National Code Workaround List
1) Medicare
- In box 1a Insured`s id# cannot have any dashes, spaces etc(a - z and 0 - 9)
- In box 11 the word "NONE" needs to be there
- In box 11a the Insured`s DOB needs to be removed
- In box 24k the Provider id# needs to be there for each line of service
- 989`s -> only AT
- 98943 -> GA GY 51
2) BCBS of Illinois
- In box 24k the provider id# needs to be there for each line of service
- All procedures -> GA
- Don`t use Group in box 32/33
3) BCBS of Alabama
- Doctors name in box 31
- Date of service in box 31
- All procedures -> GA
4) Chirocare of Wisconsin
- Doctors name in box 31
- Date of Service in box 31
- Provider id# in box 24k for each line of service
- Don`t use the group # in box 32/33
- Doctors name in box 12 a
- Date of service in box 12 b
- If 11c is Senior Preffered then for each line of service put only AT modifier
5) EDS Federal (WI Medicaid)
- In box 1 instead of a X in the Medicaid box there should be a P
- Doctors Name in box 31
- Date of Service in box 31
- Box 29(amount paid) must be 0.00
6) BCBS of MN
- Only AT modifiers
7) BCBS of Iowa (at 03/18/2009 I checked and no payer had this WO assigned maybe it needs to be deleted)
- All procedures -> only GA
8) Doctor Name/DOS in Box 31
- Doctor`s name in box 31
- Date of Service in box 31
9) Noridian Medicare _ *also applies to EDI
- Insured `s id can`t have any dashes, spaces etc (only a-z 0-9)
- 98940 / 98941 -> AT first modifier and leaves the second as it is
- Box 24e(diag pointer) must have only number 1
- Word NONE needs to be in box 11
- Nothing in box 11a, b, c, d(dob / sex / Employer`s / insurance plan / another benefit plan)
- Date of service in box 31
10) No name
- Insured`s id can`t have any dashes, spaces etc (only a-z 0-9)
- Word NONE needs to be in box 11
- Nothing in box 11a, b, c, d(dob / sex / Employer`s / insurance plan / another benefit plan)
- 989`s -> AT first modifier, and leaves the second as it is
11) Group # in Box 33b w/1B qualifier
- Group number in box 33b with 1B qualifier
12) Main clinic info in Box 33
- Put the main clinic info in box 33
- Copies the info from box 32a to 33a and 32b to 33b(NPI and other id number)
13) Bureau of Worker`s Compensation in Ohio
- Puts the provider ID in box 25 (along with keeping it the same for 24j)
- Put the doctors name and date in box 31
- Doesn`t have anything in 32a or 32b.
- Put the clinic info in box 33(group NPI in 33a)
- Adds a "-00" to the tax ID in 33b
14) Clinic NPI 32a; Doctor NPI 33a
- Puts the Clinic (group) NPI in box 32a
- Puts the Doctor (individual) NPI in box 33a
15) "1B" + Group Number
- 32a blank
- 32b blank
- 33a blank
- 33b - 1B + group number
- For each line of service puts 1B + provider number in 24J
- For each line of service puts Doctor`s(individual) NPI in box 24J(NPI section)
16) EDI workaround for BCBS MA to make sure no ref segments are sent *also applies to EDI
17) Alternative address location change
- Puts the clinic main name in box 33 and the selected alternative address from box 32 to 33
18) 31, 32, 33 changes
- Doctor`s name in box 31
- Date of Service in box 31
- Put the main clinic info in box 33
- Display Clinic NPI in 32a and 33a
- 32b and 33b blank
19) Provider NPI everywhere
- 32a and 33a provider NPI
- Provider NPI everywhere
20) Box 13 is left Blank
- Signed signature authorization form for HCFA-1500 Claim Form block 12 on file
- Remove all data from box 13.
21) Resubmission/replacement code
- Edi workaround - 7 as claim frequency code
22) GroupNumber
- 32a blank
- 32b blank
- 33a blank
- 33b - group number
- For each line of service, put 1B + Secondary provider number in 24J
- For each line of service, put Doctor`s(individual) NPI in box 24J(NPI section)
23) Workaround for U.S. Dept of Labor
- eliminates the box 24_i, 24_j and insert into 33b the Group Number ID that is entered and "checked" in the Payer record in 3rd Party Payers and entered into "Providers and Payers"
24) BCBS of Oregon wants the Payer NPI only in Box 33a if it is the same in Box 32a
- More specifically, if the NPI would be the same in both boxes, enter it only into 33a
25) PO Box workaround - add only the Alternative Facility Line 1 in Box 33
26) Will put both the PO box and the clinic name in Box 33
- puts doctors name in box 31
- and copies the info from box 32 over to box 33
- Add the Alternative Facility Info to the box 33
27) Remove Loop 2010AA or Box 32 since it is the same information as on Box 33 ( Loop 2310C ) - live on 9/16/2014 (* also applied to EDI)
28) Enter total amount patient paid for service (covered services) Loop 2300 ATM02 (* also applied to EDI)
29) Combine #20 (Box 13 needs to be blank) & #28 (* also applied to EDI) (need to have any payments made by the patient appear in Loop 2300 ATM02)
30) Clinic name instead of provider name in 33
- Puts the Clinic name in box 33 instead of individual provider name
- Puts the individual provider name in box 31 along with claim DOS
- All other claim fields are kept as-is
31) EDI only workaround, Change clinic name to provider name, etc.
- Change any instance of the clinic name to the provider name
- NM1(other number)2 changed to be NM1(other number)*1
- Individual provider NPI number (NPI number from the provider and support page) to appear instead of group NPI number
32) Adds loop 2010AB (Pay-To provider) - For providers with a PO Box as the Pay-To or mailing address, a 2010AB Loop would need to be sent since a PO Box cannot be sent in the 2010AA Loop (only applied in 837) (* only applied to EDI)
33) Workaround needed to enter the Rendering Provider and Individual NPI (as NPI already in 24J) into Box 32 and 32a, as well as 33 and 33a. (* also applied to EDI)
34) Put clinic`s alternative address in both box 32 and 33(* also applied to EDI)
35) Put clinic`s alternative address in box 33(Provider`s name and alternative address) and keep main address as is (box 32 as normal)(* also applied to EDI)
36) Eliminate Box14 information (* also applied to EDI)
37) The Billing NPI should be replaced in box 33 And 32 by Provider and Payers number (* also applied to EDI)
38) Workaround that will populate the clinic`s Medicaid ID in to box 32b on both paper and EDI claims