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Back  RFI # 2057: 837I-Tertiary Payer & DTP_573

Formal vs. Informal Help Informal Formal

Submitter

Diana Harvie

Description

Please provide clarification on enforcing the rule of not allowing the DTP_573 in both places (2430 and 2330B) when there are multiple payers with the same payer id involved in a claim?
RFI1419 says the 2330B DTP_473 is NOT USED when the 2430 loop is present on the claim.
Below are two pared down scenarios with multiple payers

Scenario #1 – 3 payers, but unique Payer Ids

2000B SBR01 = “T”
2300 CLM
2320 SBR01="P"
2330B NM109=”08201”
2320 SBR01=”S”
2330B NM109=”00210”
2330B DTP_573
2430 SVD01=08201
2430 DTP_573

This situation appears to be clear – data is compliant.

Scenario #2 – 3 payers, but non-unique Payer Ids

2000B SBR01=”P”
2300 CLM
2320 SBR01=”S”
2330B NM109 = “12345”
2330B DTP_573
2320 SBR01=”T”
2330B NM109 = “12345”
2430 SVD01 = “12345”
2430 DTP_573
There is nothing in the TR3 that prohibits having the same payer id (2230B NM109) for multiple payers (see RFI 1596).
How do you determine if the data is compliant?

Submitter Assigned Keywords

Tertiary 5010 837I 2330B 2430 005010X223A2

Response

The need to allow for non-unique payer IDs is a known issue with the guide. A change was made to version 6020 to improve linkage between the information in loop 2330B and 2430.

Recommendation

Submitter can add a suffix or prefix to one of the payer IDs to make them unique. This change must be done in both the 2320 and 2430 loops.
Submission 5/27/2015
Status Date 8/27/2015
Status F - Final
Primary References
Document 005010X223A2
Section2330B