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Back  RFI # 909: 837I Svc Facility & Billing PV

Formal vs. Informal Help Informal Formal

Submitter

James Mosteller

Description

Two questions about the TR3 Note for 2310E NM1 Segment

1) If distinct sub part unit do we promote the name, address & NPI if different OR just the NPI is promoted to the billing provider loop?

2) If service facility NPI is the same as the Billing Provider NPI do we create the 2310x loop to report name & address but no NPI?

Response

This is addressed in Section 1.10.3 of the 5010 Institutional 837 TR3. The Billing Provider must always represent the lowest level of enumeration. Therefore, the subpart and all its associated information (name, address and NPI) would be reported as the Billing Provider in loop 2010AA.

Service Facility loop 2310E is used when the location of the service is different than the location in the Billing Provider loop. When the Service Facility NPI is the same as the Billing Provider NPI, that NPI is not sent in the Service Facility loop. The Service facility NPI is only submitted when the service location is not a component of the Billing Provider and that location has an NPI.

Rendering Provider loop 2310D is used when different than the Attending Provider. The Rendering Provider would not be the same as the Billing Provider for an institutional claim, and the Rendering Provider NPI must always be sent if that provider is eligible to receive an NPI.
Submission 11/19/2009
Status Date 1/7/2010
Status F - Final
Primary References
Document 005010X223
Section2.4
Page341
Set ID837I