Box 33b. - Provider ID Qualifier & ID

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.
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**Global Remittance Override affects ANSI. In ANSI 5010, the address in the global remittance override can NOT equal the providers address or their file will fail.

 

Souce of Payment

33B/ if have no PPBIDGRP2, 33,35

Medicare

1C PPBILID-GRP4/1C PROV-MED5

ZZ PROV-Taxonomy/ ZZ PPBID-Taxonomy 20, 33,35

Medicaid

1D PPBILID-GRP4/1D PROV-MCAID13, 14, 19, 30

ZZ PROV-Taxonomy/ ZZ PPBID-Taxonomy 11, 12, 15, 16, 17, 18, 19, 20, 24,26, 32,33,35

PXC PROV-Taxonomy/PXC PROV-Taxonmy 23,25, 29

Blue Cross Blue Shield

1B PPBILID-GRP4/1B PROV-BS10

ZZ PROV-Taxonomy/ ZZ PPBID-Taxonomy 16, 28, 33,33

Commercial

G2 PPBILID-GRP4/G2 PROV-COM

ZZ PROV-Taxonomy/ ZZ PPBID-Taxonomy 31, 33,33

HMO

PPBILID-GRP4/PROV-HMO

 Blue Cross

1A PPBILID-GRP4, 27/1A PROV-BC

 Workers Comp

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

ZZ PROV-Taxonomy22,33,33

0B State License27

 

2No 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.

4 For space in 33b, need 3/24/07 and above.

5 Can NOT have a PPBID PIN or Prov PIN. It overwrites Prov-SOURCE OF PAY

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 in 24j

115/7/07 Added a pin type of  Taxonomy for NC Medicaid (works in KY box 24J only). 5/24/07 – FL, MN added. 6/18/07 – Box 33 in KY also added. 7/25/07 – Removed space between qual & ID# FL Mcaid. (ZZ only in these states)

125/28/08 – IA Medicaid: Prints ZZ Taxonomy if restore legacy ID’s (must remove Prov Mcaid & UPIN to get 24j shaded

Blank, if have a Pin type of Medicaid & PIN = Taxonomy; 24j shaded will print) (newer ECL for PrtCap: have to

have a PPBID and a pin type of Taxonomy with a PIN of ZZtaxonomy. Turn off qualifiers. See comment here on 24j)

139/14/07 – FL Medicaid will only print NPI + Legacy ID’s; no ZZ anymore except 17a if  assigned is referral.

141/09/08 – NC Medicaid will print 1D with legacy ID

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. 11/04/08 removes the space between

the  ZZ and the number.

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 33b.

            Need to turn on qualifiers.

2212/19/11  – CA workers comp; the Provider PIN type of ‘Taxonomy’ will print in 33b. NPI only & turn on qualifiers for

               ZZ in 24i & 33b.

2312/20/11  – WI Medicaid; the Provider PIN type of ‘Medicaid’ will print in 33b, (PIN type of ‘taxonomy’ will print in 24j). Set

            NPI only & turn on qualifiers for PXC in 24i & 33b (Can’t have a Medicaid PIN). PPBID will override. (Paper only.

            Get ZZ taxonomy in both in Prtcap and taxonomy must be on PPBID).

            5/14/12 – KY Medicaid works just like WI Medicaid (box 33b doesn’t work in PrtCap). (If have a PPBID taxonomy and

                            a PPBID taxonomy. PPBID = 24j & Prov PIN’s taxonomy = 33b)

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. (KY - 33b has a 1D Medicaid ID in PrtCap).

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

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 with off first). PIN type of Taxonomy will populate box 33b with ZZ Taxonomy, PIN type of UPIN will

            populate box 24i with ZZ and 24J with the number in the PINs. (doesn’t work In PrtCap).

275/8/14  –  WA BCBS; the Provider PIN type of ‘Taxonomy’ will print in 24j. Legacy ID’s off, need to turn on qualifiers and 24j.

               33B will also have Taxonomy code. PPBID will override. Works paper & PrtCap.

           TX workers comp. Need a PPBID with a ‘PIN type’ = Group and a ‘PIN’ = 0B STATELIC# (need a space between

           0B and #) (works in PrtCap) See the  CMS 1500 form for TX Workers comp. (see box 24j & box 17a)

286/XX/14 – NY for Excellus BCBS: Need Taxonomy code only when the provider bills as an Individual. Legacy ID’s are on,

               NPI only is unchecked, Payer ID must be 00806, Print qualifiers is on, Provider entity type is set to Individual & need a

           pin type of Taxonomy. (See box 24J & 32B). (See Excellus BCBS Tips for setup).

29XX/XX/13 – NE: 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]

30TX 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.

31 Ambetter – If want a provider taxonomy code in 33b shaded. Legacy ID’s on, PPBID with a PIN type of ‘Commercial’

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

329/7/16 – 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 below]

333/29/17 – 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 24J). [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.

 

 

**KY Note: If a Medicaid payer wants a different Taxonomy number in 33B than 24J and doing PrtCap…

   Legacy ID's are on, prt quals = off.  On provider PINs (or PPBID), label of Taxonomy with  the code entered

   as ZZcode = 24J; label of Medicaid with the other code entered as ZZcode payer  wants = 33b. If need a box

   32, assign a facility on case with label of Mcaid & no number and label of NPI with number.

 

**Note – 33B can always be populated with a pin type of ‘Group’ if legacy ID’s are on.

 

v10 - Go to File|Database Tables (add/edit)|Provider payer billing ID's

... select and open. In the PIN types, select Group. In the PIN's across from it, the providers PIN or group/organization ID#.

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).


Note - 06/19/2007 @ 3:21pm or above: removes space between ZZ & taxonomy code for IA Medicare.

Note - 06/19/2007 @ 3:21pm or above: Mirrors 33b into 32b for PrtCap like on HCFA.

Note - 06/23/07 and above: Removes space between qualifier and ID# for MN BC/BS.

Note - 7/17/07 and above: PrtCap - Adds space between qualifier and ID# for Medicare.

Note - 7/25/07 and above: Removes space between qualifier and ID# for FL Medicaid.

Note - 1/09/08 and above: NC Medicaid will print 1D and legacy ID.