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Back  RFI # 469: Loop 2310A Referring Provider

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Submitter

Linda Heitman

Description

If a Lab submits a claim and the Billing Provider, Pay-to Provider and the Rendering Provider Loops include the providers NPI's, but the Referring Provider in Loop 2310A does not have an NPI since they do not submit claims on their own electronically is that be compliant?

Submitter Assigned Keywords

Referring Provider

Response

The Referring Provider Identification in the NM108/NM109 is "Required if
Employer's identification/Social Security number (Tax ID) or National
Provider Identifier is known."

After the compliance date of the NPI, the NPI will be required in this
NM108/NM109 if known by the submitter. If the submitter does not know
the referring provider's NPI (either referring provider does not have an
NPI, or the submitter does not know the NPI), then tax ID must be sent
if known. If the submitter does not know either a NPI or a tax ID, then
another type of identifier is required in the Referring Provider
Secondary Identification REF segment.
Submission 10/18/2006
Status Date 11/22/2006
Status F - Final
Primary References
Document 004010X098A1
Section1
Page284
Set ID3
Segment Position
Segment IDNM1
Element Position09