RFI Browser

Back  RFI # 2013: Corrected Priority Payer TBD

Formal vs. Informal Help Informal Formal

Submitter

Sonya May

Description

If the Payer knows they are not primary (e.g., were told by the insured), but does not know the Corrected Priority Payer Name & ID, can the NM1*PR segment NOT be sent?

Submitter Assigned Keywords

Corrected Priority Payer Name, NM1*PR, NM1 PR

Response

The NM1 – Corrected Priority Payer Name Segment is required by the 005010X221A1 835 TR3 for the situation described. The segment rule states: "Required when current payer believes that another payer has priority for making a payment and the claim is not being automatically transferred to that payer. If not required by this implementation guide, do not send."

Within the segment the name and ID of the payer believed to have payment priority are required. When this situation occurs, obtaining the name and identifier of the payer believed to have payment priority is necessary to populate the Corrected Priority Payer Name NM1 segment.

Recommendation

Consider implementing a business process to gather this information from an appropriate source.
Submission 2/19/2015
Status Date 4/22/2015
Status F - Final
Primary References
Document 005010X221
Section2.4 835
Page153