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Back  RFI # 1274: 278 PER

Formal vs. Informal Help Informal Formal

Submitter

Marcia Henderson

Description

2010B PER is situational: Required when the UMO must direct requests for addl information to a specific requester contact, e-mail, fax, or phone #. If not required by the IG, do not send."

2010B NM103 is also situational: Required when name information is needed by the UMO to identify the requester. If not required by this IG, may be provided at the sender's discretion but cannot be required by the receiver.

It seems a payer could get a 278 request with no specific requester contact information (name and phone #). It is difficult to ask questions or follow-up on a request if a payer doesn't know who to contact specifically regarding the request.

Is it a correct that the requester is the party who determines if the UMO must direct the request for addl information to a specific contact? Can a payer reject the 278 transaction (AAA03=15) if there is no PER segment at the 2010B loop? Should the payer return a response of HCR01=CT so we can obtain addl information from the requester?

Submitter Assigned Keywords

278 PER Requester Contact

Response

This issue is explicitely addressed in guide 005010X217. The 2010B NM109 is required to identify the requester and should be sufficient to identify related contact information. The related NM103 is "Required when name information is needed by the UMO to identify the requester." The 2010B PER segment is "Required when the UMO must direct requests for additional information to a specific requester contact, electronic mail, facsimile or telephone number." If the NM103 and PER segments are not present, then NM109 provides the link to the provider for identification and contact purposes. Rejecting a 278 for lack of the PER is not appropriate if the information is obtainable from the NPI. The Requester determines where questions get directed. The payer cannot reject for a missing PER unless there is need for additional information AND the provider's general contact information is not known by the UMO. If rejecting, the 2010B AAA segment would be used with AAA01 codes of 15 or 46, as appropriate.
Submission 3/15/2011
Status Date 6/1/2011
Status F - Final
Primary References
Document 005010X217
Section2010B
Page84
Set ID.