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Back  RFI # 1505: 2310C/2310D Dupe Info

Formal vs. Informal Help Informal Formal

Submitter

Anthony DeOre

Description

I am a payer and I am trying to find out if my interpretation of the Subpart rules and the segment specific rules are correct.

1. A claim submission is considered invalid if the NPI submitted for the Rendering Provider (2310B) is the same as the NPI submitted for the Billing Provider (2010AA?)
2. A claim submission is considered invalid if the NPI submitted for the Service Facility (2310C) is the same as the NPI submitted for the Billing Provider (2010AA?)
Based on the Subpart rules and the Loop specifications.

Thank you,
Anthony DeOre

Response

The situational rule for 2310B/NM1 states "Required when the Rendering Provider Information is different than that carried in Loop ID-2010AA Billing Provider. If not required by this implementation guide, do not send." Therefore, if the rendering provider information, which is inclusive of the NPI and provider taxonomy, is the same as the billing provider, and the 2310B information is submitted, this does not comply with the TR3.

The second issue is addressed in RFI # 1210. Please refer to that RFI for your answer.
Submission 1/25/2012
Status Date 5/4/2012
Status F - Final
Primary References
Document 005010X222
Section1.10.3
Page262
Loop2310C
Secondary References
RFI ID 1961
Document 005010X222
Section1.10.3
Page269
Loop2310C