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Back  RFI # 363: 2310C Loop Interpretation

Formal vs. Informal Help Informal Formal

Submitter

Sarah Lasbury

Description

We are having difficulties populating the 8371 2310C loop on outpatienet claims. We have heard differing statements as to the meaning of the 2310C loop note 3 - "Required when the claim/encounter involves an other payer..." Some say that anytime another provider ordered or referred the services this loop is required. Others say that ordering the services is different than being involved in the claim. What defines other providers being involved in a claim, making this loop required? Also, many other providers are reluctant or refuse to give their SSN or EIN. How should the required NM108 and 09 be populated when the 2310C loop is required and the data is not available because the other provider won't provide it?

Response

Note 3 requires the use of Other Provider loop when the payer requires the reporting of a provider who was involved in the patient's care and that provider type does not fit into the provider types that are
specifically defined in the 837. The implementation guide requires an Employer's Identification Number or Social Security Number to identify the provider when sending the Other Provider loop. See recommendation
below for situations where the facility must report the provider, but can not obtain an identification number for that provider.

Recommendation

If the payer does not require the reporting of the provider information, and the identification number is not available, do not report any information on the provider. Payers who require the reporting of some
information (e.g. name) on these providers even when an identification number cannot be obtained should provide guidance as to the manner in which they can accept that information.
Submission 11/17/2005
Status Date 1/11/2006
Status F - Final
Primary References
Document X096A1
Section3.1
Page340
Set ID837I
Table2
Loop2310C
Segment Position250
Segment IDNM1
Industry NameCommunity Hospital & non staff physician