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Back  RFI # 423: Loop 2310D 837P 004010A1

Formal vs. Informal Help Informal Formal

Submitter

Alex Wright

Description

The loop is required when the location of health care service is different than that in 2010AA or 2010AB Billing Provider and Pay-To provider loops. The purpose is to identify specifically where the service was rendered. If rendered at a patient’s home the loop is not used. The place of service code in CLM05-1 indicates service occurred in patient’s home. For health plans implementing NPI an issue is crosswalking NPI to a legacy identifier when services are rendered at a patient’s home, and providers have multiple IDs based on Physical Location. Can health plans require providers to submit the Service Facility Location, as long as it is not the same as the Billing and Pay-To address even when the services were rendered at a patient’s home? This would allow the receipt of the providers' physical address to crosswalk the claim to the appropriate provider record. Would this interpretation apply to 2420C Service Facility Location loop of the 837P and the 2310E Service Facility Address of the 837I IGs?

Submitter Assigned Keywords

Service Facility Location Address 2310D 2420C 2310E 2310C

Response

For the Professional Claim, the 2310D and the 2420C Service Facility Location loops cannot be required by a payer to be submitted with the provider's office location when the place of service is the patient's
home. For cross walking to a proprietary provider ID, the payer must assume that the provider was operating out of the office location submitted in the 2010AA Billing Provider loop. Providers who need to
support separate contractual arrangement from multiple office locations can obtain separate NPI's for each office.

For the Institutional Claim, the notes in the 004010X096A1, 2310E Service Facility Loop, allow this use. See note #3 "This loop is required when the location of health care service is different than that
carried in the 2010AA (Billing Provider) or 2010AB (Pay-to Provider) loops".
Submission 6/28/2006
Status Date 10/4/2006
Status F - Final
Primary References
Document 004010X098
Section2310D
Page303
Set ID166
Loop2310D