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Back  RFI # 1094: Ambulance Facility NPI Missing

Formal vs. Informal Help Informal Formal

Submitter

Keni McMurtry

Description

In 837p 4010A1, Ambulance providers were able, and in some cases required by payors, to output an NPI for the pick-up location and drop-off location (many payors dropped this requirement not long after NPI was mandated since it is difficult to provide an NPI in all cases. Some pick-up locations are scenes of accidents in which case there is no NPI to provide).

We have determined that there is no element available in 5010 for a facility NPI in our new Ambulance Pick-up and Ambulance Drop-off loops (2310e and 2310). The elements we might have used have been marked as Not Used (2310e NM109 for example).

Looking at the Service Facility Location loops (ie. 2310c), there are elements available for NPI number. However, Ambulance is advised by TR3 Notes NOT to use these loops.
We are trying to ascertain if Ambulance providers were excluded from providing a facility NPI purposefully. Can you provide any information which would shed light on the missing facility NPI as it pertains to Ambulance providers?

Response

With the addition of the Ambulance Pick Up Location and Ambulance Drop Off Location segments in version 5010, it was intentional to not use the Service Facility Location Name to report ambulance services. The Service Facility Location Name identifies specifically where the service was rendered when the location of the rendered service is different than the location of the Billing Provider. The Ambulance Location segments report Pick up and Drop off information only. The NPI of the Ambulance Service is reported in the Billing Provider or Rendering Provider Loops. Please see the Ambulance example in Section 3.1.5.

Recommendation

The functionality to report the NPI for the Ambulance Drop Off Location did not exist in Version 4010A1. Furthermore, the Work Group has never been presented with a Business case to add this functionality. If there is a legitimate need to report the NPI for the Ambulance Locations it should be brought to the Work Group for consideration in a future version.
Submission 6/30/2010
Status Date 8/13/2010
Status F - Final
Primary References
Document 222
Section2310e
PageNA
Set IDNA
Loop2310e
Segment PositionNM108