Box 33 requires a mailing address where the provider wants the payments to go. Billing Provider can be a business, group, or facility. The Billing Provider is instructing the insurance payor who is submitting the claims for payment and where reimbursement should be sent
Enter the provider’s or supplier’s billing name, address, ZIP code, and phone number.
The phone number is to be entered in the area to the right of the field title. Enter the name and address information in the following format:
1st Line – Name
2nd Line – Address
3rd Line – City, State, and ZIP Code
Do not use punctuation (i.e., commas, periods) or other symbols in the address (e.g., 123 N Main Street 101 instead of 123 N. Main Street, #101). Enter a space between the town name and state code; do not include a comma. Report a nine-digit ZIP code, including the hyphen. Do not use a hyphen or space as a separator within the telephone number. If reporting a foreign address, contact the payer for specific reporting instructions
Item 33 identifies the provider that is requesting to be paid for the services rendered and should always be completed.
This field allows for the entry of the following: 3 characters for area code, 9 characters for phone number, and 87 characters in the Billing Provider Info area.
A
Example For Group NPI organization
EDI 837P Mapping
Loop Name: 2010AA Billing Provider Name -> 1st Line in CMS 1500 Box 33
| Segment ID | Segment Name | Value |
| NM101 | Entity Identifier Code | 85 |
| NM102 | Entity Type Qualifier | 1 or 2 : 1 Stands for Person and 2 Stands for Non-Person Entity |
| NM103 | Name Last or Organization Name | |
| NM104 | First Name | Required when NM102 = 1 (person) and the person has a first name |
| NM105 | Middle Name | Required when NM102 = 1 (person) and the middle name or initial of the person is needed to identify the individual |
| NM106 | Prefix Name | Not used |
| NM107 | Suffix Name | Required when NM102 = 1 (person) and the name suffix of the person is needed to identify the individual |
Loop Name: 2010AA N3 Billing Provider Address -> 2nd Line in CMS 1500 Box 33
| Segment ID | Segment Name | Value |
| N301 | Billing Provider Address Line 1 | |
| N302 | Billing Provider Address Line 2 |
Loop Name: 2010AA N3 Billing Provider City, State ,zip Code –> 3nd Line in CMS 1500 Box 33
| Segment ID | Segment Name | Value |
| N401 | Billing Provider City Name | |
| N402 | Billing Provider State | |
| N403 | Billing Provider City | |
| N404 | Billing Provider Postal Code |
Loop Name: 2010AA PER Billing Provider Contact Information –> Phone Number Field in CMS 1500 Box 33
| Segment ID | Segment Name | Value |
| PER01 | Contact Function Code | IC |
| PER02 | Billing Provider Contact Name | |
| PER03 | Communication Number Qualifier | EM –> Electronic Mail or FX –> Fax or TE – Telephone |
| PER04 | Communication Number |
2010AA Billing Provider – Sample
| Field | Value |
| Practice Name | XYZ Practice |
| Practice Address 1 | 6623 REACH BLVD |
| Practice Address 2 | APT E10 |
| Practice City | Brooklyn |
| Practice State | NY |
| Practice Zip code | 112304444 |
| Practice NPI or Group NPI | 8585858585 |
| Provider First Name | Smith |
| Provider Middle Name | K |
| Provider Last Name | Sean |
| Provider Address 1 | 5537 KINGS HIGHWAY |
| Provider Address 2 | APT 6G |
| Provider City | Frisco City |
| Provider State | NY |
| Provider Zip Code | 112348888 |
| Provider NPI Number | 6565656565 |
Use case 1 :
If the practice is enrolled with the insurance company under the practice name (or Bill with Group NPI) , then the following will be printed.
N3*6623 REACH BLVD*APT E10~
N4*Brooklyn*NY*11230-4444~
NM1*85*1*Sean*Smith*K***XX*6565656565~
N3*5537 KINGS HIGHWAY*APT 6G~
N4*Frisco City*NY*11234-8888~
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