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Back  RFI # 1546: Srvc line referring provider

Formal vs. Informal Help Informal Formal

Submitter

Kim Oberbroeckling

Description

I have a question about the 2420F loop. According to the 837P TR3, the 2420F referring provider loop should only be sent if it is different than what is sent in the 2310A.

Here's the scenario:
I have a claim with three service lines and there is no claim-level referring provider and only one service line has a referring provider; that service line referring provider applies only to that service line. When I format the claim, I am not creating a 2310A referring provider loop as there is no referring provider that applies to the entire claim. I am sending a 2420F referring provider loop for the one service line that has a referring provider. The clearinghouse I am sending to is rejecting the claim stating that a 2310A loop must exist in order to send a 2420F loop. Is that correct? Must a 2310A loop be present in order to send a 2420F loop? How do you report a claim where only one service line has a referring provider?

Submitter Assigned Keywords

837P, 2420F, 2310A

Response

The intent of the situational rules for referring provider, as well as others within the claim is that the provider information needs be submitted at the claim level unless the provider for any given service line is different than that reported at the claim level.

Recommendation

If there is a mixture of services submitted on the claim where some require a referring provider and some do not, the recommendation is to split the claim between those services that do require a referring provider and those that do not, if it is known to impact the payer’s adjudication
Submission 3/19/2012
Status Date 5/2/2012
Status F - Final
Primary References
Document 005010X222
Section2.4
Page468
Set ID837P
Loop2420F