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Back  RFI # 1902: Rendering Provider 2420C/2310D

Formal vs. Informal Help Informal Formal

Submitter

Betty Westbrook

Description

Clarification is needed for the use of the 2420C (line level).

With the verbiage for the 2420C “The Rendering Provider for this line is different than the Rendering Provider reported in Loop ID 2310D (claim level)” it could be argued that you would need the Rendering Provider at the Claim level at all times, before reporting the line level. Could you clarify the proper usage of the 2420C?

Example for review:
Situation: 837I with a Facility Type of 85, Brown is reported as Attending in 2310A and a Rendering Provider, Carlson, participated in the care.
Clarification: Is it appropriate for Carlson to be reported 2420C or must Carlson be reported first at the Claim level 2310D?

Submitter Assigned Keywords

Rendering 2420C 2310D

Response

That is correct when the Rendering Provider is different than the Attending Provider. The 2310D claim level Rendering Provider and 2420C line level Rendering Provider contain the same first two conditions in their Situational usage rule which is

“Required when the Rendering Provider is different than the Attending Provider reported in Loop ID-2310A of this claim.
AND
When state or federal regulatory requirements call for a "combined claim", that is, a claim that includes both facility and professional components (for example, a Medicaid clinic bill or Critical Access Hospital Claim.) If not required by this implementation guide, do not send.”

If these conditions are met then the 2310D Rendering Provider is required. Information in Loop ID-2310 applies to the entire claim unless overridden on a service line by the presence of Loop ID-2420 with the same value in NM101.

If the additional condition of “The Rendering Provider for this line is different than the Rendering Provider reported in Loop ID 2310D (claim level).”, then the 2420C Rendering Provider is also required. If this condition is not met, the 2420C loop must not be sent.

In your example, the rendering provider “Carlson” would be reported in the claim level 2310D loop and the 2420C loop would not be sent.
Submission 3/3/2014
Status Date 4/14/2014
Status F - Final
Primary References
Document 005010X223
Section2.4
Set ID837I
Loop2420C