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Back  RFI # 313: NPI Dual Identifiers on 835's?

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Submitter

Ryan Reddick

Description

Should a payer adopt the dual identifier approach to NPI requesting both the NPI and a secondary ID (Legacy ID, Tax ID, etc), must the payer employ the same dual identifier approach for the 835?

Under the dual identifier apporach, a payer may require both NPI and secondary IDs (Legacy ID, Tax ID, etc) on all inbound claims for subsequent processing. Is that payer then required to return both identifiers (NPI and secondary ID) on the subsequent ERA, or is it acceptable for a payer to only return a secondary ID?

Submitter Assigned Keywords

NPI Dual Identifier usage on the ERA/835

Response

This issue is explicitly addressed in guide 004010X091. The provider can be
identified at multiple locations within the 835. In the 1000B loop, NM1 segment, elements 08 and 09, once the NPI is mandated that is the only identifier permitted, and it is required. A secondary ID in the REF segment "should" be provided, the Federal Taxpayer's Identification Number. Additional REF segments may be provided at the payer's discretion.

Within the 2100 loop, NM1 segment, the NPI is again required. The REF segment for Rendering Provider Identification is used for any additional IDs that were submitted on the original claim.

The 2110 loop REF segment Rendering Provider Information is only used when the provider number is specific to that service line. At this level, HIPAA policy will dictate what types of provider numbers are permissible.

So, since the 1000B and 2100 loop levels require the use of the NPI once it is mandated, it is not permissible to report only a secondary Provider ID within the 835.
Submission 8/23/2005
Status Date 8/26/2005
Status F - Final
Primary References
Document 004010X091A1
SectionN/A
Page73
Set IDN/A
Table1
Loop1000B
Segment Position080
Segment IDN1
Element Position04
Industry NamePayee Identification Code