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Back  RFI # 541: ATTENDING PHYSICIAN SPECIALTY

Formal vs. Informal Help Informal Formal

Submitter

Todd Omundson

Description

Per Loop 2310A in the 837i, PRV usage is situational:

Note 4: "Required when the billing provider is a billing service and taxonomy is know to impact the adjudication of the claim."

In the institutional setting, this situation (billing provider is a billing service)simply does not exist and therefore this data element would never be required.

Some state Medicaid plans are demanding this data element merely because it is "situational", regardless of the actual circumstances.

Please clarify what is meant by Note 4.

Response

The Attending Physician taxonomy may only be required when the institutional Billing Provider is a Billing Service AND it is needed for the payer's adjudication.
Submission 3/30/2007
Status Date 5/25/2007
Status F - Final
Primary References
Document 004010X096A1
Section3.1
Page21
Set ID837
Table2
Loop2310A
Segment Position255
Segment IDPRV
Industry NameATTENDING PHYSICIAN SPECIALTY