UPINs for Providers

sunsetsystems wrote on Tuesday, May 10, 2005:

Well, it seems Medicare is rejecting claims that do not include the referring provider’s name and UPIN.

A couple of problems with that are: (a) OpenEMR does not have a place to put UPINs, other than as the one and only provider number for a given combination of provider and insurance company; and (b) FreeB does not have any code to generate the required loop (2310A) in the electronic claims.

Therefore I will be checking in some changes to a few source files sometime tomorrow, after we are done testing them.  This will include adding a "upin" column to the "users" table.

If anyone knows something I may not in relation to this, or if you have actually received payment for an electronic Medicare claim generated by FreeB, please drop me a note!

– Rod <rod at sunsetsystems dot com>

tekknogenius wrote on Wednesday, May 11, 2005:

I was wondering the same things. Many (most) insurance’s give the participating physician a provider number and suggest using that when submitting claims. We’re testing with Proxymed now and I asked them the same question, where to put it. I haven’t gotten a reply as of yet. Proxymed requires the physician/facility EIN (federal tax id), but that’s it. I don’t think you should add it to the user table, but rather add it to the insurance table (sorry, don’t remember the actual table name) and call it provider id or something along those lines.

sunsetsystems wrote on Wednesday, May 11, 2005:

Well you can already go into Administration/Practice Settings/Insurance Numbers and for each provider you can  enter a “provider number” and “group number” for any number of insurance companies.  That’s not the problem.

The problem is that Medicare wants the UPIN for the referring doctor, and also their (Medicare) provider number for the doctor providing services.  That’s TWO identifying numbers required by ONE insurance carrier, and right now we just have space for one.

So, I will be adding a UPIN field to the users table.

As a further note of interest, it appears UPINs will be phased out in favor of a "National Provider Identifier" (NPI) sometime in 2007, and alll this nonsense of a different provider number for each insurance company will eventually go away.  This is a HIPAA mandate.

– Rod <rod at sunsetsystems dot com>

drbowen wrote on Wednesday, May 11, 2005:

UPINs are only required by CMS in two situations:

If I bill a consultation code, it is necessary to also include the name and UPIN of the referring physician.

If I perform in-house laboratories then the UPIN needs to be included.

tekknogenius wrote on Thursday, May 12, 2005:

Thanx. Does that info get sent in the X12 file?

sunsetsystems wrote on Thursday, May 12, 2005:

Yes.  It will show up in the HCFA form also.

The changes are now checked in.

– Rod <rod at sunsetsystems dot com>

ajperezcrespo wrote on Friday, May 13, 2005:

I thought that the UPIN on the pulldown for partner types on the X12 partnerships screen provided for this.

sunsetsystems wrote on Friday, May 13, 2005:

I’m not sure what you mean… don’t see anything like that.  There’s a UPIN type available for insurance numbers, but again, you only get one insurance number per physician per insurance company.

– Rod <rod at sunsetsystems dot com>

ajperezcrespo wrote on Friday, May 13, 2005:

My mistake, your talking about referring doctors, sorry. That means that I should get to bed earlier or wear my eye-glasses.

sunsetsystems wrote on Friday, May 13, 2005:

It seems Medicare is also requiring the CLIA (Clinical Laboratory Improvement Amendment) number for in-house lab charges (X12 claims only).  So I have just checked in some changes to accomodate that also.  You can now enter this number on the facility edit page.

– Rod <rod at sunsetsystems dot com>