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Back  RFI # 1012: Other Subscriber Info 835

Formal vs. Informal Help Informal Formal

Submitter

Sarah Ruud

Description

For Loop 2100 Segment NM1 Other Subscriber Name there is some confusion as to whether the other subscriber could possibly be the original recipient submitted in the claim or if it truly had to be a different person. Medicaid does not have dependents set up as recipients. Each member has their own ID and file. But for other insurance that may be on file, the policy holder may be a different person (mother, father, spouse, etc) so should the NM1 name only be sent if the name of the policy holder is different than the member in the claim or sent all the time?

Submitter Assigned Keywords

other subscriber medicaid

Response

This issue is explicitly addressed in guide 005010X221. The situational rule on the Other Subscriber NM1 sehment reads "Required when a corrected priority payer has been identified in another NM1 segment AND the name or ID of the other subscriber is known."

This rule requires usage of the segment when there is a corrected priority payer and the other subscriber informatiion is known. There is no aspect of the requirement that differentiates between the other subscriber being the same person as the patient or the same person as the subscriber for the current payer.

Therefore, the other subscriber information is required whether or not the other subscriber is the patient or subscriber for the current payer.
Submission 3/31/2010
Status Date 5/21/2010
Status F - Final
Primary References
Document 005010X221
Section2
Page156
Set ID835