MN–ITS Help – 837D, 837I & 837P Billing Provider Information

The table below describes the individual fields on the Provider Information screens. MN_ITS auto-populates the information on this screen using the current MHCP enrollment data from the login NPI/UMPI. * The Field Name column identifies X12 loops and elements only for fields that display in the MN-ITS screens. Refer to the X12 HIPAA Companion Guides available through the WPC X12 Registry for additional instruction when submitting batch claims.

Select MN–ITS User Guides to obtain additional instruction for submitting claims for specific services using MN–ITS Direct Data Entry (DDE).

Field Name *
(X12 Loop & element)

Valid Values

Character Length

Field Description

Organization
(Loop: 2010AA, NM103 (last or organization)
NM104 (first)

 

35
(alphanumeric)

Billing Provider or Organization Name

The Billing Provider may be an individual only when the health care provider performing services is an independent, unincorporated entity. In these cases, the Billing Provider is the individual whose Social Security number is used for 1099 purposes

Taxonomy
(Loop: 2000A, PRV03)

 

10
(alphanumeric)

This field only displays information when a Health care provider specialty/location code has been added to the provider file.

If multiple taxonomy codes have been added, additional information will display. Select the radial button to identify appropriate location for this claim.

Address 1
(Loop: 2010AA, N301)

 

28
(alphanumeric)

The first address line reported on the provider file

Address 2
(Loop: 2010AA, N302)

 

28
(alphanumeric)

The second address line reported on the provider file

City
(Loop: 2010AA, N401)

 

18
(alphanumeric)

The city name for the address in address fields 1 and 2

State
(Loop: 2010AA, N402)

 

2
(alpha)

The state name for the address in address fields 1 and 2

Zip
(Loop: 2010AA, N403)

 

6
(alphanumeric)

The zip code for the address in address fields 1 and 2

Telephone
(Loop: 2010AA, PER04)

 

10
(numeric)

Telephone number reported on the provider file