RFI Browser

Back  RFI # 1757: Locum Tenens 2

Formal vs. Informal Help Informal Formal

Submitter

Claudette Sikora

Description

CMS thanks the ASC X12 for working with us to identify both the locum tenens and absent provider on a claim. The workaround included identifying the locum tenens provider in the Rendering Provider Loop, which requires an NPI to identify the provider if the provider is eligible to receive one. The CMS Office of General Counsel has indicated that CMS cannot require providers not enrolled in Medicare to obtain NPIs, and there may be locum tenens providers not otherwise required to obtain an NPI (e.g., submit own claims only on paper). Because locum tenens providers need not be enrolled in Medicare and because they may not necessarily have an NPI, there will be situations where the locum tenens provider cannot be identified in the Rendering Provider Loop.

CMS requests an amendment to permit identifying the locum tenens provider with a universal identifier (e.g., social security and/or state medical license) or a new workaround that will allow identifying the locum tenens provider without an NPI.

Submitter Assigned Keywords

locum tenens absent provider Medicare

Response

The 2310B REF Rendering Provider Secondary Identification segment is "Required on or after the mandated NPI Implementation Date when the NM109 in this loop is not used and an identification number other than the NPI is necessary for the receiver to identify the provider". If this situation is met, then this segment must be sent.
Submission 2/26/2013
Status Date 4/9/2013
Status F - Final
Primary References
Document 005010X222
Section2.4
Page262
Set ID837
Table2
Loop2310B
Segment Position2500
Segment IDNM1
Element Position09
Industry NameRendering Provider Identifier
External Code ListCode Source 537
Secondary References
RFI ID 2226
Document 5010X222
Section2.4