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Created: Tue May 20 17:09:23 2008
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Anthem Blue Cross and Blue Shield
State Sponsored Business
Provider Bulletin
May 16, 2008
Institutional 837 NPI Enumeration and Contractual Chart
Anthem Blue Cross and Blue Shield's (Anthem) State Sponsored Business implemented a contingency period for the
National Provider Identifier (NPI) on May 23, 2007, that will continue through May 23, 2008.
Anthem's NPI contingency period will formally end on May 23, 2008, unless further guidance is provided by CMS to
allow for an extended contingency period. Anthem is currently processing NPI-only claims and encourages all
providers to move to NPI-only submission on transactions by the deadline. If a provider is currently submitting with
dual identifiers, we encourage the provider to submit a sampling of claims to Anthem with NPI-only identifiers prior to
the deadline. After the end of the formal contingency period, we will work with providers and providers' contracted
vendors to maintain current business operations, while supporting providers' efforts to comply with the requirements of
HIPAA's NPI Rule.
During Anthem's State Sponsored Business contingency period, we are analyzing claims trends in our ongoing efforts
to help ensure a smooth NPI transition. To that end, we developed the following chart to assist our institutional claims
submitters. Strictly a reference tool, the chart is a guide for entering NPI information appropriately on the electronic
837. Please note that the chart only applies to providers including NPI numbers. The chart is a reference tool only and
does NOT replace the American National Standards Institute (ANSI) X12N 837 institutional implementation guides,
companion documents or trading partner agreements.
**Legacy Identifiers (highlighted below in blue) are optional during the contingency period, except for providers who
are not eligible for an NPI. NPI-only electronic claim submissions will be required beginning May 24, 2008. Electronic
claims submitted with legacy identifiers may be REJECTED after the end of the contingency period. (Identifiers that
may not be accepted include: 0B, 1A, 1B, 1C, 1D, 1G, 1H, E2, LU, N5, X5).
In Indiana: Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark. The Blue Cross and Blue Shield names and
symbols are registered marks of the Blue Cross and Blue Shield Association. 0408 INW2144 05/20/08
State Sponsored Business, Anthem Blue Cross and Blue Shield
Institutional 837 NPI Enumeration and Contractual Chart
May 16, 2008
Page 2 of 2
Institution or facility UB04
Data enumerated with Institutional
Loop ID Element Type 2 NPI Claim Form
2000A PRV01 "BI" or "PT"
Billing or Pay-to Provider specialty PRV02 "ZZ"
information PRV03 Provider Taxonomy
Code
This loop is situational per the IG, however
required by CMS for Medicare and strongly
recommended by Anthem's State Sponsored
Business.
2010AA Billing Provider NM101 85
NM108 XX
Per the Implementation guide this loop required. NM109 Type 2 NPI FL56
REF01 EI or SY FL57
REF02 Tax ID or SSN FL57
REF01 1A**or 1C** FL57
REF02 Your Current Provider FL57
ID#
2010AB Pay-To-Provider NM101 87 71 72
Per the Implementation guide, only required if the NM108 XX
pay-to-provider is different than the billing NM109 Type 2 NPI Attending NPI Operating NPI
provider. FL76 FL77
REF01 EI or SY
REF02 Tax ID or SSN
REF01 1A**or 1C**
REF02 Your Current Provider
ID#
Please note, this chart is only a guide. If you need further guidance, please contact your provider representative/consultant or your
EDI Helpdesk.