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Back  RFI # 1875: Other Payer Primary Identifier

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Submitter

James McConnell

Description

Since the National Plan ID is not yet in place, we are receiving claims where we are the secondary payer. The claim comes in with 2 other payers identified in respective 2320/2330 loops. One of the other payers was primary, the other is noted as being tertiary. Our problem is that both other payers have the same ID but the names are different. For example:
NM1*PR*2*ABCINSURANCE*****PI*98998~
NM1*PR*2*WELLKNOWNGOVTINS*****PI*98998~

When we try to balance the COB lines, it fails because there is no amount paid for payer 98998 even though the first one is accurate. Is there any requirement that the IDs be different for different payers? I have seen the RFI for multiple previous 2320/2330 loops for the same payer.

This is specific to the 837P but applies to all 837s.

Submitter Assigned Keywords

Other Payer ID

Response

Your question is whether the 005010X222A1 Technical Report Type 3 (TR3) requires the value of Other Payer Primary Identifier in data element NM109 in each of the Other Payer Name segments (2330B/NM1) to be unique.

The 005010222A1 TR3 does not explicitly require a unique Other Payer Primary Identifier in each 2330B loop. Therefore, a transaction in which the 2330B/NM109 values are not unique does comply with the TR3.

Future versions of this TR3 will report the Other Payer Responsibility Sequence Code in each 2430/SVD segment. This will uniquely assign each payment to the payer that is primary, secondary, tertiary, etc., even if the payers share the same Other Payer Primary Identifier.

Recommendation

Submission 10/30/2013
Status Date 1/21/2014
Status F - Final
Primary References
Document 005010X222
SectionTable 2
Page320
Set ID837P
Table2
Loop2330B
Segment Position1
Segment IDNM1
Element Position9