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Back  RFI # 255: 837D 2010AA NM108=XX REF=TJ

Formal vs. Informal Help Informal Formal

Submitter

Brian Kitts

Description

There is a difference of interpretation regarding the 4010X097A1 837D IG. For the 2010AA loop NM108, note 3 states "If code “XX - NPI” is used in the NM108/NM109 of this loop, then either the Employer’s Identification Number, Social Security Number or Federal Tax Identification Number of the Provider must be carried in this REF." When NM108=XX, must ALL the 2010AA REF01s contain EI, LU or IE, or can the REF01 values be any valid value (for example 1H) when there is also present a REF that satisfies note 3 (for example REF01=EI).

Submitter Assigned Keywords

837D 2010AA NM108=XX REF=TJ

Response

This issue is explicitly addressed in guide 004010X097A1. The 2010AA loop REF segment has a repeat value of 5. There is no statement that when a Billing Provider Secondary ID # REF segment containing codes EI, LU or IE is present, no other iterations of segment using other listed REF01 values may occur. As a result, additional Billing Provider Secondary ID # REF segments can be present at this location using other listed REF01 values, up to a maximum of 5. This is subject to the additional instructions present in segment note 2 - "If the reason the number is being used in this REF can be met by the NPI, carried in the NM108/NM109 of this loop, then this REF is not used."
Submission 5/6/2005
Status Date 5/6/2005
Status F - Final
Primary References
Document 004010X097A1
Section3.1
Page80
Set ID837D
Loop2010AA
Segment Position35
Segment IDREF
Element Position01
Industry NameReference Identification Qualifier