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Back  RFI # 981: New 835 NM1*74 5010 Rules

Formal vs. Informal Help Informal Formal

Submitter

Brian Wagner

Description

We interpret the new situational rule for the NM103-NM105,NM107, and NM109 data elements of the NM1*74 segment in the 5010 to mean that ONLY the data that is different should be communicated. So, if the provider submitted a subscriber named "JOHN DOE", but our enrollment record has "JOHN J DOE, JR" on file, the following should be submitted in the 835. Would you please confirm that this is correct?

NM1*IL*1*DOE*JOHN****MI*12345678901~
NM1*74*1***J**JR~

Also, can the NM1*74 be used to be communicate that data should NOT be sent? For example, if a provider submitted the subscriber named "JOHN PHILIP SOUSA", but our enrollment record just has "JOHN SOUSA", we would like to send the whole name without the middle name, but that wouldn't satisfy the situational rule for the NM103 and NM04. The only way we can think to communicate this is as follows, but it isn't clear what needs to be changed. Please advise how this can be handled.

NM1*IL*1*SOUSA*JOHN*PHILIP***MI*12345678901~
NM1*74*1~

Submitter Assigned Keywords

NM1*74 835 Corrected Subscriber 5010

Response

Example # 1 would be correct

Example #2
The Corrected segment is intended to support actual corrected data so if
the middle name, first name or suffix is blank there is no way to report
that as corrected to blank.
This will be considered for a future guide.

Recommendation

Submission 3/5/2010
Status Date 8/26/2010
Status F - Final
Primary References
Document 005010X221
Section2.4
Page144
Set ID835
Table2
Loop2100
Segment Position0300
Segment IDNM1
External Code List74