RFI Browser

Back  RFI # 1977: 837D loop 2300 REF*9F

Formal vs. Informal Help Informal Formal

Submitter

Vo Huong

Description

Hi,

Is it correct to say that for 837 dental, when loop 2300 REF*9F is used, Loop 2310A NM1 Referring Provider must be used also? and vise versa?

Thanks.

Response

There is no direct interdependency requiring Loop 2300 Segment REF – Referral Number and Loop 2310A Segment NM1 Referring Provider if the other is present.

Loop 2300 Segment, REF – Referral Number is “Required when a referral number is assigned by the payer or Utilization Management Organization (UMO) AND a referral is involved.” Loop 2310A Segment NM1 - Referring Provider is “Required when this claim involves a referral.”

From a practical business perspective a referral is made by a referring provider and thus Loop 2310A Segment NM1 - Referring Provider is required because a referral is involved. In situations where a referral number is assigned by the payer or Utilization Management Organization (UMO) AND a referral is involved, then Loop 2300 Segment, REF – Referral Number is also required.

The usage of the two segments is dictated by the situational usage rule of each segment independent of the other. It is not correct from a TR3 usage perspective that one of the segments is required or not required by the presence or absence of the other.
Submission 9/30/2014
Status Date 12/22/2014
Status F - Final
Primary References
Document 005010X224A1
Section2.4
Page169
Set ID837D
Table2
Loop2300
Segment Position1800
Segment IDREF
Element Position01
Industry NameReferral Number
Code Value9F
Secondary References
RFI ID 2452
Document 005010X224A1
Section2.4
Page190
Set ID837D
Table2
Loop2310A
Segment Position2500
Segment IDNM1
Element Position01
Industry NameReferring Provider Name