Important Billing information for CAHs Paid Under Optional Method Regarding PCIP - TrailBlazer

Critical Access Hospital (CAH) providers were instructed to submit their National Provider Identifiers (NPIs) using the “other provider” field located in loop 2310C on the 4010A1 electronic claim format effective April 1, 2012. With the implementation activities to convert from the Accredited Standards Committee (ASC X12) Version 4010A1 to the Version 5010A2 format, loop 2310C was redefined to mean “other operating physician.” For providers using the 837I 5010A2 format, the correct loop is 2310D, “rendering physician”; however, Medicare systems are not updated to assign Primary Care Incentive Payment Program (PCIP) bonus payments to the NPI reported in this field. As a result, CMS plans to update system and billing instructions to address this change. In the meantime, to ensure there is not a delay in the PCIP bonus payments, CAH providers shall continue to submit claims using the “other provider” field, loop 2310C rather than in loop 2310D until further notice from CMS. For more information, click here.