This update introduces new functionality allowing users to override NPI values for Box 32a and 33a based on the Client Zone Address, similar to the existing logic for zone-based address for these fields.
Overview of the Feature
This functionality allows organizations to dynamically override the NPI for Box 32a and/or 33a on CMS 1500 and ANSI 837 claims based on the client’s assigned zone, rather than a static NPI based on site or funding source settings.
This override only becomes available when Client Zone Address is selected in the Site Funding Source settings for Box 32 and/or 33.
How It Works
Triggering the Override Option
Navigate to Site Settings > Service and Rate > Site Funding Sources
Under Box 32 and Box 33 Configuration, select Client Zone Address
When this is selected:
You’ll see two additional checkboxes:
Client Zone 32a Override
Client Zone 33a Override
What These Do
If either checkbox is enabled, the system will pull the NPI from the assigned Client Zone, not from site or funding source.
The NPI is pulled from Zone Settings > NPI Override fields for 32a and/or 33a.
If a tilde symbol
~is used in the NPI override field, the value will be left blank in the ANSI file.
(This mimics existing NPI-blanking behavior in Funding Source settings.)
NPI Pulling Precedence (for both 32a and 33a)
The system checks:
Funding Source NPI (CMS1500_32a or CMS1500_33a)
Zone NPI Override (if box checked)
NPI set at the Site level
Visibility in Claims
When Client Zone 32a/33a Override is enabled, the NPI override will show on the following claim formats:
CMS 1500
ANSI/837 file in (Loop 2310C, Element 09 for Box 32 and Loop 2010AA, Element 09 for Box 33)
Office Ally Text File
Notes
This logic only triggers when Client Zone Address is selected for Box 32/33 and the corresponding checkboxes in Site Funding Source Settings are checked
Applies to Primary Billing only for the time being. Secondary billing soon to come!