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Back  RFI # 529: Where to put the NPI in 835

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Submitter

Mark Thomas

Description

Here is our situation: We are a small co-op of pharmacies. At our corporate office, we receive check and 835 files from health plans, and we send 835 files and checks to our member pharmacies. We call this "Central Payment". Basically, this system is a clearinghouse for insurance reimbursements. We don't deal directly with medicaid or medicare, so our NPI implementation should not be very complicated.

Here is our question: It would appear that we should start to expect the pharmacy NPI number in place of the NCPDP identifier in the TS3 segment (TS301). We would also populate the TS301 with the pharmacy's NPI in the outgoing files (although these generally contain only one NCPDP number per file, since we send a file to each pharmacy). Is this correct?

Thanks,

Response

Since you are creating a new 835 and check specific to a particular pharmacy, that pharmacy's NPI must be located in the 1000B N1 segment. The pharmacy's tax ID must then be in the 1000B REF segment. Usage of the TS3 segment is not necessary, but if used, the NPI would be sent in TS301. In addition, if applicable, the NPI must also be carried in the 2100 and 2110 Service/Rendering Provider segments and the PLB segment
Submission 3/8/2007
Status Date 5/25/2007
Status F - Final
Primary References
Document 004010X091
Section3
Page80
Set IDTS3