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Box 33

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Box 33 - Billing Provider Info

What’s in the box?

This box contains the Billing Provider’s name, address, and phone number. This information lets the Insurance company know where to direct payment.

Note that the Billing Provider can be an individual or a group/organization. This depends on how a practitioner is contracted with an Insurance company.

Where does this info live in Jane?

There are two different areas that can be used to configure box 33 on both CMS1500 and EDI files:

Option 1: Clinic Location

This is the preferred option when all practitioners at your clinic require the same information in box 33 for all Insurance companies. If more flexibility is required (i.e. some Insurance companies require each practitioner’s name in box 33), then scroll down to Option 2.

This information is set up within Settings > Clinic Info & Locations> Edit Location under the heading Billing Address. If you have multiple Locations, you’ll need to enter this information for all Locations.

Option 2: Staff Insurance Billing Settings

This is the preferred option when practitioners need a little more flexibility with box 33.

Within each Staff Member’s Billing tab, both Default Claim Information and Insurance Specific Claim Information can be configured.

Default Claim Information

If a provider at your clinic wants a custom name and/or address in box 33 (that differs from the Location Billing Info), and they want that same information for all Insurance companies they bill, then all they need to do is add Default Claim Information.

To add Default Claim Information, head to Staff Profile > Billing and click the View button beside your Default Claim Info.

To add a Custom Billing Provider Name, check the ‘Staff Member is the Billing Provider?’ box. Note that you will need to enter both a First and Last name. If you have a Custom Billing Provider Name entered, then it will be used on the CMS1500 and EDI files instead of the Location Billing Legal name.

📍Key Note: If you add a Custom Billing Provider Name to your Staff Billing Settings, you will likely also need to add a Custom Billing Provider NPI in Box 33a. If you don’t, you will likely experience rejected claims.

When you submit a Custom Billing Provider Name, you are essentially saying the billing provider is an individual. If you don’t add Custom Billing Provider NPI, then your Organization NPI (set in your location) is sent. This means you’re telling the Insurance company that the Billing Provider has an Organizational NPI but is an individual, which is quite confusing!

To add a Custom Billing Provider Address, check the ‘Use Customer Billing Provider Address?’ box. Note that all address fields will need to be completed. If you have a Custom Billing Provider Address, then Jane will use it on the CMS1500 and EDI files instead of the Location Billing Address.

Insurance Specific Claim Information

If a provider needs the same info in box 33 for most Insurance companies they bill, but there are a few Insurers that require different information, then in addition to creating default claim information, they may need to set up Insurance Specific Claim Information. This can be set up in the same way as Default Claim Information (see above).

For example, if I am contracted with most Insurers under a group/organization, but I’m contracted with Blue Cross/Blue Shield as an individual, then I can head to my Staff Profile> Billing tab, and click Add New under Insurance Specific Claim Information.

Here, you can select the Insurance company you are required to submit custom information for (ex. Blue Cross/Blue Shield) and enter a Custom Billing Provider Name and/or a Custom Billing Provider Address.

Note: The phone number listed in box 33 will always come from the phone number present in the Location (Settings> Clinic Info & Locations) where the service/sale was scheduled.

Is this required?

  • The billing provider name and address are optional when setting up a Location in Jane, but are required on the CMS1500, so should be treated as required in Jane. The phone number is optional and can be treated as optional.
  • The billing provider name and address are required when billing via EDI file. The phone number is optional.

What about the EDI file?

The Billing Provider info is sent in Loop 2010AA - Billing Provider.

  • The Billing Location Name or Billing Provider Last Name is sent in Loop 2010AA - Billing Provider,Segment NM103.
  • The Billing Provider First Name (if present) is sent in Loop 2010AA, Segment NM104.
  • The Billing Provider Address is sent in Loop 2010AA, Segments NM3 and N4.
    • Street Address line 1 is sent in N301
    • Street Address line 2 (if present) is sent in N302
    • City is sent in N401
    • State is sent in N402
    • Zip Code is sent in N403
  • The Location Phone Number is not sent in the Billing Provider Loop in EDI files.
    • The Location Phone Number is sent in Loop 1000A - Submitter Info, Segment PER04.

📍Key differences between the CMS1500 & EDI

  1. Address line 2 is not included on CMS1500s, but it is included on EDIs.
  2. Location Phone Number is only relevant to the Billing Provider on CMS1500s.
     

Box 33a - Billing Provider NPI

What’s in the box?

This box contains the Billing Provider’s NPI. This can either be the NPI of an individual (usually the Rendering Provider), or it can be an organizational type 2 NPI if the claim is being billed under a group. The NPI in this box helps the Insurer identify the individual or group billing the claim.

Where does this info live in Jane?

There are two different areas that can be used to fill box 33a on both the CMS1500 and EDI files:

Option 1: Clinic Location

This is the preferred option if all staff members at your clinic bill under the same group (Type 2) NPI to all Insurance companies. If more flexibility is required (i.e. some staff members need to send a different NPI in box 33a), then scroll down to option 2.

This information is set up within Settings > Clinic Info & Locations. If you have multiple Locations, you’ll need to enter this information for all Locations.

If a staff member does not have a Custom Billing Provider NPI configured in their Staff Profile> Billing settings, then the NPI in the Location where the service/sale took place will be used in box 33a on all claim submissions.

Option 2: Staff Insurance Billing Settings

If a provider needs a custom NPI to be sent in box 33a, or they need the same NPI but sent as an Individual/Type 1 NPI for one or more Insurers, then they’ll need to set up Default and/or Insurance Specific Claim Information in their Staff Profile Billing Settings.

Default Claim Information

If a provider needs a custom NPI in box 33a for all or most Insurers that they bill, they’ll want to set Default Claim Information.

To add Default Claim Information, head to Staff Profile > Billing and click the View button beside your Default Claim Info.

To add a Custom Billing Provider NPI & NPI Type, check the ‘Use Custom Billing Provider NPI?’ box. Be sure to add the NPI and the NPI type. If you have a Custom Billing Provider NPI entered, then it will be used on the CMS1500 and EDI files instead of the NPI that’s present in your Clinic Location.

Insurance Specific Claim Information

If a provider only needs a custom NPI in box 33a for a couple of Insurers (and otherwise wants to use the NPI in the Clinic Location or in their Default Claim Information), then they likely need to set up Insurance Specific Claim Information. This can be set up in the same way as Default Claim Information (see above).

For example, if I am contracted with most Insurers under a group/organization NPI, but I’m contracted with Blue Cross/Blue Shield with my individual NPI, then I can head to my Staff Profile> Billing tab, and click click Add New under Insurance Specific Claim Information.

Next, select the Insurance company you are required to submit custom information to (ex. Blue Cross/Blue Shield). Lastly, enter in a Custom Billing Provider NPI and NPI Type and Save.

Is this required?

  • The billing provider NPI is optional when setting up a Location in Jane, but is required on the CMS1500, so should be treated as required in Jane.
  • The billing provider NPI is required when billing via EDI file.

What about the EDI file?

The Billing Provider NPI & NPI type is sent in Loop 2010AA - Billing Provider Info

  1. The Billing Provider NPI Type (Individual/Type 1 or Organization/Type 2) is sent in Loop 2010AA, Segment NM102.
    • If the NPI Type is Individual, then ‘1’ will be sent
    • If the NPI Type is Organization, then ‘2’ will be sent
  2. The Billing Provider NPI is sent in Loop 2010AA, Segment NM109.
    • Note that the qualifier that denotes an NPI (‘XX’) is sent in Loop 2010AA, Segment NM108.
    • The qualifier ‘85’, which means Billing Provider, is sent in Loop 2010AA, Segment NM102.

📍 Key Note

If you do not have a Custom Billing Provider NPI and NPI Type in your Staff Insurance Billing settings, then the NPI in the Location will be used. The Location NPI is sent as an Organization/Type 2 NPI.

If you do have a Customer Billing Provider NPI and NPI type, you can choose to send the NPI as an Individual/Type 1 or Organization/Type 2.
 

Box 33b - Billing Provider Secondary ID

What’s in the box?

This box is used to indicate the non-NPI payer-assigned identifier of the Billing Provider. This box would be used in cases where Insurers require, for example, that claims be submitted with the Billing Provider’s Taxonomy in 33b. This box should only be used if advised by the payer.

Where does this info live in Jane?

If one or more Insurers require that you submit claims with a Billing Provider Taxonomy, then you can enter a Taxonomy within your Staff Profile> Billing> Default and/or Insurance Specific Claim Information.

If all Insurers you submit to require the same Taxonomy in box 33b, then you can just set up Default Claim Information. If only some Insurers require a Taxonomy for Billing Provider identification, then Insurance Specific Claim Information will be needed.

Is this required?

  • A Taxonomy Code is optional when generating a CMS1500 in Jane.
  • A Taxonomy Code is optional when billing via EDI file.

Note: You should only enter a Taxonomy Code if advised to do so by an Insurance company. Sending a Taxonomy Code in this box when the Insurer isn’t expecting one can cause a rejection.


What about the EDI file?

If present, the Taxonomy Code is sent in HL Loop 2000A - Billing Provider Info

  • The Taxonomy Code is sent in Segment PRV03
    • Note the qualifier ‘BI’, which means Billing, is sent in PRV01. This tells the Insurer that the ID in this segment belongs to the Billing Provider.
    • Note, that the Taxonomy qualifier ‘PXC’, which is used to tell the Insurer the non-NPI billing provider ID is a Taxonomy, is sent in Segment PRV02.