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Back  RFI # 2146: 837 Professional SBR09

Formal vs. Informal Help Informal Formal

Submitter

Vo Huong

Description

837 Prof Version 5010X222A1 Loop 2320 SBR, TR3 stated "Required prior to mandated use of HIPAA NPI". We received a claim with Loop 2320 SBR without SBR09. Our translator erred out because the SBR09 was missing. Does it mean SBR 09 should always be present when Loop 2320 SBR segment is present?

Submitter Assigned Keywords

837 Prof. 5010X222A1 SBR09

Response

Yes, the claim filing indicator code (loop 2320 SBR09) is required when the other subscriber information segment (loop 2320 SBR) is present, until additional guidance is issued from CMS. The situational rule for the 2320 SBR09 reads “Required prior to mandated use of the HIPAA National Plan ID. If not required by this implementation guide, do not send." Within the healthcare industry, the acronym NPI refers to the National Provider ID not the National Plan ID. CMS developed the Health Plan ID (HPID) to serve as the National Plan ID. At this time, CMS does not require that the HPID be used in claim transactions. Questions on the status of National Plan ID mandate should be directed to CMS.
Submission 5/6/2016
Status Date 6/20/2016
Status F - Final
Primary References
Document 005010X222A1
Section2.3.1
Page295
Set ID837
Table2
Loop2320
Segment Position2900
Segment IDSBR
Element PositionSB
Industry NameOther Subcriber Information