RFI Browser

Back  RFI # 1156: Interpretation of 2310D usage

Formal vs. Informal Help Informal Formal

Submitter

Stacey Bickford

Description

In 837p 4010A1, loop 2310D is defined as “Service Facility Location”, required when the location of the health care service is different than that provided in loop 2010AA. Some payors are rejecting Ambulance claims, requiring an NPI to output in loop 2310D NM109 at all times. Some ask for the NPI of the pick-up facility, impossible if it was a “Scene of accident” or “Residential” pick-up. Some are requiring “Billing Provider NPI” in this field. This would be a duplication of loop 2010AA NM109 output. In addition, one payor is requesting the Billing provider’s NPI plus a 3 digit “Location Indicator” added to the NPI to further clarify which location (if the provider has numerous sites) provided the transport. It has been suggested that “Transportation Type Providers” should not need to output this information. Some payors have dropped this requirement since it is difficult to provide an NPI for all claims. We feel that this goes against the Guide’s intent. Can you provide clarification please?

Response

In the 4010A1 transaction for ambulance services, the Service Facility Location loop is used to report the pick-up location. An NPI is not reported in that loop unless the pick-up location was a facility that has an NPI and the biller knows that identifier. Sending the Billing Provider NPI in the Service Facility Location loop is inconsistent with the Implementation Guide. Furthermore, in all loops where the NPI is used, including the Service Facility Location loop, the value must be the 10 digit NPI without additional suffixes or prefixes.
Submission 9/22/2010
Status Date 12/8/2010
Status F - Final
Primary References
Document x098A1
Section3
Set ID837P
Table2
Loop2310