Since April 2017, behavioral health agencies (BHAs) have been required to report in their claims and encounters the specific site ID of the agency where a service was performed. This requirement was implemented to support institutions for mental diseases (IMD) reporting requirements [CFR 438.3(e)(2)] in addition to the CMS regulations regarding enrollee encounter data [42 CFR 438.242(c).]
This reporting requirement has not changed; however, instead of reporting the site-specific ID, BHAs must report the site-specific Department of Health (DOH) licensure number instead. This number is searchable on the Facility Search page of the DOH website.
IMPORTANT: Due to this requirement, starting March 1, 2025, CHPW will deny claims if the DOH Certification number is omitted. Should you experience a denial for omitting the DOH certification number, you could submit a corrected claim within CHPW’s timely filing limits for corrected claims (24 months) from the DOS – original claims must be filed within 12 months from the DOS.
The DOH license number must be reported as follows:
- Loop 2310C, REF*G2 Segment for 837P
- Loop 2420C, REF*G2 Segment for 837P
- Loop 2310E, REF*G2 Segment for 837I
- If paper claim, Box 19 on CMS 1500 is used to provide additional information
Additional Resources:
The Behavioral Health Data System guide (BHDG; also known as the Behavioral Health Supplemental Transaction Data Guide) references this field in “Appendix F: Instructions for submitting License Number in P1.” It states: “Please refer to the State of Washington 837 Professional and Institutional Encounter Data Companion Guide.” The BHDG is only for supplemental data in the Behavioral Health Data System (BHDS); it should not be used as a reference guide to submit encounter data.
In addition, the 837 Professional and Institutional Encounter Data Companion Guide references this field in section “3 Transaction Specifications” for loops 2310C and 2420C.
WAC 246-341-0300, Agency licensure and certification—General information, is intended to help outline the process for obtaining a license number through DOH.
For questions, please contact Provider Relations: [email protected]
