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Back  RFI # 590: 277 4010 Multiple 2100C loops

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Submitter

Albetski Allan

Description

The following is an actual 277 version 004010X093A1 (de-identified) fragment that we received from a payer. The second occurrence of a 2100C loop has us questioning if this is compliant. We would appreciate some insight as the intent behind the implementation documentation that seemingly allows for this loop to repeat. Is the >1 an error in the documentation?

It appears that this payer is attempting to communicate both the Tax ID and NPI of one provider. Is this even allowed?

Even if this is legal in structure, what would be the business purpose of having multiple 2000C loops?


HL*3*2*19*1~
NM1*1P*2*XXXXXX CLINIC*****FI*999999999~
NM1*1P*2*XXXXXX CLINIC*****XX*9999999999~
HL*4*3*22*0~

Submitter Assigned Keywords

277 4010 2000C

Response

The 004010X093A1 does allow for multiple occurrences of the 2100C loop within each 2000C loop. Since the 004010X093A1 does not have a REF segment within the 2100C to report a secondary provider number, repeating the 2100C loop allows for secondary provider identification number reporting. The purpose of multiple 2000C loops within the 277 structure would be to respond with claim status for multiple providers within the transaction.

Recommendation

This response does not address any HIPAA policy issues related to NPI reporting and dual identification. You may submit questions of HIPAA policy to CMS at askhipaa@cms.hhs.gov
Submission 8/15/2007
Status Date 10/22/2007
Status F - Final
Primary References
Document 004010X093A1
Section3
Page125
Set ID277
Table2
Loop2100C
Segment Position050
Segment IDNM1
Industry NameProvider Name