RFI Browser

Back  RFI # 571: 837I Pay To

Formal vs. Informal Help Informal Formal

Submitter

Patrice Kuppe

Description

We are having payers send our checks to our facilities instead of to our Pay to Address. I would like to make sure we are mapping things right....
On the paper claim form (some payers require us to use paper!) we map it this way:
Box 1 - Facility and address where services were rendered.
Box 2 - Pay to address (PO Box)

On the electronic claim form:
2010AA = Facility and address where services were rendered.
2010AB = Pay to Address (PO Box)

The payer should be sending checks according to Box 2 or Loop 2010AB correct?

Submitter Assigned Keywords

837I Pay To

Response

It is the intent that the 837 guide works in the same principle as the UB04 claim form. Per NUBC manual, form locator 1 for billing name and address must be a street address, Form locator 2 is to be submitted if the intent of payment is to be sent to an address other than what is reported in form locator 1.

Therefore, the submitter may request that payment be sent to an address other than the location in the Billing Provider Name Loop ID 2010AA by sending that mailing address in the Pay-to Provider Loop ID 2010AB.
Submission 6/14/2007
Status Date 8/6/2007
Status F - Final
Primary References
Document 004010X096A1
Section2
Page70
Set ID837I
Loop2010