We have a customer who is not able to properly fill the new HCFA 1500 form, box 33b.
I believe the format of the form may have changed. Where the UPIN used to go, this new ID needs to go, but there is a limit on the number of characters for that field.
I’m not quite sure of the mapping, and what the proper solution is. Any advice on this issue would be greatly appreciated.
// 33b. Billing Facility Other ID
// Note that Medicare does NOT want this any more.
if ($claim->providerGroupNumber() && $claim->claimType() != 'MB') {
put_hcfa(61, 63, 2, $claim->providerNumberType());
put_hcfa(61, 65, 14, $claim->providerGroupNumber());
}
The third number, (e.g. 2 and 14) indicate the maximum field size. Not sure exactly of your requirements, but if you need more than 14 characters why don’t you just try upping that number
From the CMS Manual System - Pub 100-04 Medicare Claims Processing, page 19:
“Item 33b - Item 33b is not generally reported. However, for some Medicare policies you may be instructed to use this item; direction as to how to use this item will be in the instructions you received regarding the specific policy, if applicable.”
What does the Medicare EOB say? If carrier is not Medicare, it’s not likely that Box 33b needs to be completed.
Before the advent of the NPI, Medicare UPIN or TIN would go into 33a and 33b would be left blank.
in this case it’s a Texas Worker’s Comp rule that the facility license #
with some extra formatting identification codes are required. Claims are
being rejected due to this.
So… Should we reuse Upin field or create a new facility element and
trigger it by payor or some other model?
From the CMS Manual System - Pub 100-04 Medicare Claims Processing,
page 19:
“Item 33b - Item 33b is not generally reported. However, for some Medicare
policies you may be instructed to use this item; direction as to how to use
this item will be in the instructions you received regarding the specific
policy, if applicable.”
What does the Medicare EOB say? If carrier is not Medicare, it’s not
likely that Box 33b needs to be completed.
Before the advent of the NPI, Medicare UPIN or TIN would go into 33a and
33b would be left blank.
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Have the client ask the local Comp. board if it’s acceptable to have the NPI in Box 33a and the Comp. number in 33b. See attachment 1.
If acceptable, the Comp. number should go into the Group box for Workers’ Compensation. See attachment 2.
Because gen_hcfa_1500.inc.php grabs the data from Insurance Numbers for a specific insurer, there should be no mixup with other carriers. If the practice does not use the Group box for other insurers, only the Workers’ Compensa- tion paper claims will have Box 33b populated.
Texas, like many other states in the Union, requires their own medical form, the DWC-069, in addition to the CMS 1500, as noted on this webpage.
In our state Ophthalmic practices are required to complete a specialized form for Eye injuries in lieu of the regular medical Comp. form.
Because of the small number of Comp. patients in our office, we completed the equivalent form manually in the past. It was faster on the typewriter than with the old Practice Management Software.
And I thought that Comp. & No-Fault in our state are pains to deal with.
In what box does Texas want the facility Comp. number?
If it’s 33a, line 673 will have to grab that number from a new entry in the Edit Facility dialog box instead of the NPI or from Insurance Numbers for Comp.; whichever is the easier coding task.
The other possibility is to have CMS 1500 just for Comp. and the regular form for all other insurers. Staff will have to remember to distinguish between the two.
One saving grace is that there’s no mucking about with the 837P’s because Comp. is not set up for electronic claims.
I am wondering if a fourth Insurance type (Comp Related) in addition to Primary/Secondary/Tertiary currently available would be a reasonable way to address this type of issue.
As pointed out before it seems that Workman’s Comp isn’t really another “primary.” for the same patient.
A difficulty with the COB approach is that the Billing Manager queues the insurers. At present there is no way to “jump the line”. Staff would have override the order by pretending the primary, secondary or tertiary insurers did not pay, thereby shunting the claim to the quaternary insurer. Can hear staff grumbling vociferously.
Even if the patient has no other insurance, we are still left with the problem of how to get the Comp. facility number into the box (probably 33a) acceptable to Texas.
For the sake of the Texan client, we hope that they are not required to submit Comp. e-claims on top of the mini mess with the paper claims.
“(DD) billing provider’s NPI number (CMS-1500/Field 33a) is required when the billing provider is eligible for an NPI number; and
(EE) billing provider’s state license number (CMS-1500/field 33b) is required when the billing provider has a state license number;the billing provider shall enter the ‘0B’ qualifier and the license type, license number, and jurisdiction code (for example, ‘MDF1234TX’).”.
with the likely number of workcomps maybe manual override of each claim to wherever you’d like to put insurer and then “type” in the medical license of the rendering provider with the additional characters in field 33b
Found another guide for the 08-05 CMS 1500, with the same instructions for 33a and 33b.
The client must be a fairly new practice, unaccustomed to the requirements of a form that has changed little since 2006.
Texas assigns the medical license number with prefixes and suffixes as the physician’s Workers’ Comp. number. There is really no Comp. identifier assigned to the billing facility per se. The Comp. number for the physician and the facility is one and the same.
Solution:
Box 33a, physician’s NPI. This requires no code change.
In Insurance Numbers for Workers’ Comp., OB and the equivalent of MDF1234TX should go into the Group Number box.
Box 33b, OB and the equivalent of MDF1234TX should appear automatically. No code change here either. The 11 characters should fit in the allotment of 14 spaces.
This schema should ensure seamless processing of Comp. claims without impingement or corruption of other paper claims. There is no additional work for staff because they need to click the Generate CMS 1500 PDF button but once.
But,
there may be another stumbling block. Box 24j always prints with the physician’s NPI. Both Texas guides instruct that this field be left blank if the billing physician is the same as the rendering physician.
If the NPI appears in 24j, then the practice is required to enter OB and the physician’s Comp. number in the shaded portion of 24j. The gen_hcfa_1500 script makes no provisions for this. Is this an actual problem?
Presently the Fee Sheet does not permit a blank for Rendering in the drop down menu. A work-around is to create a user, A Blank with no NPI number. The Superbill will need a special notation to the billing person to choose A Blank from the drop down menu for a Comp. claim.
The practice may need to speak directly with the Workers’ Compensation Board in Austin if it continues to have denials.