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Back  RFI # 240: UID and the 835

Formal vs. Informal Help Informal Formal

Submitter

Mike Winston

Description

We are currently in the process of implementing our unique ID project for our members and will be sending out new ID cards by end of this year, A question has come up on reporting Insured information on the 835. The question is this: If the Insured has a unique Identification but the provider still submits the Insured's Social security number on the 837 would we report the Social security number as billed on the 837 in the 2100 loop "Insured Name" nm109 segment and the Unique ID ( how we paid) in the 2100 loop "Corrected Patient/Insured name NM109 segment. Or is this backwards, We have some who interpret the IG to mean both and need to make sure we do the right thing. Thanks very much for your time.

Submitter Assigned Keywords

835

Response

This issue is explicitly addressed in guide 004010X091 on page 108. The name of the NM1 segment is "Corrected Patient/Insured Name" and the note reads "Use this NM1 segment to provide corrected information about the patient or insured." This segment will always contain the corrected information. The original information from the claim (837) is populated in the Patient Name or Insured Name NM1 segments.
Submission 4/14/2005
Status Date 4/21/2005
Status F - Final
Primary References
Document 004010x091a1
Section2100
Page105
Set IDnm109