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Back  RFI # 1292: 276/277 4010 2100C NM108

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 XX, SV or FI are valid codes at this level in the NM108 element.

The 4010 guide has 2 requirements attached to the NM108 element.

Code SV states “When a provider does not have a National Provider ID and Payer has assigned a specific ID number to this provider this code is required.
Code XX states “Required value if the National Provider ID is mandated for use. Otherwise one of the other listed codes may be used.

Since NPI is now mandated for use, does that mean that SV and FI are no longer valid codes in NM108? Or does the requirement for SV must also be taken into consideration and SV and XX are the only valid codes in NM108 now that the NPI is mandated?

Any help clearing up this issue would be appreciated. Thank you!

Response

This issue is explicitly addressed in guide 004010X093A1. The note on the 2100C NM108 Element Code "XX" reads, "Required value if the National Provider ID is mandated for use. Otherwise, one of the other listed codes must be used."
When the provider being identified is an atypical provider that cannot have an NPI, (and therefore the NPI cannot be mandated for use), it is required that one of the other values (SV or FI) 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 4/6/2011
Status Date 4/8/2011
Status F - Final
Primary References
Document 004010X093A1
Section3
Page67
Set ID276277
Loop2100C
Segment IDNM1
Element Position08