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Formal vs. Informal Help Informal Formal

Submitter

vani katta

Description

Is it correct or incorrect for a submitter to include the same payer as "the destination payer" (Loop 2010BB "Payer Name") and and as an “other payer known to be potentially involved on this claim” (Loop 2330B "Other Payer Name")?

Page 17 of the Combined HIPAA Institutional guide says that "Loop ID-2320 occurs once for each payer responsible for the claim, except for the payer receiving the 837 transaction set (destination payer). The destination payer's information is located in Loop ID-2000B".

Therefore, I believe that it is incorrect to include the same payer as the destination payer and as an other insurer known to be responsible for the claim.

Submitter Assigned Keywords

Destination payer Other insurer

Response

The information in the 2330B - NM1 segment with Qualifier PR can be identical to the 2010BC - NM1 segment with Qualifier PR. There are several instances where this would occur. One example is when husband and a wife both work for the same company, both carry the insurance, and therefore both have the same payer.
Submission 6/14/2005
Status Date 8/15/2005
Status F - Final
Primary References
Document 004010X096A1
Section1.4.2.1.
Page17
Set ID2000b