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Back  RFI # 1912: Referring Provider Drop-down

Formal vs. Informal Help Informal Formal

Submitter

William Roberts

Description

We are running into issues that providers are stating the Referring Provider Loop-2310A would drop down to the Ordering Provider Loop-2420E if the same. We believe their interpretation of the ASC x12n/005010X222 (v5.1) on page 257 under TR3 Note 1 is incorrect due to it reads "When reporting the provider who ordered services such as diagnostic and lab, use Loop ID-2310A at the claim level." Due to the provider billing lab services they interpret this to mean that the ordering would be listed in Loop 2310A under the referring field. From our understanding due to the ordering is not listed at the claim level they would have to list the Ordering Provider in Loop 2420E at the line item level. We are trying to establish if the Referring in Loop 2310A is supposed to drop down to the Ordering Provider Loop 2420E if they are the same.

Response

The situational rule for the 837P 2420E Ordering Provider Name loop reads “Required when the service or supply was ordered by a provider who is different than the rendering provider for this service line. If not required by this implementation guide, do not send.”

There is a separate 2420F loop for the Referring Provider with a situational rule that reads “Required when this service line involves a referral and the referring provider differs from that reported at the claim level (2310A).”

The 2420F loop TR3 Note # 1 reads “When reporting the provider who ordered services such as diagnostic and lab, use Loop ID-2310A at the claim level. For ordered services such as Durable Medical Equipment, use Loop ID 2420E at the line level.”

The TR3 note on the 2420F loop impacts when not to use the 2420F.

The Situational rule on the 2420E loop determines its usage. As a result, while 2310A may be populated with the ordering physician for diagnostic and lab services (based upon the 2420F TR3 Note), the 2420E loop must be populated with the ordering physician information on each service line when the ordering provider is different than the rendering provider for the service.
Submission 3/10/2014
Status Date 4/3/2014
Status F - Final
Primary References
Document 005010X222
Section2.3.1
Page257
Set ID837
Table2
Loop2310A