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Formal vs. Informal Help Informal Formal


Linda Borges


278 IG states that the specialist is situational: required if requesting the services of a specific person, facility, group practice or clinic and the servicing provider ID is known by the requestor. Required value if NPI is mandated for use. If the specialist is not a covered entity, can the provider leave the Service Provider Identifier field blank?


This issue is explicitly addressed in guide 004010X094. For entities not mandated to have an NPI, the 2010E Service Provider Name NM108/9 would be required when one of the other specified IDs was known (Employer ID, SSN or ETIN). When not known the NM108/9 elements would be left blank. When blank, NM103 would then be required for a specialty person, facility, group practice, or clinic.
Submission 11/17/2006
Status Date 11/30/2006
Status F - Final
Primary References
Document 004010x094
Set ID278
Segment Position170
Segment IDNM1
Element Position09
Industry NameService Provider identifier