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Back  RFI # 286: 837P - Billing/Rendering Prov

Formal vs. Informal Help Informal Formal

Submitter

Kathy Cool

Description

We have several payers within our PPO network who are receiving the HIPAA X098 4010a from us. They are overriding the billing tax id in loop 2010AA with the tax id from loop 2310B if 2310B is different. Then claim payment is going to the wrong tax id. I can't find anything in the guide specifically addresses this one way or the other that's what should be done. I would like to tell the payors that what they are doing is wrong but I have nothing to back it up with. Please help.

Submitter Assigned Keywords

billing provider tax id rendering provider tax id

Response

The Billing and Pay-To Provider loops are designed to allow the submitter to indicate the provider entity to be paid. This direction is supported by the reference to 1099 reporting in the Secondary Identification REF segments in these loops.

The Tax ID qualifier appears in the Rendering Provider loop only as a means of provider identification for those trading partners who are using tax numbers to identify individual providers until the National Provider Identifier (NPI) is implemented.

Note: Response continued in Recommend section.

Recommendation

The interdependency between Billing Provider and Rendering Provider has nothing to do with the entity, and tax number, to be paid. Rather, it has to do with what provider rendered the service. When Rendering
Provider information is not reported in the Rendering Provider loop, the Billing Provider is assumed to have rendered the service. Stated another way, a payer would consider the Billing Provider to have rendered the service, unless another specific individual is reported in the Rendering Provider loop. In this case, the data in the Rendering Provider loop
"overrides" the data in the Billing Provider loop, identifying the provider who rendered the service.
Submission 7/19/2005
Status Date 9/16/2005
Status F - Final
Primary References
Document 004010X098A1
Section2010AA
Page290
Set ID837P