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Back  RFI # 400: 837 NPI Returned on 835 NPI?

Formal vs. Informal Help Informal Formal

Submitter

vani katta

Description

Is there a specific requirement for returning the same NPI sent in on the 837 back on the 835 for a given EIN/SSN group?

For example, does the NPI included in the 835 Loop 1000B N104 (Payee Identification) have to be the same as the NPI that was sent in the 837 Loop 2010AA NM109 (Billing Provider Identifier)? Or could we send another NPI on the 835 that has the same EIN/SSN value (e.g. part of a provider group) as the NPI sent in on the 837?

Submitter Assigned Keywords

837 NPI Returned on 835 NPI

Response

Although there is no explicit requirement to return the same NPI that was submitted on the claim, the intent and expectation was an identifier should flow through the life cycle of the claim.

Recommendation

Payment can be made to a provider's corporate entity NPI or other NPI than what was received on the claim. However, this may only occur when there is a separate, explicit, notification from the provider identifying the payee NPI and the related Billing Provider NPIs.
This notification/agreement must adhere to any state or federal legislation/regulation. (The intent is that no payer can force a provider into receiving payment under a specific NPI)
Submission 4/13/2006
Status Date 11/6/2006
Status F - Final
Primary References
Document 004040X091A1
SectionNPI
Page73
Set IDNPI