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Back  RFI # 2152: Clarification of RFI 1531

Formal vs. Informal Help Informal Formal

Submitter

James McConnell

Description

1531 stated that if either name of NPI were different, then 2310B was required. We have run into a situation where the provider sent the name associated with the NPI (from NPPES) in the 2010AA loop. In 2310B, the provider sent the name that appears in the NPPES other name column. This provider is a lab.
In this situation, is this compliant?

Submitter Assigned Keywords

Rendering Provider 2310B

Response

The Situational rule, "Required when the Rendering Provider Information is different than that carried in Loop ID-2010AA Billing Provider. If not required by this implementation guide, do not send." does not require that the Billing and Rendering Providers be different entities. It only requires that the Rendering Provider information be different than what was carried in Loop ID-2010AA Billing Provider. Therefore, the situation you describe in your request for interpretation is compliant with the 005010X222A1 TR3.

Recommendation

NPI compliance or NPPES related questions are outside the purview of ASC X12. Please direct those questions to the Centers for Medicare and Medicaid Services (CMS).
Submission 5/31/2016
Status Date 7/6/2016
Status F - Final
Primary References
Document 005010X222A1
Section1.10.3
Page43