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Back  RFI # 2196: 2310C REF LU

Formal vs. Informal Help Informal Formal

Submitter

Betty Westbrook

Description

A payer is denying claims when the Service Facility Location Number, Loop 2310C Segment REF*LU is missing on an 837P claim.
Loop 2310C is not transmitted by the Clearinghouse to the Payer since the NPI’s in both the Service Location and the Billing Provider (2010AA) are the same.
The Payer has stated that the only information they require in the 2310C to be present is the Service Facility Location Number in Segment REF*LU. They are not requiring their hospitals to have different NPI’s for each line of business.
Can this segment be required in any situation when the Service Facility Location and the Billing Provider are the same?

Example of the Payers requirements:
2010AA NM1*85*2*ABC Hospital*****XX*1234567890~
N3*Address~
N4*City*ST*Zipcode~
REF*EI*123456789~
2310C NM1*77*2*ABC Hospital~
N3*Address~
N4*City*ST*Zipcode~
REF*LU*1234567890-000~

Submitter Assigned Keywords

2310C REF LU 2010AA

Response

The REF*LU segment is positioned within the 2310C loop and can only be sent when that loop is present. The situational rule for this loop is "Required when the location of health care service is different than that carried in Loop ID-2010AA (Billing Provider). If not required by this implementation guide, do not send."
In the example provided, the billing provider and the service facility are shown as the same entity at the same address; therefore, the 2310C REF*LU segment cannot be required by an 837P receiver and must not be sent
In addition, though not illustrated in the example provided, the 2310C REF cannot be submitted if a NPI is submitted in the 2310C NM109.
If a NPI is associated to multiple physical locations, then it is allowable to report a billing address in the 2010AA and the service location address in the 2310C REF LU so long as the NPI associated to multiple physical locations is not used in the 2310C NM109 and a non-NPI is used in 2310C REF LU. In the example provided, a (identical) NPI appears to be provided in both the 2010AA NM109 and the 2310C REF02, and this is not 837P compliant as the applicable situational rule is "Required on or after the mandated NPI Implementation Date when NM109 in this loop is not used and an identification number other than the NPI is necessary for the receiver to identify the provider. If not required by this implementation guide, do not send."
Submission 2/8/2017
Status Date 7/10/2017
Status F - Final
Primary References
Document 005010X222A1
Section2.4