Continuing with our review of medical billing formats, we're going to cover NSF 3.01 format for the BA0 record, fields 13 - 28 which will conclude our coverage of the BA0 record, which is for provider data.
BA0 field 13, positions 90 - 104, is the provider CHAMPUS number. Not a lot of people, even those in the medical billing field, know what CHAMPUS is. CHAMPUS stands for Civilian Health And Medical Program for the Uniformed Services. This field is the assigned number that the provider needs to send if they are sending a CHAMPUS claim, which isn't very common.
BA0 field 14, positions 105 - 119, is the provider Blue Shield number. This is the number that needs to be sent if the provider is sending a claim to Blue Shield.
BA0 field 15, positions 120 - 134, is the provider commercial number. This is the number that needs to be sent if the provider is sending a commercial claim. A commercial claim is one that would go to a place like Prudential or Mutual Of Omaha.
BA0 fields 16 and 17, positions 135 - 164, are the provider other numbers. These are other provider numbers assigned for sending claims to companies that don't fall into any of the regular categories or if a provider has more than one Blue Shield or commercial number.
BA0 field 18, positions 165 - 197, is the provider organization name. It is critical that the name entered here be the full name and not some nickname like Pru Life. It must be the legal name of the company.
BA0 field 19, positions 198 - 217, is the provider last name. This is in case the provider isn't a clinic and is an actual doctor. His last name must appear here. Field 20 is the doctor's first name and also follows the same rules as does field 21 which is his middle initial.
BA0 field 22, positions 231 - 233, is the provider's specialty. This is actually a code that the doctor can get from a list of specialties that carriers accept.
BA0 field 23, positions 234 - 248, is the provider's specialty license number. Each provider that has a particular specialty, such as gastroenterologist, is given a license number. This number must be filled in here.
BA0 field 24, positions 249 - 263, is the provider's state license number. This is the number of the license that allows the provider to practice medicine in that particular state. This must be filled in.
BA0 field 25, positions 264 - 278, is the dentist license number. This is only filled in if the provider happens to be a dentist. This is important because dental claims are processed differently from regular claims such as DME claims.
BA0 field 26, positions 279 - 293, is the Anesthesia License Number. This is only filled in if the provider is an anesthesiologist.
BA0 field 27, position 294, is the provider participation indicator. This tells whether or not the provider is a participant in that particular program such as Medicare.
BA0 field 28, positions 295 - 320, is national filler and must be blank or the claim will be denied.
This concludes our review of the BA0 provider record.