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Back  RFI # 130: 835 No middle initial

Formal vs. Informal Help Informal Formal

Submitter

Whicker Jim

Description

Payer can't say "no middle initial" and not violate an X12 rule when using the "corrected name" function in the 835.

Is the guide reporting differences in names/spelling or reporting the paid individual is DIFFERENT than the one billed.

Need guidelines that define how to report - that won't fail X12 syntax or violate guide usage. Suggest that the full NM1 segment Fist, last, AND middle initial be reported as the payer has it. Receiver to compare and identify what's different.

Submitter Assigned Keywords

835 Corrected Name NM1

Response

The X091 guide does not provide specific direction for this situation. The Corrected Patient/Insured segment is situational and the notes on usage imply to only use the first, last, and middle name elements when that specific element is changed. Sending a segment without names or IDS does not violate syntax, but it also does not convey the needed business information.

Recommendation

In order to properly identify a correction that does not have a specific component, we recommend using all name elements (NM103, NM104, NM105, and NM107) whenever the name information is different in the payers system than what was submitted by the provider. If unknown, the payer must return the appropriate data element separator.
Submission 11/9/2004
Status Date 1/6/2005
Status F - Final
Primary References
Document 004010X091
Section3
Page107
Set ID835
Table2
Loop2100
Segment Position030
Segment IDNM1
Element Position05
Industry NameCorrected Middle Name