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Back  RFI # 844: Provider Proprietary IDs

Formal vs. Informal Help Informal Formal

Submitter

Todd Cochrane

Description

The 2420A/B/C/D loop REF segments all have notes on REF01 code G2 that state "This code designates a proprietary provider number for the destination payer identified in the Payer Name loop, Loop ID-2010BB, associated with this claim." This seems to preclude usage of G2 for a non-destination payer. The related REF04 notes state "Required when the identifier reported in REF02 of this segment is for a non-destination payer. Do not use this composite when the value reported in REF01 is either 0B or 1G." For loops A, B and C this seems to only allow REF04 with qualifier LU. 2420D has no other qualifier, making it appear that REF04 can't be used there. This seems to be a contradiction. How is this REF04 supposed to be used to identify the related payer when a proprietary provider ID is sent in REF01/02? Are the G2 code notes erroneous and Should they be ignored?

Submitter Assigned Keywords

non-destination 2420 prov

Response

The identifier belongs to the destination payer when
REF04 is Not Used. When REF04 is used, it belongs to the payer
identified in REF04. The 837 workgroup has interpreted this as a
request to change the REF01 note for qualifier G2 in Loop 2420A. This
will be discussed at the next X12 trimester meeting and if the workgroup
agrees with the recommendation it will be updated in a future version of
the 837I TR3 document.
Submission 8/25/2009
Status Date 10/5/2009
Status F - Final
Primary References
Document 005010X223
Section2
Page459
Set ID837I
Table2
Loop2420X
Segment Position5250
Segment IDREF
Element Position4