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Back  RFI # 1861: 2310B Rendering Provider

Formal vs. Informal Help Informal Formal

Submitter

Stacey Bickford

Description

NY Medicaid requires the use of 2310B to indiate the license plate number for non-emergency transportation providers. Per the 5010 837P IG 2310B Situational Rule "This information can only be required if different than the Billing provider 2010AA loop". Transportation providers are being forced to duplicate the 2010AA information in 2310B to allow for a REF, with a G2 indicator, to indicate the drivers license number and advising this is a valid requirement because Non-emergency transportation providers in NY are considered a-typical providers. Can you please clarify if this can be required for a-typical providers although it is against the IG?

Submitter Assigned Keywords

Rendering Provider, 2310B, a-typical providers

Response

The answer to your question depends on whether the billing provider and rendering provider are the same entity.

The 005010X222A1 837 Professional Technical Report Type 3 states that the 2310B Rendering Provider Name loop is ‘Required when the Rendering Provider information is different than that carried in Loop ID-2010AA Billing Provider. If not required by this implementation guide, do not send.’

Therefore, if the rendering provider is the same entity as the billing provider, the rendering provider information is not to be sent. Using the 2310B loop to identify the same provider reported in the 2010AA loop is not compliant with the TR3. This requirement also applies to atypical providers. Using the 2310B loop to identify the same atypical provider reported in the 2010AA loop is not compliant with the TR3.

If the rendering provider is not the same entity as the billing provider, the rendering provider information is required by the TR3 and the 2310B loop must be sent. It is not compliant with the TR3 to omit the 2310B loop when the rendering provider is a different entity than the billing provider. Again, this requirement applies to both atypical and enumerated providers.

When identifying an atypical billing provider in the 2010AA loop, there is no NPI to report and it is appropriate to report an identifier in the Billing Provider UPIN/License Information REF segment. When identifying an atypical rendering provider in the 2310B loop, there is no NPI to report, and it is appropriate to report an identifier in the Rendering Provider Secondary Identification REF segment.
Submission 9/25/2013
Status Date 3/14/2014
Status F - Final
Primary References
Document 005010X222
Section2310B
Set ID837P
Loop2310B
Segment IDNM1
Element Position02
Code Value2