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Back  RFI # 1480: 5010 Billing Provider NPI

Formal vs. Informal Help Informal Formal

Submitter

Tami Drew

Description

I am asking for clarification of the TR3 Notes for Loop 2010AA. (Page 87 of the 5010 IGGuide)
I am interpreting these notes to say that all providers must begin billing with same NPI to all payers, and that you can only bill with an Individual NPI if you are a sole proprieter and do not have a group NPI, otherwise, you must bill to all payers with the group NPI.
I have spoken to several of my payer contacts that are also interpreting it that way. However, I have a client in TN that is disputing this and stated that their TN BCBS Representative told them they can still bill to them with their Doctors' Individual NPI, even though they bill to all other payers with the practices Group NPI.
Can I get confirmation one way or the other as to what these notes in the IG Guide are saying? Any literature I can pass on to my clients would be most appreciated regarding this topic. thanks!

Response

You are correct, the group NPI must be submitted in the 2010AA Billing Provider Loop as explicitly addressed in TR3 note #4 of the NM1 segment in TR3 005010X222A1. It is further addressed in section 1.10.4 Subparts and the 2010 AA - Billing Provider Name Loop
Submission 12/16/2011
Status Date 2/27/2012
Status F - Final
Primary References
Document 005010X222
Section2.4
Page87