RFI Browser

Back  RFI # 1990: Corrected Insured Employer

Formal vs. Informal Help Informal Formal

Submitter

Chip Evelsizer

Description

The response to RFI #1317 included a recommended solution to send a default value “NONE” in the 835 2100 Insured Name segment NM109 element when the original 837 transaction does not contain a 2010BA Subscriber Name NM109 value.

For Workers’ Comp, where the insured is typically an employer and an organization, if the payer knows the true Insured ID number, since that value is different than what was submitted on the 837 (null), is it required to return the Corrected Patient/Insured Name segment? Is it required to populate the value in the NM109 element of the Corrected Patient/Insured Name segment if that segment is sent and the value is known to the payer?

Submitter Assigned Keywords

835 Corrected Insured Employer NM109

Response

The situational rule for the NM109 element in the Corrected Patient/Insured Name segment explicitly states, “Required when the adjudicated patient/insured identification number is different than the identification submitted on the claim. If not required by this implementation guide, do not send.” So when no Insured ID number was sent in the 837 and the payer does know the Insured ID number, the correct Insured ID Number is required to be returned in the Corrected Patient/Insured Name NM109.
Submission 10/31/2014
Status Date 2/19/2015
Status F - Final
Primary References
Document 005010X221A1
Section2.4
Page143
Table2
Loop2100
Segment Position0300
Segment IDNM1