Medicaid Billing Requirements Reminder for Home and Community-Based Waiver Services Providers

Date: 11/12/25

The information in this notice applies to Home and Community-Based Services (HCBS) Provider types 90 (Aging), 92 (Persons with Disabilities), 93 (HIV/AIDS) and 98 (Traumatic Brain Injury), who deliver services for the HealthChoice, YouthCare and MMAI (DSNP effective 1/1/2026).

For all claims received on or after 11/20/2025, Meridian will begin validating CMS 1500/837P claims for accurate Medicaid Provider ID numbers. If your claim fails to meet the expectations (see below and in the IAMHP Comprehensive Billing Guide), your claim will be denied with EXWT- WAIVER MUST BILL WITH MEDICAID NUMBER NOT NPI* or EXM1 DENY: NO MEDICAID PROVIDER NUMBER ON FILE**

When billing HCBS services, the provider should only use their Medicaid Provider ID and should NOT send in an NPI on the claim. Further, MCOs require that the Medicaid Provider ID used on the claim matches the provider’s IMPACT registration for the type of waiver service billed. For example, a Medicaid Provider ID registered in IMPACT as an Aging waiver service provider should not be used on a claim for a member who has a TBI waiver.

A valid Medicaid ID must be on the 837P Loop 2010BB in a REF01 Segment qualified by ‘G2’ and the REF02 equal to the provider’s Medicaid ID as registered in IMPACT for their respective waiver provider type.

If the provider has multiple registrations with HFS for provider types outside of the HCBS service realm, the provider should ONLY bill their NPI on the claim for NON-HCBS services.

For example, if the provider is registered as a Home Health provider type (050) and is also registered as a HCBS service provider (090), when billing for Home Health services the provider will bill on an 837I claim format using their NPI in the 2010AA Billing Loop. When billing for HCBS services, the claim must be on an 837P, and use the Medicaid Provider ID, and not an NPI. Refer to the IAMHP Billing manual Home Health section for billing rules to MCOs.

If you are registered with HFS as Provider Type 090, 092, 093 or 098, please be sure to follow the guidance noted in the Home and Community Based Waiver Services section of the IAMHP Comprehensive Billing Guide Section (see section F: Coding Requirements).

837P Submission Guidelines:

Paper Claim CMS-1500	HIPAA 5010 837P Loop	HIPAA 5010 837P Segment	Waiver Reimbursement
Box 24b	2300	CLM05-1	Place of Service Code
Box 24f	2400	SV1-02	Appropriate procedure code as indicated in the coding grid above
Box 24j	2310B	NM1-09	Should not submit
Box 31	DOES NOT MAP IN THE 837	DOES NOT MAP IN THE 837
Box 32	2310C	NM1	Service Facility Location Information
Box 33	2010AA	Do not send NPI in NM109 – See 2010BB Loop below	Registered HCBS Organization Name, billing address, HFS Medicaid ID, and applicable taxonomy (as registered in IMPACT). Per X12 EDI guidance NO P.O. Boxes or LOCK box permitted in this loop (2010AA)
Box 33B	2010BB	REF01 = G2 REF02 = Provider’s HFS Medicaid ID	HFS Medicaid ID for provider Example 2010BB example: REF*G2*Provider HFS Medicaid ID Paper Example
Pay to Provider No field for this on CMS 1500	2010AB	NM1*87	Pay to Provider Address (P.O. Box or Lock Boxes acceptable in this loop) **

Example of a correctly billed HCBS Waiver claim- no NPI billed, only the Medicaid ID:

Example of incorrectly billed HCBS Waiver Claim, do not bill an NPI, use your Medicaid ID:

Example of incorrectly billed HCBS Waiver Claim: Only bill the HFS Medicaid ID- Do not bill NPI

Claim billed incorrectly- Only bill the HFS Medicaid ID- Do not bill the NPI as well

For questions please contact Provider Services at 866-606-3700 or reach out to your Provider Engagement contact. For more information on billing requirements download the IAMHP Billing Guide (PDF).

* CARC A1
** CARC 16/RARC M56