RFI Browser

Back  RFI # 506: Other Payer ID for COB

Formal vs. Informal Help Informal Formal

Submitter

chuck wilhelm

Description

Some Healthcare insurance carriers are requiring secondary claim submitters to populate loop 2330B (Other Payer) NM109 data element with their proprietary payer id numbers. This is not always plausible, particularly when the primary claim was submitted on a paper form or via EDI through entities that use their own proprietary payer ids. Such as a clearing house requires a proprietary payer ID for submission then converts that payer ID to what the payer expects on the inbound claim. In these situations the ID known by the submitter differs from the expected proprietary payer ids designated by the secondary payer. The problem is the lack of a standard payer ID and its impact on the secondary billing, both in the payer-to-payer model or provider to payer model. We are requesting the X12N committee clarify if the payer ID sent in 2330B NM109 should be the payer ID that is known by the submitter not the expected ID designated by the secondary payer

Response

At this time there is no national standard for payer identification numbers. The guide is silent as to what this ID must be absent the National Plan ID. The fact the guide does not explicitly define the code source means there is none. In essence, this leaves it up to the trading partners to define. The submitter is required to ensure the payer ID is unique from other payers in the claim.
Submission 1/8/2007
Status Date 3/14/2007
Status F - Final
Primary References
Document 004010X098A1
Section3
Page342
Set ID837
Loop2330B
Segment IDNM1