonomy for 24j).

              PPBID overrides Provider PINs. Also works in PrtCap.

 

#1) v10 - File/DB Tables/payors/open/printed claims options - print provider's id# (12/90 box 24k 08/05 box 24j)

Note - box checked = prints in box 24J, box unchecked = box 24J is blank

 

#2) If there is a NPI number on the provider's PINs tab (NPI on Prov/Pay bill ID will NOT print), it will print in the lower half of box 24J, the non-shaded portion of the form.

Note - do for all doctors and payors/profiles as required

Note - MN for Blue Shield, try provider/ID/Blue Shield

Note - v9 - 1/12/04 box 24j shows the $ amount paid by Primary (must do item line item entries when entering Primary payments) when print a bill when Medicaid is secondary in MI.

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).