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Back  RFI # 536: Referring Provider NPI

Formal vs. Informal Help Informal Formal

Submitter

Laurie Woodrome

Description

Once NPI use is mandatory, how can a secondary provider create a compliant 837P file with the 004010X098A1 guide when the NM 108/109 fields are left empty pursuant to the guide because the primary provider's NPI is unknown, but the REF segment of the 2310A loop, which the guide requires to be submitted when the NM 108/109 fields are empty, contains legacy identifiers that cannot be submitted?

Submitter Assigned Keywords

Referring Provider NPI

Response

A Secondary Provider, such as a Laboratory, must use the Referring Provider loop 2310A or 2420A when the situational rule is met (Required if claim involved a referral.). When the Loop is used, NM109 has a situational rule which states: “Required if Employer’s Identification/Social Security number (Tax ID) or National Provider Identifier is known.” The “XX” Qualifier for NPI has a situational note “Required value if the National Provider ID is mandated for use. Otherwise, one of the other listed codes may be used.” With the NPPES dissemination, the NPI’s needed for the Referring Provider should be available.
When NM108 and NM109 are used, use of the REF segment for a legacy identifier is not needed.
Submission 3/23/2007
Status Date 8/6/2007
Status F - Final
Primary References
Document 004010X098A1
Section3
Set ID837P
Loop2310A