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Back  RFI # 528: loop 2310e when p.o.s=home

Formal vs. Informal Help Informal Formal

Submitter

Shay vaughan

Description

We have a situation where our client is an FQHC that bill claims electronically. We are receiving clearinghouse rejections because of missing information in loop 2310E Service Facility loop when services are rendered in the patient's home. In this instance, loop 2310E NM108/NM109 & REF01/REF02 are blank because there isn't an id assigned to the patient's home. Loop 2310E N3 & N4 segments are also blank. It is possible for us to fill segments N3 & N4 with the patients address but, what would the service location name be, Home? That still leave the id fields & qualifier NM1 segment? If you could also direct me to any documentation on this subject, that would be great too.

Response

Per the usage note for the Service Facility Name NM1 segment in Loop ID-2310E of the 837 institutional implementation guide the facility loop is required when the location of health care services is different than that carried in the 2010AA (Billing Provider) or 2010AB (Pay-to-Provider) loops. Elements NM108 and NM109 are situational and only required when ID is known. In this case, a patient’s home does not have an ID and therefore can remain blank. REF segment would also not be sent because there are no other identifiers to report for patient home.
Submission 3/8/2007
Status Date 5/7/2007
Status F - Final
Primary References
Document 004010X096A1
Sectiondetail
Page345
Set ID837I
Loop2310e
Segment PositionNM109
Element Position67