As a reminder, per the Health care Authority, behavioral health agencies (BHAs) must report the site-specific Department of Health (DOH) licensure number. This number is searchable on the Facility Search page of the DOH website.
IMPORTANT: Make sure to use this format for your DOH license: REF*G2*8-digit number; numeric only, no alphabetical characters.
Thank you for your efforts to comply with the DOH license requirements on your claims. To further assist providers, we have created the DOH Licensure FAQ below.
FAQ
In April 2025, CHPW applied a system edit to deny claims when the DOH License number is omitted. After the system edit was applied, we have monitored claims and found that most denials are relevant to the following root causes:
- The DOH license number is not placed in the correct location in the 837 electronic claims.
- The Service Facility Location NPI and Address (Loop 2310C) is the same as the Billing Provider NPI and Address, so it is being deleted by a clearinghouse.
Included below is information that can help with DOH license claims submissions.
Reporting Requirements
CHPW is currently denying for those providers where behavioral health supplemental data (BHSD) is required. As stated in the Behavioral Health Data System guide, the following are currently required to submit supplemental data:
- BHAs contracted with BH-ASO or MCO to provide BH services
- The DOH license number is not required for Adult Family Homes billing facility services (billed with HCPCS S5126)
- Freestanding E&Ts
- Non-hospital secure withdrawal management
- Stabilization facilities
The DOH license number must be reported as follows:
IMPORTANT: Use this format: REF*G2*8-digit number; numeric only, no alphabetical characters for the DOH license number.
Electronic Claims
- Loop 2310C, REF*G2 Segment for 837P (professional)
- Loop 2420C, REF*G2 Segment for 837P (professional)
CMS 1500 Paper and Electronic Claims
If you use a CMS 1500 to start the claim process, it is turned into an 837 X12 by your software vendor.
Your vendor delivers it to their clearinghouse and then it is ultimately delivered to CHPW from our clearinghouse.
Please communicate with whomever is translating the CMS 1500 into the 837 and ensure they understand that wherever the DOH licensure number is on the CMS 1500, when it is translated into the 837 the DOH must be:
- In Loop 2310C, in the NM1*77 segment located directly after the service location address, City, State, and Zip.
- The proper format is: REF*G2*12345678, substituting your actual DOH licensure number for the “12345678”.
- Numeric only, 8 digits; no alphabetical characters.
It is possible the Service Facility Location is the same as the Billing Address. Most clearinghouses will drop the Loop for the Service Facility Location if it is identical to the Billing Provider Address Loop.
CHPW has found that omitting the duplicated NPI in the Service Facility Location Loop and ensuring the NM1*77 address and REF*G2 are present after the City, State, and Zip will prevent it from being deleted as a duplication.
Professional Claims
The NM1*77 Service Facility Location segment (Loop 2310C) must be present to ensure the correct communication of the DOH license number, because without it, the REF*G2 line could be mistaken to belong to the previous Loop (2310B) which is the Rendering Provider. Both Loops 2310B and 2310C use the REF*G2 function.
The DOH License Number belongs to the Loop 2310C. If the Service Facility Location is same as the Billing location, then omit the NPI in Service Facility Location Loop, NM1*77 segment.
- Professional claim entirely at one location
If the NPI for the Service Facility Location is the same as the Billing NPI then Loop 2310C should look like this:NM1*77*2*ABC Clinic******~ (leaving off the NPI when it is the same as the Billing NPI)
N3*123 Main Street~
N4*Kansas City*MO*64108~
REF*G2*12345678 - Professional claim line if different location from 2310c
If the NPI for the Service Facility Location is different than the Billing NPI, then Loop 2310C should look like this:NM1*77*2*ABC Clinic*****XX*1234567891~
N3*123 Main Street~
N4*Kansas City*MO*64108~
REF*G2*12345678
Additional Resources
The Behavioral Health Data System guide (BHDG; also known as the Behavioral Health Supplemental Transaction Data Guide) references the appropriate 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 section “3 Transaction Specifications” references 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].
