Referring Provider And POS

Referring Provider Information

Effective July 1, 2004, anesthesia providers must submit the UPIN number of the referring surgeon/physician on the claim. If you file hard copy, the UPIN number should be populated in block 1 7a of the CMS 1500 claim form. For those who file electronically, you should submit the referring surgeon/physician’s UPIN number. This is necessary for proper claims processing.

Anesthesiologists should use OTH000” as the referring or attending UPIN number for providers who are not assigned a UPIN number by Medicare. For example, when providing anesthesia services for recipients who are being treated by dental providers, please use OTH000” as the UPIN number in block 1 7a of the CMS 1500 form. Use OTH000” and the ID qualifier 1 G when filing claims electronically.  As a reminder, claims for anesthesia providers not containing this information will deny.

Place of Service Codes
The following place of service codes apply when filing claims for CRNP services:

POS Code                Description
11                              Office
12                              Home
22                              Outpatient Hospital
25                              Birthing Center
26                              Military Treatment Facility
31                              Skilled Nursing Facility or Nursing Facility
32                             Nursing Facility
33                             Custodial Care Facility
54                             Intermediate Care Facility/Mentally Retarded
71                             State or Local Public Health Clinic
72                             Rural Health Clinic

Required Attachments

To enhance the effectiveness and efficiency of Medicaid processing, your attachments should be limited to the following circumstances:

•  Claims With Third Party Denials

NOTE: When an attachment is required, a hard copy CMS-1500 claim form must be submitted.