UPDATE for Providers Billing on UB-04 and 837I Claims, CR 110840  

Aug 19, 2022

Effective October 31, 2022, UB-04 and 837I claims submitted without an attending provider will be denied.  

This message is to amend a previous message sent on July 1, 2022. We have changed the implementation date for when submitting UB-04 claims without an attending provider will be denied. The attending provider requirement includes all claim submission methods, (paper, online Portal, or 837I).  This change will be effective October 31, 2022. The previous effective date was August 31, 2022.  

Providers who bill on UB-04 or 837I claims must include an Attending Provider Name, including secondary identifiers, when submitting claims in MIHMS.  Form Locator 76 is a required field and will be used to validate that your attending provider is enrolled with MaineCare.  

We are also clarifying the definition for attending provider, in alignment with Medicare claims processing rules: the attending provider is the individual who has overall responsibility for the patient’s medical care and treatment reported in this claim/encounter. Additionally, to help providers identify opportunities to improve compliance with this requirement, all Remittance Advices now populate an ALERT message for claims that do not include an enrolled attending MaineCare provider.  

• The Remittance Advice Remark Code (RARC) is N613: “Although this was paid, you have billed with an ordering provider that needs to update their enrollment record.  Please verify that the ordering provider information you submitted on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record.  Unless corrected, a claim with this ordering provider will not be paid in the future.” 

• Please note that while the language of the RARC above references an ordering provider, this RARC will appear when there is no attending provider on the claim.  

There are only a few services that do not require a National Provider Identifier (NPI) in the Attending Provider field.  

Services that do not require an NPI in the Attending Provider field:  

1. Emergency ambulance trips  

• Emergency transportation services when they are the only services on the claim. Service codes identified: A0021, A0225, A0420, A0424, A0425, A0427, A0429, A0430, A0431, A0432, A0433, A0434, A0435, A0436, A0998, and A0999 (to also include A0428 when billed with modifier QL)  

• Revenue code 0540  

2. Singular or roster billing of Influenza or Pneumococcal Vaccinations and their administrations when these are billed as the only services on the claims. Administration codes are:  

• Influenza G0008  

• Pneumococcal G0009  

• If all UB-04/837I billers are using the above admin codes, Revenue Code 0771  

3. Vaccines  

• Influenza 90655, 90656, 90657, 90658, 90660, 90673, 90685, 90686, 90688  

• Pneumococcal 90670  

• Revenue Code 0636  

Type 1 vs. Type 2 NPI  

Providers are required use a Type 1 NPI unless a self-referred screening mammography is the only service billed on the claim. As a reminder, Private Non-Medical Institutions (PNMI) are required to use a Type I NPI once you have completed the full enrollment revalidation process. See the e-message from April 12, 2021 for more detail.  

When screening mammography services are self-referred, and as a result an attending provider NPI is not available, use the facility Type 2 NPI in the attending provider identifier field on the claim. For the self-referred mammography screenings, Type 2 NPIs are allowed.  

• 77057, Screening mammography, bilateral (2-view film study of each breast)  

• G0202, Screening mammography, producing direct digital image, bilateral, all views  

• 77063, Screening digital breast tomosynthesis, bilateral (list separately in addition to the code for primary procedure)  

• 77052, CAD screening mammography  

In addition to including the attending provider’s NPI, you must also include a secondary identifier qualifier, as listed below.  

UB-04: Secondary Identifier Qualifiers  

Secondary qualifiers are not needed for paper claims (FL76), however, other field locators (77, 78, or 79) may require the use of a secondary qualifier when using an identification number other than the NPI.   

• 0B - State License Number  

• 1G - Provider UPIN Number  

• G2 - Provider Commercial Number  

837I: Secondary Identifier Qualifier  

This is based on the provider’s NPI or Atypical Provider Identifier (API) number(s). If the provider enrolled with an NPI, then use “EI” and the NPI number as in the example below.  

NPI Example:  

NM1*71*1*LastName*FirstName****XX*9999999999~  

REF*EI*111111111~  

If the provider enrolled with an API then use “1D” and the Employer Identification Number (EIN) number as in the example below.  

API Example:  

NM1*71*1*LastName*FirstName****24*111111111~  

REF*1D*A#########~  

Health PAS Online Portal  

When entering claims in the portal, you will enter the NPI only in the attending provider field. Do not enter the provider’s name, as the portal will not translate that information to MIHMS at this time.  

Please call Provider Services with questions at: 1-866-690-5585.