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Back  RFI # 1606: 2010AB NM Pay-To Name

Formal vs. Informal Help Informal Formal

Submitter

Mendenhall Gigi

Description

005010X222 lists the 2010AB NM103 as not used. Other Payers processing after Medicare do not always have the provider information to determine where payment should be sent; therefore the 2010AB N3/N4 is used to obtain the address. The problem is that the 2010AB NM103 is not used and the Other Payer does not have a valid Pay-To name for the check. CMS CR 3101 instructs Medicare Contractors to use their internal Provider file when creating the 2010AA & AB information sent to Other Payers. Medicare sends the Practice Name in the 2010AA NM1 and checks are being written to the Provider Name found in 2010AA NM1. This causes problems as the Practice Name could be different from the Pay-To Name and the check is not written to the correct entity. For example 2010AA NM1 will contain Family Clinic, but the Pay-To Name is Health Systems Organization. Is it correct to send the Practice Name in the 2010AA NM1 or should the Pay-To Name be in this element? Would like to see 2010AB NM103-107 allowed in a future guide.

Submitter Assigned Keywords

Pay-To Name

Response

In 5010, the Billing Provider and Pay to provider are one and the same and are reported in 2010AA Loop. If the address where the payment is to be made is different than that reported in the 2010AA Loop, the pay to address is submitted in the 2010AB Loop.

The decision of what name to use in Loop 2010AA is outside the scope for ASC X12 to comment. It would be a decision between the trading partners involved in the claim when crossing over to another payer for payment.

In order to consider supporting Loop 2010AB NM103 for Pay to Name in a future guide, a business case with additional information would need to be submitted to the work group through a DSMO request or change request. Here are the URLs to make a request, http://www.x12.org/TR3ChangeRequest/ and http://www.hipaa-dsmo.org/Main.asp.

Section 1.4.1.1. of the 5010 TR3 identifies what needs to be changed in the secondary claim. The Billing Provider information is not changed in the secondary claim and must be the same as in the primary claim.
Submission 6/13/2012
Status Date 10/21/2012
Status F - Final
Primary References
Document 005010X222
Section2.4
Page101
Set ID837
Table2
Loop2010AB
Segment IDNM1
Element Position03