Test Procedures: Step 1 - Pre-testing Phase
Providers currently sending paper claims who wish to submit claims electronically to UUHP must complete some initial set-up before sending their first test file. We will need the following information about your facility or providers.
Please download the Trading Partner Set-Up form and fax it to 801-587-6433 - attention EDI Coordinator.
Please review our Companion Document which will explain more about how the 837 file should be submitted to UUHP.
After receiving your EDI Trading Partner Set-Up form we will fax your UUHP assigned provider numbers for each provider and the group (when applicable) back to you.
We are expecting to find the UUHP assigned provider number in the following locations in the 4010 file.
Rendering Provider (professional claims only)
Loop 2310B, REF segment with a qualifier G2 - Provider Commercial Number
- HL*1*20*1
- NM1*82*2*PROVIDER NAME****24*876000525
- N3*35 WEST BROADWAY
- N4*SALT LAKE CITY*UT*84105
- REF*G2*76566
Billing Provider
- Loop 2010AA, REF segment with a qualifier G2 - Provider Commercial Number
- HL*1*20*1
- NM1*87*2*PROVIDER NAME****24*876000525
- N3*35 WEST BROADWAY
- N4*SALT LAKE CITY*UT*84105
- REF*G2*76566
Pay-To-Provider
- Loop 2010AB, REF segment with a qualifier G2 - Provider Commercial Number
- HL*1*20*1
- NM1*85*2*PROVIDER NAME****24*876000525
- N3*35 WEST BROADWAY
- N4*SALT LAKE CITY*UT*84105
- REF*G2*76566
Help for ProClaim Providers
If you are using ProclaimWin the UUHP assigned numbers may be added through the Provider Setup Function. You will need to go to Setup then Provider Maintenance. The UUHP assigned number needs to be added in the Provider ID column located in the bottom portion of the screen. In the Type column, click on the drop down arrow and choose Commercial ID. In the Payer column, click on the drop down arrow and choose Uhin-U of U Health Plans then click on Save prior to exiting the Provider Maintenance Screen. The UUHP unique ID numbers will need to be added for each rendering provider, billing provider, and/or pay to provider.
National Provider Identifier (NPI)
What to expect
The NPI (National Provider Identifier) was introduced as a part of HIPAA to standardize transactions between healthcare providers and health plans. Each provider's NPI will be used for all health plans nationwide; this will eliminate the various id numbers assigned by each health plan. The NPI will not replace your tax id number. The tax id number is required by the IRS and will still need to be used when submitting transactions. Each provider's NPI will be a continuous lifelong number; it will not change even if the provider changes addresses, practices, or specialties. All healthcare providers and health plans, excluding small health plans (plans whose annual revenue is less than $5 million), are required to begin using the NPI as of May 23, 2007. Small health plans are required to begin using the NPI as of May 23, 2008. As we move forward with implementing the NPI you should be informed by the different health plans of how and when to begin submitting your NPI within the different transactions. The University of Utah Health Plans is not currently accepting the NPI in EDI transactions but anticipates doing so in the near future.
There are three ways to apply for your NPI:
- You may apply for the NPI on the web at NPPES. This approach is recommended by UHIN (Utah Health Information Network) as being faster and more efficient.
- You may submit a paper application. The paper application may be found on the web at NPPES or you may call 1-800-465-3203 to request an application.
- The third way is, given your permission, an organization may apply for your NPI in an electronic file.
Once you have received your NPI, please inform all of the health plans you submit claims to including Medicaid and Medicare, of your new number. CMS has developed an instructional viewlet available on their website at NPI. The viewlet contains more information about the NPI, who it affects, and how to complete the application.