Temporary Change to Claim Edit for Rendering Provider Location

Claims are currently pended when the provider location cannot be matched with the information on the provider file. The majority of claims pended for this edit are due to invalid rendering provider location. On March 2, 2015, the system will be changed to search for any active location on the provider record for which the rendering taxonomy code on the claim is valid and process the claim using that location. An Informational (pay and report) Edit 04528 RENDERING PROVIDER LOCATION CODE SET BASED ON TAXONOMY will be posted with EOB 04528 on the Remittance Advice, alerting providers to the need to update the rendering provider location on the provider record. EOB 04528 states “UNABLE TO DETERMINE RENDERING PROVIDER LOCATION CODE BASED ON THE SUBMITTED ADDRESS. LOCATION CODE HAS BEEN SET BASED ON THE RENDERING PROVIDER TAXONOMY ONLY. CONTACT THE RENDERING PROVIDER AND ASK THEM TO COMPLETE A MANAGED CHANGE REQUEST ADDING THE SERVICE FACILITY ON THIS CLAIM AS AN ACTIVE SERVICE LOCATION.�

This approach should result in a significant reduction of claims pended for invalid rendering provider location. For claims already pended for invalid rendering provider location, they will recycle after the edit change is made on March 2. No action is required by providers.

If no active location can be found on the provider record for the rendering taxonomy code, the claim will be pended for invalid rendering provider location. For more information regarding how to correct these pended claims, see the May 27, 2014 announcement on the NCTracks Provider Portal. Note that claims with invalid billing or attending provider locations will also continue to pend.

This is intended to be a temporary change to allow providers time to update their provider records with the correct rendering provider location information. The User Guide “How to Change the Primary Physical Address in NCTracks,” which explains how to update provider location information, can be found under the heading Provider Record Maintenance on the Provider User Guides and Training page of the NCTracks Provider Portal. An announcement will be posted before this temporary change is discontinued.