RFI Browser

Back  RFI # 440: Usage of Loop 2310B

Formal vs. Informal Help Informal Formal

Submitter

Linda Heitman

Description

We have been informed by one of Medicare's Intermediaries that they will be implementing an edit that will reject claims when the situational Loop 2310B is sent for what they term as a "solo provider". Their interpretation of the I.G. is that "when Loop 2310B is different than Loop 2010AA, Loop 2310B is required, but if Loop 2010AA and 2310B contains 'some' of the same data content, then Loop 2310B "cannot" be sent".

The I.G. does state that Loop 2310B is "required when the Rendering Provider NM1 information is different than that carried in either the Billing Provder NM1 or the Pay-toProvider NM1 in the 2010AA/AB loops respectively." The I.G. does not state that Loop 2310B cannot be used if it is the same as 2010AA/AB. Please provided clarification on the usage of these loops.

Submitter Assigned Keywords

2310B-2010AA/AB Usage

Response

The Situational usage note of the 2310B Rendering Provider Name 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."

While the intent of the guide is that the item should not be sent when the provider information is already provided at the higher level, this definition does not establish a firm requirement, merely a suggestion. Therefore, the submitter may send the 2310B Rendering Provider when it is the same provider as in the Billing or Pay-To Provider loops.
This Ambiguity was addressed in more recent versions by adding the phrase "If not required by this Implementation Guide, do not send".
Submission 8/9/2006
Status Date 9/22/2006
Status F - Final
Primary References
Document 004010X098A1
Section1.3
Page290
Set IDNM1
Loop2310B
Segment Position250
Element Position98
Industry NamePremera Blue Cross