RFI Browser

Back  RFI # 807: P&C Patient Identifiers

Formal vs. Informal Help Informal Formal

Submitter

Shelagh Kalland

Description

MN law requires providers to submit electronic HIPAA compliant claims to insurers who may be non-HIPAA covered entities. The 5010 837 does not allow for an identifier for both the subscriber and patient. For P&C, there is a need to identify both the subscriber/insured (often an employer/company) and the patient. This HIR seeks a solution to allow continued use of the electronic claim submission for non-HIPAA covered entities. A suggestion is to use P&C claim number at the subscriber loop to report P&C claim event and P&C claim number at the patient loop to report unique patient identifier when one is known to be required. Is this an acceptable solution? If not, please advise of alternative. Please note there is concern with using a field for something other than what it was intended.
Examples: A: Subscriber is ABC Roofing, Patient is John Smith (employee) – work comp B: Subscriber is Judy Smith (homeowner), patient is Joe Johnson (visitor to home) – liability

Submitter Assigned Keywords

P&C patientID

Response

The Workgroup’s recommended workaround to carry the patient’s identification number for a claim billed to a Worker’s Compensation carrier is to use the 2010BA Subscriber Loop NM103 to contain the name of the Employer and the NM109 to contain the Patient’s Primary Identifier. If the Patient Primary Identifier is not the patient’s Social Security Number, the patient’s SSN can be sent in the 2010BA Secondary REF02 if needed by the claim processor. The Patient’s name is sent in the 2010CA Patient Name loop. A 2000B SBR09 value of ‘WC’ identifies the claim as a Worker’s Compensation claim.

When billing for other Property and Casualty lines of business, the 2010BA Subscriber Name loop NM1 segment contains the name and primary identifier of the Subscriber. The patient is identified by name only in the 2010CA Patient Name loop NM1 segment. This reporting for other P&C lines of business is supported by the guide.

Recommendation

Submission 7/10/2009
Status Date 12/18/2009
Status F - Final
Primary References
Document 005010X222
SectionTable 2
Page148
Set ID837P
Table2
Loop2010CA