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Back  RFI # 548: Nurse Pract/Phys Asst Claims

Formal vs. Informal Help Informal Formal


Victoria Siegfried


How can payers tell if the Rendering Provider is a Nurse Pratitioner or a Physician Assistant since in Loop 2310B NM101 = 82, there is not a field for credentials?

We are aware that if the Rendering Provider is supervised by a Physician then Loop 2310E NM101 = DQ is required, but 'HOW' can you tell if the Rendering is supervised?

Submitter Assigned Keywords

Nurse Practitioner, Physician Assistant, Supervising Provider


This is a business issue rather than a request for interpretation. The payer should have a variety of ways to tell if the provider is an NP or a PA, such as with the provider enrollment data on their system. A similar request for interpretation was provided in HIR 538.

When sending claims with a Nurse Practioner or Physicians Assistant as the Render Provider must the Supervising Provider Loop then be present and recognized as the NP and PA require a Physicians supervision? If so would this apply even if the NP or PA did not require certification by the Payer?

Whenever the provider reported as "Rendering Provider" is supervised by a physician, the Supervising Physician Name loop ID-2310E must be sent. This requirement is stated in usage note 2 of the Supervising Provider Name NM1 segment. This requirement is not dependent on the certification requirements of the payer.
Submission 4/16/2007
Status Date 8/6/2007
Status F - Final
Primary References
Document 004010X098A1
Set ID837P
Segment Position250
Segment IDNM1
Industry NameRendering Provider /Supervising Provider