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Back  RFI # 589: Pay-to provider field 837I

Formal vs. Informal Help Informal Formal


Ron Hess


Which instructions take precedence for electronic institutional claims: the 837I 4010A1 or the UB-04 manual?
In the 4010A1, the Pay-to loop is situational and should only be sent if the entity is different than the Billing provider.
However in the UB-04 manual, it says the Pay-to address is required if the address is different than the Billing provider.

We are seeing providers submit 837I 4010A1 with the same entity in the Pay-to and Billing Provider but with the street address in the Billing Provider address and a P.O. Box in the Pay-to Provider address. Is this allowed?


It is the intent that the 837 guide works in the same principle as the UB04 claim form. Per page 91 of the institutional 837 4010, the Pay to loop is required if different than the Billing provider loop. The submitter is requesting 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 8/9/2007
Status Date 10/22/2007
Status F - Final
Primary References
Document 004010X096A1
Set ID837I