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National Provider Identifier (NPI) Changes to the 835/Electronic Remittance Advice (ERA) Transaction

National Provider Identifier (NPI) Changes to the 835/Electronic Remittance Advice (ERA) Transaction

Implementation Date for Part A and B Providers:  April 7, 2008

As a result of Medicare Learning Network (MLN) Matters article 5452, the following changes will take place for the 835 (ERA) transaction:

  1. The NPI will be reported in the N104 segment, when available. The Medicare Provider Transaction Access Number (PTAN) (provider/group/oscar number) will no longer be reported in the REF (1C) when an NPI is present on the adjudicated claim.
  2. The Tax ID number (TIN) will be reported in the REF (TJ) segment.  The Tax ID will no longer be reported in the N104 segment when an NPI is present on the adjudicated claim.

Software vendors should make the appropriate changes to their ERA software programs. Once the software changes have been completed, please notify your Part A and B providers of the updates by the implementation date indicated above. 

To review these changes in detail, please refer to the MLN Matters article 5452 located at
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5452.pdf External PDF

For further information, contact our EDI Help Desk at 1-877-273-4334 or via e-mail at NGS.EDI.A@Anthem.com for Part A and NGS.EDI.B@Anthem.com for Part B

 

Posted: 04/01/2008

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