Section title: Requests for Interpretation
RFI #
1317
835 Insured Identifier
Description

The 835 4010A1 and 5010A1 guides both require NM108 and NM109 in the 2100 Insured Name segment. The 837 4010A1 and 5010A1/A2 guides situationally require the NM108 and NM109 in the 2010BA Subscriber Name segment (person type 1). the 837 5010A1/A2 Errata states that if NM108 or NM109 are not required, do not send. The 835 5010A1 guide also states "This segment contains the same information as reported on the claim". If the original 837 Subscriber NM108 and NM109 are not sent (Org type 2), what value must be returned in the NM108 and NM109 Insured Name 835 segment?

RFI Response

This inconsistency between the 837 and 835 guides will need to be fixed in a future version. Until then, since the 835 requires something to be populated in the Insured identifier (which may not have been sent in the 837), we recommend populating NM108 with 'MI' and NM109 with a default value of 'NONE'. While we try to avoid default values, providers should not be burdened to populate a true ID number when it is not needed.

DOCUMENT ID
005010X221