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Back  RFI # 1459: 837P 2330B NM109 2420D REF0402

Formal vs. Informal Help Informal Formal

Submitter

Rajiv Fernandez

Description

We are receiving the following data from one of our trading partners.

The file does not contain the Other Subscriber loop (2320) and hence does not have the 2330B NM1 Loop (2330B NM109 is absent). It does however, contain the 2420D NM1 loop. The 2420D REF0401/02 is populated. Should this file be rejected because of this rule on the REF0402 - "The payer identifier reported in this field must match the cooresponding payer identifier reported in Loop ID-2330B NM109" - or should this be considered "Situational Data" and ignored?

This also applies to the other 2420 REF segments and the other 837 formats.

Submitter Assigned Keywords

837P 2330B NM109 2420D REF0402

Response

The 2420x REF04 element is information related to a non-destination, previous payer, that is listed in the 2330B loop. If a claim contains information about other coverage, the 2320 Other Subscriber Information loop is required (per Situational Rule for the 2320 SBR). And, if the 2320 loop is used, the 2330B Other Payer Name loop is required. Therefore, if information is sent in the 2420D REF04 element which by definition relates to another payer, there must be 2320 and a 2330B loops. Information in the REF04-2 without corresponding 2330B Payer Name information is not compliant with the TR3.
Submission 11/29/2011
Status Date 1/13/2012
Status F - Final
Primary References
Document 005010X222
Section2420D
Page452
Table2
Loop2420D
Segment Position5250
Segment IDREF
Element Position04
Component Position02
Industry NameREF - SUPERVISING PROVIDER SECONDARY
Secondary References
RFI ID 1913
Document 005010X222
Section2330B
Page320
Table2
Loop2330B
Segment Position3250
Segment IDNM1
Element Position09
Industry NameNM1 - OTHER PAYER NAME