For additional questions or assistance from the Network Development and Provider Relations team, please visit the Provider Assistancepage and complete a Provider Ticket Submission Form.
HealthSmart is PHP’s Third-Party Administrator (TPA). HealthSmart provides various management services for Partners Health Plan (PHP) including, but not limited to, claims processing.
Contact HealthSmart EDI Support at 1-888-744-6638. You will have to complete an EDI enrollment form, as well as, a User License Agreement to begin the submission process.
This code identifies that you have submitted a procedure code which requires the NDC Code, Qualifier, and Units for which you did notsubmit any or all these data elements on your claim submission.
This identifies that you have submitted a procedure code which requires the NDC Code, Qualifier, and Units for which you did not submit any or all these data elements on your claim submission.
New York State Department of Health (NYSDOH) mandates that all Managed Care Plans must report National Drug Codes (NDCs) for all physician-administered drugs.
All physician-administered drugs, by all provider types, require a valid 11-digit NDC number and the applicable quantity and measurement. This includes all J-codes and all other applicable drug codes (i.e., chemotherapeutics, therapeutics, etc.).
In either the 837I or 837P format providers must report the 11-digit NDC and its corresponding information, in addition to the procedure code, in the LIN segment of Loop ID 2410 to specify the physician-administered drug that is part of the service described in SV1 forthe 837 format. Providers must also report the quantity and unit of measure of the NDC as outlined in the table below:
CMS-1500 Box 24A example: NDC qualifier (N4) + NDC (11-digits) + unit of measurement qualifier (UN) + unit quantity (1)
UB04 FL 43 example: NDC qualifier (N4) + NDC (11-digits) + unit of measurement qualifier UN) + unit quantity (1)
*The following are the only acceptable values forsubmission as a Unit of Measurement Qualifier: • GR (gram) • ML (milliliter) • ME (milligram) • UN (unit) • F2 (international unit)
On an Institutional UB-04 claim you should submit as a corrected claim, which is identified by utilizing the applicable Bill Type ending in ‘7’ to designate as corrected (i.e., XX7, 137, 737, etc.)
On a Professional CMS-1500 claim you should mark the claim as corrected and include the original claim number in Box 22 ‘Original Reference No.’.
All resubmissions/corrected claims should include all original claim lines, not just the correction to the physician-administered drug claim line.
The Partners Health Plan Network Development and Provider Relations team is here to assist you with your billing, claims, authorization, education, and any other general inquiry. Use the Contact Us button below to complete a Provider Ticket Submission Form.
H9869_PHPWeb_Provider FAQ and Reference Guide_2022_Pending
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