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Back  RFI # 1321: 834 Provider ID in 2310\NM1

Formal vs. Informal Help Informal Formal

Submitter

Julia Dunicheva

Description

In light of situational rule for elements NM108/09 and TR3 note 1 for segment NM1 in loop 2310:
1. Is it compliant with the TR3 not to send NPI in 2310/NM1 segment when such NPI is not available to sender of the transaction even though provider might have an NPI issued ?
2. Is it compliant with the TR3 to send other IDs except NPI for atypical / not-covered providers such as payer assigned ID ?

Response

When the provider is mandated to obtain a National Provider ID, the NPI must be sent. NPI’s are publicly available through the NPPES.

When a provider is atypical, an alternate identification number as assigned by the payer may be sent.
Submission 5/16/2011
Status Date 7/8/2011
Status F - Final
Primary References
Document 005010X220
Section2.4
Page155
Set ID834
Loop2310
Segment IDNM1
Element Position08