Rendering NPI Update: Tiered Copay Clarification

October 6, 2011

In our August 2011 Blue Review, we alerted you that, effective Oct. 1, 2011, inclusion of rendering provider NPIs would be required for each service line on all professional claims submitted to BCBSIL. We also stated that the rendering provider’s taxonomy code should be entered on the service line to help identify the provider’s primary servicing role. 

The August article explained that inclusion of rendering provider NPIs will help reduce the number of duplicate denials when multiple services are performed on the same day, but rendered by different providers within the same group. The article also specified that entry of the taxonomy code will enhance BCBSIL’s ability to correctly apply the member’s benefits, including tiered copays. 

Please note that rendering NPIs are still required as communicated previously. However, the enhancement to apply tiered copays has been moved to Nov. 14, 2011. 

For additional information, continue to watch the News and Updates, as well as upcoming issues of the Blue Review.