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Back  RFI # 1317: 835 Insured Identifier

Formal vs. Informal Help Informal Formal

Submitter

Chip Evelsizer

Description

The 835 4010A1 and 5010A1 guides both require NM108 and NM109 in the 2100 Insured Name segment. The 837 4010A1 and 5010A1/A2 guides situationally require the NM108 and NM109 in the 2010BA Subscriber Name segment (person type 1). the 837 5010A1/A2 Errata states that if NM108 or NM109 are not required, do not send. The 835 5010A1 guide also states "This segment contains the same infomration as reported on the claim". If the original 837 Subscriber NMa08 and NM109 are not sent (Org type 2), what value must be returned in the NM108 and NM109 Insured Name 835 segment?

Submitter Assigned Keywords

835 Insured Subscriber

Response

This inconsistency between the 837 and 835 guides will need to be fixed in a future version. Until then, since the 835 requires something to be populated in the Insured identifier (which may not have been sent in the 837), we recommend populating NM108 with 'MI' and NM109 with a default value of 'NONE'. While we try to avoid default values, providers should not be burdened to populate a true ID number when it is not needed.
Submission 5/5/2011
Status Date 7/22/2011
Status F - Final
Primary References
Document 005010X221
Section2.4
Page140
Set ID835
Loop2100