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Back  RFI # 908: 837P 5010 Situational notes

Formal vs. Informal Help Informal Formal


Jennifer Delmont


Requesting clarification on the new situational notes "If not required, do not send". Based on section 1.12.5 should payers only ignore redundant data when it is claim versus line level or does it apply to all situational notes that are written in this manner? For example what should payers do if a provider submits a NPI in Loop 2010AA NM109 and also submits the REF segment in Loop 2010AA with a 1G qualifier for UPIN? The situational rule was not satisfied to allow the provider to submit that UPIN considering it is after the NPI mandate and the NPI is present in NM109 so is the intent to reject or ignore in that case?


Submission of the UPIN in addition to the NPI is not an example of redundant data, therefore 1.12.5 does not apply to this example or any other example of non-redundant data. However, section does apply. It explicitly states that the information in the TR3 on what constitutes a transaction that complies with the implementation guide "is not intended to require or imply that the receiver must reject non-compliant transactions." clearly states that it is a business policy of each entity. Entities that receive transactions need to establish business processes for dealing with non-compliant transactions, and that process can be to accept the transaction for processing. Note: please reference the Disclaimer below.
Submission 11/17/2009
Status Date 5/7/2010
Status F - Final
Primary References
Document 005010X222
Set ID837P