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Back  RFI # 552: 837 Taxonomy Code

Formal vs. Informal Help Informal Formal

Submitter

Pamela Grosze

Description

NM Medical Assistance Pgm's NPI implementation (Supp. 07-01) requires the taxonomy code to be reported for both the Billing (2000A) & Rendering providers(2310B). According to the 837P 004010X098A1 IG, the taxonomy code may be reported at either the Billing/pay-To Provider (2000A) level or the Rendering Provider (2310B) level, but not both. The payer states that they have every right to situationally require any data element that is within the IG regardless of any segment or data element notes. They also state that the only way the industry will move to a standard is if every vendor and clearinghouse builds complete flexibility into their products to handle anything a payer may want to see on the claim.

Are we correct in stating that the taxonomy code cannot be required in both locations? And are we correct in restating to the payer that they are required to adhere to the notes that are stated in the implementation guide?
Thank you.

Submitter Assigned Keywords

837 Taxonomy Code

Response

The implementation guide specifically does not permit the Billing/Pay-to Provider taxonomy code to be sent when that provider is a group and the individual rendering provider is sent in the 2310B Rendering Provider loop. This usage limitation is contained in Note 2 on the Billing/Pay-to Provider Specialty Information PRV segment, loop ID-2000A.

This HIPAA Implementation Guide Interpretation function is intended to provide clarification of the contents of the HIPAA guides. Any complaints about trading partners requiring non-standard data should be addressed to the HIPAA enforcement function at CMS.

Recommendation

Submission 4/24/2007
Status Date 8/6/2007
Status F - Final
Primary References
Document 004010X098A1
SectionDETAIL
Page79
Set ID2000
Loop2000A
Segment IDPRV