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Back  RFI # 854: PRV usage in loop 2000A

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Submitter

Julia Dunicheva

Description

Segment PRV in loop 2000A has following note :
1. Required when adjudication is known to be impacted by the provider taxonomy code, and the Service Facility Provider is the same entity as the Billing and/or Pay-to Provider. In these cases, the Rendering Provider is being identified at this level for all subsequent claims/encounters in this HL and Loop ID-2310E is not used.

Loop 2000A has following note :
4. If the Billing or Pay-to Provider is also the Service Facility Provider and Loop ID 2310E is not used, the Loop ID-2000 PRV must be used to indicate which entity (Billing or Pay-to) is the Service Facility Provider.

So which note takes precedence when loop 2310E is not sent : is segment PRV always required in such situation ? or it can be omitted when adjudication is not impacted by the provider taxonomy code?

Response

The intent of the notes addressing the use of the PRV is to use the PRV to indicate whether the Billing Provider address or the Pay-to Provider address is the service location when the Service Facility loop (2310E) is not sent. Therefore, the 2000A PRV must be used when the 2310E loop is not sent and both Billing and Pay-to Providers are sent. If 2310E is not sent, and there is a Billing Provider but not a Pay-to Provider, then the 2000A PRV is only sent if needed for adjudication.
Submission 9/10/2009
Status Date 10/16/2009
Status F - Final
Primary References
Document 004010X096A1
Section3
Page12
Set ID837I
Loop2000A
Segment IDPRV