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Back  RFI # 1682: RFI # 472 - Clarity in 5010

Formal vs. Informal Help Informal Formal

Submitter

Zachary Minner

Description

Hello,
Recently there has been discussion surrounding if a Tax ID is still required to be sent in Loop 1000B - REF*TJ if an NPI is submitted in Loop 1000B - N1*PE in Version 5010 835's. The 5010 835 IG states that Loop 1000B - REF*TJ is a situational loop but based on the information in RFI # 472 it would appear that it is still very much required to be sent by payer entities. Please provide clarity on if RFI # 472 is still valid in Version 5010.

Submitter Assigned Keywords

TaxID Tax ID NPI 835 5010 REF TJ N1 PE

Response

There is no explicit direction in the 5010 835 guide.
Since the Tax ID is used to identify a provider as a tax paying entity, NOT as a healthcare provider, it is not a violation of the NPI Final Rule to report the Tax ID as the secondary identifier in the REF segment.

Recommendation

It is still the intent of the authors, as stated in prior RFI responses, that the Tax ID is necessary as the secondary identifier in the 5010 version of the TR3. It is necessary as the secondary identifier when TIN is not primary.

The rule for qualifier TJ in the Payee Additional Identifier segment states:
This information must be in the N1 segment unless the National Provider ID or the National Health Plan Identifier was used in N103/04.

If the TIN is not the primary ID in the N1, then the authors feel there is a need for TIN as Payee Additional Identifier for Tax reporting and 1099 processing because this is a financial transaction. So it is the intent that this REF be reported because the authors believe the payee is dependent upon this number for payment.
Submission 9/13/2012
Status Date 11/13/2012
Status F - Final
Primary References
Document 005010X221
Section2.4
Page107
Set ID835
Loop1000B
Segment Position1200
Segment IDREF