Wednesday, November 18, 2015

CMS 1500 box 24 H EPSDT value and 24i ID Qualifier

24h EPSDT/Family Planning (For providers participating in EPSDT and Family Planning programs only)
Valid values include: Spaces = not applicable Y = EPSDT N = Non-EPSDT


24i ID Qualifier
Shaded area: Enter ZZ when entering the taxonomy code for the servicing provider in block 24j If the rendering provider is a One to Many provider, (one NPI to more than one legacy number), enter the provider’s taxonomy code in 24j along with the qualifier ZZ in block 24i if applicable.


24j Rendering provider’s NPI in unshaded area
Unshaded area: Enter in the rendering provider’s NPI number Entry is required if the provider is a physician, CNP, therapist; a person and the payment/remit is going to a group or “pay-to” location documented in block 33 Shaded area: If the rendering provider is a One to Many provider, (one NPI to more than one legacy number), enter the provider’s taxonomy code in 24j along with the qualifier ZZ in block 24i if applicable.

25 Fed Tax ID
Enter in Tax ID #


26 Patient Account Number or Name
Alphanumeric characters may be used (maximum of 20). The account number or name will be printed on the remittance advice.

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