Rendering Provider Reporting - CMS 1500 Box 24J

Date: 06/03/26

Reminder: Correct Rendering Provider Reporting - CMS 1500 Box 24J

Arizona Complete Health-Complete Care Plan has recently identified instances where Box 24J (Rendering Provider NPI) is reported with a supervising physician (MD/DO), while the service was likely rendered by a mid-level practitioner (e.g., NP or PA).

Billing Requirement

AHCCCS requires that professional claims follow CMS-1500 completion standards, including accurate reporting of the rendering provider.

Per AHCCCS Provider Billing Manual “A servicing (rendering) provider is the provider who actually performed the services for/to an AHCCCS eligible member. For purposes of AHCCCS claim submissions, the servicing (rendering) provider cannot be an AHCCCS registered provider type of “01,” a Group Billing Entity.”  Reference: https://www.azahcccs.gov/PlansProviders/Downloads/FFSProviderManual/FFSChapter3ProviderRecordsandRegistration.pdf

Box 24J must reflect the NPI of the individual provider who rendered the service. There are exceptions to this, some provider types are permitted to bill using the Clinic’s NPI in Box 24J, those Provider Types include but are not limited to Integrated Clinics (IC), Behavioral Health Outpatient Clinics (77), General Clinics (05), and FQHCs (C2).   

Summary

Accurate reporting of the rendering provider NPI in Box 24J is required for AHCCCS claim compliance. The NPI must represent the provider who actually delivered the service, not a supervising physician.

Questions? Contact your Provider Engagement Account Manager. Need their contact information? Email us at:

📧  AzCHProviderEngagement@azcompletehealth.com.

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