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Back  RFI # 527: IG Interpretation 4010/4010A

Formal vs. Informal Help Informal Formal


Gladys Wheeler


837 P
I need an X12 interpretation and since this has been revised in 5010 I thought it might be a simple answer for you.
4010 837 P
Loop 2310A, NM 108, XX
There seems to be some confusion in the industry regarding how “mandated” is interpreted?
How does X12 interpret it???
1-Mandated means that the health plan requires it and, a non-covered health care provider who is a referring provider must get an NPI
2-Mandated means that if the rule requires that a provider get an NPI because it is a covered health care provider, the NPI is required in NM 108 if the situation is met
3-Other interpretation
Since X12 actually wrote the guide and the fact that this segment changes significantly in 5010 It would be most hopeful to know any history or thought processes that you might share.
Gladys Wheeler

Submitter Assigned Keywords

mandated referring provider NPI


"Mandated for use" in the 837 transactions means as you state in your #2. If under the NPI Rule a provider is required to obtain and use an NPI, then it must be sent as the primary identifier in the NM108/NM109 of the appropriate loop(s) after the compliance date.
Submission 3/8/2007
Status Date 5/7/2007
Status F - Final
Primary References
Document 004010X098A1
Set IDNM108