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Back  RFI # 175: 835 Insurance type and NPI

Formal vs. Informal Help Informal Formal

Submitter

Chris Lack

Description

Since the 835 has the insurance type in the detail (CLP06), when there are no claims, it could be difficult to correctly identify the insurance type. This could be compounded by the "genericizing" of the provider number with NPI. Till now, we have used the provider number to identify the insurance type (Medicare A, B, Medicaid).

This could leave us at the mercy of senders - that they send separate RA's for each major insurance, and have different ID's for each insurance.

Submitter Assigned Keywords

835 NPI insurance type

Response

This issue is explicitly answered in guide 004010X091 in section 3 on page 53. Whether there are claims present or not, the TRN segment uniquely identifies the payer in TRN03 with the tax ID and in TRN04 with a supplemental ID that is required when needed by the payee to uniquely identify the payer. So, in your example of one company handling Medicare part A, B and Medicaid, they must either be using different Tax IDs in TRN03 for each insurance or provide supplemental information in TRN04 to uniquely identify that specific remittance as Medicare Part A, Part B or Medicaid.
Submission 1/10/2005
Status Date 2/3/2005
Status F - Final
Primary References
Document 004010X091A1
Section3-trxSet
Page73
Set ID835
Table1
Loop1000B
Segment Position080
Segment IDN1
Element Position03