Section title: Requests for Interpretation
RFI #
1007
Service Location on 837P
Description

In instances where one pay-to provider has multiple service locations attached to it, is it possible to populate the NM101 segment in the 2310D loop with 77 qualifier, populate the REF01 segment in the 2310D loop with LU qualifier and enter the service location ID in the REF02 segment? We cannot reimburse providers properly without knowing the service location ID. NHIC has tested claims with both LU and 1D qualifiers and has denied them.

RFI Response

Guide 004010X098A1 doesn’t exclude the usage of secondary proprietary IDs to identify the Service Facility when they are necessary for that identification, and supports up to five secondary identifiers. However, the intent of the ASC X12 837 workgroup was to allow only one occurrence of each allowable qualifier within the REF segment. Prior to NPI mandate each payer's identifier was accommodated by using the 2310D Loop for the destination payer and the 2330G Loop for the non-destination payers. When NM109 in Loop 2010AA contains the NPI and the Health Care Provider chose not to enumerate its subpart being sent in 2310D, then reporting primary and secondary identifiers in the Service Location in Loop 2310D is prohibited by CMS FAQ.

DOCUMENT ID
005010X222