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Back  RFI # 1020: 270 2100B REF01=HPI post NPI

Formal vs. Informal Help Informal Formal

Submitter

A Meisheid

Description

The 4010A1 2100B REF01 note states that HPI "may be used prior to NPI mandate"; however, it does not specifically say that it CANNOT be used after NPI has been mandated. If a transaction has a 2100B NM108=XX, and NM109=validNPI, is it valid to also have the 2100B REF01=HPI with a 2nd valid NPI (different NPI)?

If not valid, what type of a rejection is appropriate?

Submitter Assigned Keywords

HPI NPI 2100B REF

Response

In the 4010A1 270/271, the REF01 value of HPI is not allowed now that the NPI is mandated for use. The NM108/NM109 elements within the 2100B NM1 segment should be used to communicate the provider’s NPI.

Recommendation

It is unclear whether the 270 or the 271 is being referenced in this question. If additional provider identifiers are needed to identify a specific provider as it relates to a member or their benefits, that provider with their respective name and/or provider ID can be sent in the NM1 or PRV segments in the 2120C/D loop.
Submission 4/9/2010
Status Date 7/30/2010
Status F - Final
Primary References
Document 004010X092A1
SectionN/A
Page54
Set ID270
Table2
Loop2100B
Segment Position040
Segment IDREF
Element Position01
Code ValueHPI