New EOB Codes for Claim Denials Related to National Provider Identifiers and Taxonomy Codes

Effective May 23, 2008, all claims must contain a National Provider Identifier (NPI) and a taxonomy code (except pharmacy claims, which only require an NPI).  Claims will deny if they are

• Billed without an NPI and/or taxonomy (unless atypical)
• Billed with MPN only (unless atypical)

The following EOB codes indicate claim denials related to NPIs and taxonomy codes:

• EOB 3091 - Billing NPI and/or Billing Taxonomy is missing. Attending NPI and/or Attending Taxonomy, when required, is missing.
• EOB 3092 - Billing NPI and/or Billing Taxonomy is missing.
• EOB 3093 - Attending NPI and/or Attending Taxonomy, when required, is missing.
• EOB 3094 - Referring NPI is missing.
• EOB 3101 - Taxonomy code for attending provider is missing.
• EOB 3102 - Taxonomy code for billing provider is missing.
• EOB 3208 - Void or adjustment cannot be processed.  Billing NPI does not match NPI on file for original provider.
• EOB 3209 - Void or adjustment cannot be processed.  Billing NPI does not match NPI filed on original claim.

The following EOB codes indicate pharmacy claim denials related to NPI:

• EOB 3106 - The NPI submitted for the prescribing provider cannot be the same as the pharmacy’s NPI.
• EOB 1801 - Service Provider ID Qualifier is not 01.
• EOB 1802 - Service Provider ID is not numeric.

The following EOB codes have been modified to include NPI-related claim denials:

• EOB 270 - Billing provider is not the recipient’s Carolina Access PCP.  Authorization is missing or unresolved.  Contact PCP for authorization or EDS Provider Services if authorization is correct.
• EOB 3007 (for Hospice) - Patient facility identification is missing, invalid, or unresolved.  Verify patient facility ID and resubmit as a new claim or contact EDS Provider Services if ID is correct.
• EOB 8326 - Attending provider ID is missing or unresolved.  Attending provider is required.  Verify attending provider ID and resubmit as a new claim or contact EDS Provider Services if ID is correct.
• EOB 2270 - Service must be referred by Carolina Access PCP, LME, or Medicaid enrolled psychiatrist.  Enter referral # on claim or contact EDS Provider Services if referral # is correct.

May 22, 2008