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Back  RFI # 1613: Patient Identifier in 835

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Submitter

Chip Evelsizer

Description

The 005010X221A1 Patient Name segment TR3 note #2 states that the segment must provide the information from the original claim. The NM109 element situational rule in the Patient Name segment states that the element is required when the patient identifier is known or was reported on the healthcare claim. If the 5010 837 claim is submitted (e.g. 005010X222A1), contains a 2010CA loop with a Property and Casualty Patient Identifier REF segment, is this patient identifier (e.g. social security number) required to be returned in the 835 NM109 Patient Name segment because it is both known and has been reported in the healthcare claim?

Submitter Assigned Keywords

Patient 835

Response

The NM109 element situational rule in the.835 Patient Name segment states that the element is required when the patient identifier is known or was reported on the healthcare claim. If the 5010 837 claim is submitted with a 2010CA loop with a Property and Casualty Patient Identifier REF segment, this patient identifier (e.g. social security number) was sent, and is known, then it is returned in the 835 NM109 Patient Name segment.
Submission 6/20/2012
Status Date 8/10/2012
Status F - Final
Primary References
Document 005010X221
Section2.4
Set ID835
Table2
Loop2100