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Back  RFI # 1289: 276/277 NPI use

Formal vs. Informal Help Informal Formal

Submitter

Malene Davis

Description

Our validation software vendor is interpreting the usage of the NPI, Tax ID, and Service Provider Number differently then we are. We are requesting interpretation of the 2100C NM1 segment to help clarify this issue. It is our belief that SV or FI are valid codes at this level in the NM108 element. Unlike the 270/271, there is no entity identifier code (NM101) other then 1P for provider, so there is no way for a provider to be identified as a health care provider covered under NPI or a non-covered entity. All TR3 notes on the NM1 segment and element notes on the NM108 segment do not indicate that a non-covered entity is not allowed to submit a 276 and the NM108 explicitly states that if the provider of service is not a health care provider covered under NPI to use one of the code other then XX. Any help clearing up this issue would be appreciated. Thank you!

Response

This issue is explicitly addressed in guide 005010X212. The note on page 51 for the 2100C NM108 Element Code "XX" reads "Required value when the National Provider ID is mandated for use and the provider is a covered health care provider under the mandate. Otherwise, one of the other listed codes must be used."

Therefore, when the provider being identified is an atypical provider that cannot have an NPI, it is required that one of the other values be used in NM108 to provide the appropriate identification code qualifier. The related value in NM109 must then correspond to that qualifier designation (Federal Taxpayer's Identification Number or Service Provider Number).
Submission 3/31/2011
Status Date 4/4/2011
Status F - Final
Primary References
Document 005010X212
Section2.6
Page49
Set ID276277
Loop2100c
Segment IDNM1
Element Position08