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Back  RFI # 2040: 837P billing npi not in 835

Formal vs. Informal Help Informal Formal

Submitter

Sharon Sieve

Description

Some Payers are returning the Billing NPI for the rendering physician rather than the Billing NPI sent on the 837P claim. This occurs when a physician can perform both Hospital Professional services and belongs to a billing group for office or specialty groups. The billing npi's are different for each line of business. The rendering npi's could be billed on each. Can we please confirm what is compliant? our understanding of the npi rule is what we send should be returned. We are not aware that there are different standards for 837I and 837P npi rules.

Submitter Assigned Keywords

837I and 837P NPI final Rule

Response

Although there is no explicit requirement in the 835 (005010X221A1) to return the same NPI that was submitted on the 837 claim, the intent and expectation is a provider identifier should flow through the life cycle of the claim.

If the Rendering Provider was submitted in either the 005010X222A1 (837P) or 005010X223A2 (837I) based on the Situational Rules of the 837s, then the intent of the 835 is to supply at the 2100 claim level (and variations at the 2110 service level) the provider who rendered the service, if different than the payee. The Service Provider in the 835 should be the Rendering Provider, if the Rendering Provider is present in the claim.

See RFI 1559 for information related to the Payee being different from the Billing provider submitted on the claim.
Submission 4/27/2015
Status Date 6/15/2015
Status F - Final
Primary References
Document 005010X221
Section2.4
Page102
Set IDPayee
Loop1000B
Segment PositionN104
Segment IDID
Industry NameNPI Final Rule