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Back  RFI # 1797: 835 Rendering Provider

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Submitter

Peggy Billhartz

Description

5010 835 - If an 837 Institutional claim is received with a Rendering Provider and that Provider is stored in the system, but is not used by the system to adjudicate the claim, does that Rendering Provider need to be returned on the 835 for that claim?

Submitter Assigned Keywords

835 Rendering Provider

Response

The Situational Rule of the Service Provider Name segment reads: "Required when the Rendering Provider is different than the payee. If not required by this implementation guide, do not send." If the Rendering Provider is different than the payee, then it is required to be sent in the 835. If the Rendering Provider is the same as the payee, then the Rendering Provider must not be sent. This situational rule applies whether rendering provider information is used during adjudication or not.
Submission 5/22/2013
Status Date 6/21/2013
Status F - Final
Primary References
Document 005010X221
SectionTable 2
Loop2100
Segment IDNM1
Industry NameService Provider Name