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Back  RFI # 254: 2310B usage

Formal vs. Informal Help Informal Formal

Submitter

Richard Navaro

Description

In the 837 Professional, the 2310B is Situational, being required when
"3. Required when the Rendering Provider NM1 information is different than that carried in either the Billing Provider NM1 or the Pay-to-Provider NM1 in the 2010AA/AB loops respectively.

We've encountered a carrier that is 'Requiring' the 2310B in all cases, even
when the NM1 data in the 2010AA/AB loops is identical.

Is this kind of demand within the scope of what a carrier can require in their 'implementation guide'?

Does this requirement conform to the standard?

Submitter Assigned Keywords

2310B Implementation Guide

Response

This issue is explicitly addressed in guide 004010X098 in section 3.1 with the definition of "Situational". That definition states "The item should be used whenever the situation defined in the note is true; otherwise, the item should not be used."

While the intent of the guide is that the item should not be sent when the provider information is already provided at the higher level, this definition does not establish that as a firm requirement, but a suggestion. Therefore, the submitter may send the 2310B Rendering Provider in all cases, but the receiver may not require that information when it is the same provider as in the Billing or Pay-To Provider loops.
Submission 5/4/2005
Status Date 6/27/2005
Status F - Final
Primary References
Document 004010X098A1
Section837
Page276
Set IDNM1
Loop2310B