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Back  RFI # 938: Service Facility - Home Visits

Formal vs. Informal Help Informal Formal

Submitter

Marcia Henderson

Description

In 4010, providers do not have to complete the service facility information if the services are performed in the patient's home. The POS indicates patients home and the patient's address is required.

In 5010, the service facility information (both 837I and 837P) is required if the location/address is different than the billing provider. Is the intent that providers must always complete the service facility information if the service is rendered in the patients home?

Response

This issue is explicitly addressed in the 5010 837 Professional implementation guide. The related 2310 Service Facility Location Name loop NM1 segment situation rule states for both guides "Required when the location of health care service is different than that carried in Loop ID-2010AA (Billing Provider). If not required by this implementation guide, do not send."

Therefore, if services are rendered in the patient's home and the patient's home address is not the same as the billing provider address then the Service Facility Location Name loop is required and must be completed by providers.
Submission 1/6/2010
Status Date 2/12/2010
Status F - Final
Primary References
Document 005010X222
Section2310C
Page269
Set ID837P
Table2
Loop2310C
Secondary References
RFI ID 845
Document 005010X223
Section2310E
Page341
Set ID837I
Table2
Loop2310E