August 19, 2016
Attention All Providers: Site Determination Enforcement Implementation
Effective with AlphaMCS Build 1.19, Partners Behavioral Health Management (Partners) has begun enforcing the site determination logic that has actually been in place since March of 2015. (See the June 17, 2016 Provider Alert for reference.)
Claims edits in AlphaMCS are now being enforced to verify the correct submission of site information on 837 electronic claims files. Therefore, PROVIDERS MUST APPROPRIATELY IDENTIFY THE ENROLLED SITE LOCATION RESPONSIBLE FOR THE SERVICE BILLED AS THE BILLING PROVIDER in accordance with Version 5010 of the Center for Medicare and Medicaid Services’ regulations for submission of electronic healthcare claims.
On the 837 electronic claim files, the provider’s facility or site location is reported as the BILLING PROVIDER (837 Loop 2010AA). AlphaMCS edits will ignore information presented as the Service Facility in 837 Loop 2310C in the site determination process.
The Service Facility Location Loop 2310C is reserved for reporting ONLY when services were provided at a health care facility that is NOT operated by the billing provider.
The Rendering Provider NPI, Loop 2310B is a “Situational” field and should only be used when the Rendering Provider information is different from what is reported in the Billing Provider Loop 2010AA. The site location or Rendering Provider address still must be reported in the Billing Provider Loop 2010AA, N3 and N4 segments.
The Provider’s billing or administrative office address should NOT be reported in the Billing Provider Loop unless it is the same address where the service was rendered.
To ensure that your claims are approved in AlphaMCS, you must report the following in the Billing Provider Loop 2010AA on your 837 Electronic file:
- Billing Provider NPI number, reported in Loop 2010AA, segment NM109, MUST match the NPI registered at NCTracks and what is recorded in your provider profile in Partners’ AlphaMCS, and mapped to the appropriate site and the authorization for the services being billed.
- Billing Provider’s Location Address, which is identified by the 9-digit Zip code (Zip+4) that is reported in Loop 2010AA, segment N403. The Zip+4 on the claim must be associated with the NPI submitted for the Billing Provider and must match the physical address in Partners’ AlphaMCS for the provider location responsible for the services being billed, and must also match what is on file at NCTracks.
If you have any questions, please contact Partners’ Claims Department at 1-877-864-1454 ext. 6486 or email firstname.lastname@example.org.