Provider Alert from Colorado Access

We have noticed a claims trend where providers are billing a mismatched NPI/TIN combination when billing their claims and/or missing a rendering provider. Our new claims system is better equipped to catch this billing error. For this circumstance, claims are being denied appropriately per billing standards. These claims can be corrected and resubmitted for payment. If you have questions about this or have other claims issues please contact your provider network services manager.

If you received a denied claim for this reason, please refer to the instructions and diagrams for how to submit a corrected claim. Note: There are separate instructions and diagrams.

Diagram 1 - Utilize if you bill with EIN/TIN Numbers.

Diagram 2 - Utilize if you bill with Social Security numbers.

Resubmitting A Corrected Claim For EIN/TIN Billers

Make sure to enter your entity/business name and National Provider Number (NPI) in box 33a rather than your individual name and NPI.

If you need to correct a claim to receive payment:

Make sure the corrected claim lists resubmission code 7 and the denied HealthRules Payor (HRP) claim number in the Original Ref No. field in box 22.
Enter the entity/business Name and NPI in Box 33a.

See the below illustration for more information.

Health Insurance Claim Form

Box 22 - Resubmission code 7 (corrected claim)

Original reference no. field must contain the original denied claim number.

Box 24 J – Enter the individual NPI of who rendered the service. If it was an unlicensed provider, list the supervising provider's NPI here.

Box 25 – Enter your Tax ID

Box 32 – This should be the business address of where the services were rendered.

Box 33 – Enter the business name as filed with the IRS.

Box 33a - List the business organizational NPI here.

Resubmitting A Corrected Claim for Social Security Billers

Boxes 32 and 33 should contain the individual name and NPI, not a business name.

How to take action and correct the claim to obtain payment:

Make sure the corrected claim lists resubmission code 7 and the denied HealthRules Payor (HRP) claim number in the Original Ref No. field in box 22.
Enter the Individual Name and Individual NPI in Box 33 and 33a.

See the below illustration for more information.

Health Insurance Claim Form

Box 22 - Resubmission code 7 (corrected claim)

Original reference no. field must contain the original denied claim number.

Box 24 J – Enter the individual NPI of who rendered the service. If it was an unlicensed provider, list the supervising provider's NPI here.

Box 25 – Enter Social Security number and also check the SSN Indicator (NOT the EIN indicator).

Box 32 – This should be the business address of where the services were rendered.

Box 33 – Enter the Individual rendering name and address.

Box 33a - The Individual NPI must be listed here.