Box 19 is used to identify additional information about the patient's condition or the claim. As of January 1, 2023, Arizona Medicaid requires Behavioral Health providers to add participating provider information into box 19 when the providers rendering the services are different from the provider on the service line.
To populate Box 19 for Professional Services:
- Ensure any provider that needs to be placed in Box 19 has the Medicaid Registerable toggle enabled on their profile under Practice Admin > Rendering Providers.
- Click on the Name of the Rendering Provider and click Edit on the Baseline.
- Enable the Is Medicaid Registerable toggle and click Save.
If the selected Additional Rendering Provider has the Medicaid Registerable toggle set to Yes in their profile, “XXNPIProviderLastName, FirstName” will be added to Box 19
If the selected Additional Rendering Provider has the Medicaid Registerable toggle set to No in their profile, “999999999999ProviderLastNameFirstName” will be added to Box 19
- Standalone Services: For Standalone Services, you can select up to 2 rendering providers for Box 19 under the Additional Providers section when creating or editing the service on the Attendance Calendar.
- U/R Required Services: For U/R Required Services, you can select up to 2 rendering providers for Box 19 under the Additional Providers section when creating or editing the service on the Attendance Calendar.
Already Submitted Services: To add an additional Provider when updating a new service, un-submit the attendance by clicking on the Lock icon and clicking on the Edit icon to edit the existing date of service.
From there, follow the same steps of adding an additional provider to a claim before resubmitting.
Resubmitting the Claim
Once you've added Rendering Providers, you can go to the Work Center > Create Corrected Claims to create a Corrected Claim with the updated Box 19 information.
Loops 2300/2310a-d, Segment NTE/PWK/REF 01/REF 02