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Back  RFI # 569: NPI clarification

Formal vs. Informal Help Informal Formal

Submitter

Clay Rehm

Description

The agency I work for, a covered entity, has been trying to understand the
requirements between the Provider Name and standard ID (NPI now) in
loop 2310, NM1 segment, of the 834. Please verify that we understand the following points correctly as of now:

1 - Assuming no contingency plan (1 year good faith extension), the NPI is the only standard identifier
that can now be sent in NM109 to identify the provider in the 2310 loop.

2 - The provider name information cannot be sent if the NPI is sent in
NM109.

3 - If the sender does not have the provider's NPI, then the name should be
sent, but is not required.

4 - The guide does not establish any requirement for the sender of the 834
to go out and find provider NPIs in order to provide the standard identifier.

Submitter Assigned Keywords

NPI Provider

Response

Points 1, 2 and 4 are correct. Point 3 is not correct. The note on the 2310 NM1 segment reads "Use the name fields, NM103 through NM107, only when the sponsor has the name of the provider but is not able to pass a standard ID in NM109." The notes on the name elements read "The name should only be used when the sponsor is not able to provide the standard
ID number." The authors intended this to establish an obligation to use the name when the standard identifier is not present. Point 3 should read "If the sender does not have the provider's NPI, then the name should be considered required."

Recommendation

Submission 6/4/2007
Status Date 7/6/2007
Status F - Final
Primary References
Document 004010X095A1
Section3
Page142
Set ID834
Table2
Loop2310
Segment Position320
Segment IDNM1