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Back  RFI # 1489: 2310B NM1 supporting role

Formal vs. Informal Help Informal Formal

Submitter

Cindy Monarch

Description

As part of a patient’s care management, a PCP requests one of the noted affiliated group practice nonphysician provider types (certified asthma educator, certified diabetes educator, certified health educator, clinical pharmacist, registered dietician, LPN, MS trained nutritionist; respiratory therapist, and RN) to provide patient self management education and training.
The group practice bills the PCP, not the nonphysician provider type, as the rendering because the nonphysician provider type is performing the service in a supporting role. The TR3 does not define rendering physician in the same way that NUCC does with regard to supporting roles (NUCC rendering provider definition excludes supporting roles). Is billing the PCP as the rendering in this situation considered noncompliant with the 837 TR3?

Submitter Assigned Keywords

2310B NM1 supporting role nonphysician provider type

Response

Identifying the PCP as the rendering provider in the situation described is compliant with the 837P. While there is no explicit statement either way, the intent of the authors is to use the same definition for Rendering Provider as is used by the NUCC.
Submission 1/4/2012
Status Date 5/3/2012
Status F - Final
Primary References
Document 005010X222
Section2.4
Page262
Loop2310B
Segment IDNM1
Industry NameRendering Provider Name