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Back  RFI # 513: Provider site id

Formal vs. Informal Help Informal Formal

Submitter

Sou Chon Young

Description

A payer is requiring us to send over a site id to differentiate between inst. vs. prof. claims. Our legacy billing provider ID on the HCFA and UB are the same. Currently, the payer uses a "site id" in conjunction w/TIN to determine the billing provider (i.e. they have us send over "000" (UB site id) and "001" (HCFA site id).

Even with NPI, the issue will be the same. The payer is requiring site ids for UB vs. HCFA in order for us to e-bill. Is this compliant? They should they be able to determine an inst. vs. prof. claim via GS08 (004010X096A1 vs. 004010X098A1) but the payer is adamant on having us send over site id. They are asking us to send over the site id in REF02 (Loop 2010AA), qualifier "G5". Is this complaint? If I understand the IG correctly, REF02 will be required after NPI but will be limited to only send Employer's Id # or SS#. Would we even be able to use this field to send over a site id? If not, is there somewhere else we might be able to send over this type of information?

Submitter Assigned Keywords

Additional info - site id

Response

After the implementation date for NPI, the NPI and Tax ID are required in loop 2010AA when a health care provider, who has an NPI, is billing. The receiver should use GS08 to determine if the services are professional or institutional. In addition to the GS08 value, there is the version identification REF in the header loop (TRANSMISSION TYPE IDENTIFICATION). This is also the purpose of GS03 - Application Receiver's Code. Appending this information to the NPI would invalidate the NPI, thus becoming an invalid value. One occurrence of the REF is required after NPI and must contain the Employer ID or Social Security Number. Adding a value to these numbers also invalidates them. An additional 2010AA REF with REF02=G5 would only be allowed until the NPI is mandated for use in version 4010A1." Please see CMS/HHS FAQ 5816 for further clarification.
Submission 1/19/2007
Status Date 3/14/2007
Status F - Final
Primary References
Document 004010X098A1
Section3.1
Page91-2
Set ID837P
Table2
Loop2010AA
Segment Position035
Segment IDREF
Element Position2
Industry NameBilling Provider Secondary Id
Secondary References
RFI ID 465
Document 004010X096A1
Section3.1
Page82-4
Set ID837I
Table2
Loop2010AA
Segment Position035
Segment IDREF
Element Position2
Industry NameBilling Provider Secondary Id