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Back  RFI # 740: REF01, Loop 1000B, Requirement

Formal vs. Informal Help Informal Formal

Submitter

Olwill Tina

Description

For an 835 pharmacy file it is unclear by the IMP Guide if the REF01 & REF02 are required. The copy I have shows this as a situational field and is optional.

Since the NPI has been mandated and is required to be sent in the N1 Segment in fields NM03 and NM04, is REF01 and REF02 necessary for further identification?

According to the IMP guide....

Use this REF segment only when more than one identification number
is required to identify the payee. Always use the ID number available
in the N1 segment before using the REF segment.

If the NPI has already identified the payee then is the REF01 & REF02 required?

If they are required must they be TJ/Payee Tax Id? As there are many qualifiers and payee identifiers available.

Response

This issue isn't directly addressed in guide 004010X091. Based only on the guide content, any of the available qualifiers may be used in the 1000B REF segment when the segment is used, and usage is based on the need to send secondary IDs. The NPI Final Rule imposes additional requirements and restrictions.

Recommendation

Based upon the NPI Final Rule, only two kinds of ID can be used to identify providers covered by the NPI rule - the NPI and the Tax ID (when directly related to payment). As a result, since this loop identifies the payee, the NPI should be sent in the N1 segment and the Tax ID in the REF segment when the provider is a covered provider as far as NPI is concerned.
Submission 3/17/2009
Status Date 6/2/2009
Status F - Final
Primary References
Document 004010X091
Section3.1
Page77
Set IDREF
Loop1000B
Segment Position120
Segment IDREF