RFI Browser

Back  RFI # 1475: 5010 837I Rendering Issue

Formal vs. Informal Help Informal Formal

Submitter

matthew klischer

Description

The 5010 837I TR3, the 2310D/2420C Rendering NM1 has the following:
Situational Rule: Required when the Rendering Provider is different than the Attending Provider reported in Loop ID-2310A of this claim.
AND
When state or federal regulatory requirements call for a “combined
claim”, that is, a claim that includes both facility and professional
components (for example, a Medicaid clinic bill or Critical Access
Hospital Claim.)
If not required by this implementation guide, do not send.
Medicare is trying to develop edits to determine when to accept/reject this NM1 and we cannot find what exactly constitutes a “combined claim”. What criteria would identify a claim with both facility and professional components?
A CAH claim is an example and is identified by a specific institutional bill type, but we need to know what other bill type(s) or other criteria to identify all claims that are affected by this situational rule so when we cross over claims to our COB trading partners we are compliant.

Submitter Assigned Keywords

rendering

Response

Facility and professional components are identified by revenue codes which are maintained by the NUBC and can be found in the UB-04 manual. The State and Federal regulations dictate what information should be included and under what circumstances a claim should have facility and professional components combined on one bill. The NUBC does not define the criteria, it defines codes which are used as part of the criteria.
Submission 12/15/2011
Status Date 2/9/2012
Status F - Final
Primary References
Document 005010X223
Section2320D
Page336
Loop2320D