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Back  RFI # 345: 2420A without a 2310B

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Submitter

Ginger Wright

Description

On the CMS 1500 the rendering provider is only carried at the detail line level so when we map to the 837 we are mapping to the 2420A loop(s). We are not building a 2310B loop. We reasoned that if say there were say 4 detail lines and only 1 had a different rendering than the Billing/Pay-to it would be incorrect to map that 1 rendering to the 2310B representing it as the claim level rendering. Our validator, and others we tested with would not allow a 2310B when it is identical to the Billing/Pay-to as specified in the IG. Our validator and some others allow the 2420A without a 2310B. We have a claim where each detail line has the same rendering, which is different than the billing and a trading partner is rejecting saying we must have the rendering in the 2310B and no 2420A loops. Please advise.

Submitter Assigned Keywords

2310B 2420A

Response

This issue is explicitly addressed in guide 004010X098. Note 3 for Loop 2310B NM1 segment states "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." Since, in your situation, the Billing Provider information does not match the Rendering Provider for ANY of the services, the 2310B loop is required to contain the Rendering Provider for the services. The 2420A loops can not be used in place of this requirement.

Continued in recommend:

Recommendation

Note: There is no restriction from duplicating that provider information in both the 2420A and 2310B.

When the provider in the Billing/Pay-to Provider (2010AA/AB) is the same as the Rendering Provider for some but not all lines, the line level Rendering Provider (2420A) can be used without a claim level Rendering provider (2310B). In this situation, the 2420A is used to indicate Rendering Provider information on the lines where it is different than the Billing/Pay-to Provider. (see 2420A NM1 Note 2)"
Submission 10/24/2005
Status Date 12/20/2005
Status F - Final
Primary References
Document 004010X098A1
Section3
Page290
Set ID837
Table2
Loop2310B
Segment IDNM1