Section title: Requests for Interpretation
RFI #
1989
837 2310B Rendering Provider
Description

The 837I/P guide states that the Rendering Provider Loop is required when different than the Billing Provider. RFI #1531 states the difference includes both name and Id. In the situations where staff members provide services under a group NPI (e.g. Case Management services), the billing provider name would be the organization and the billing provider npi would be the group npi. Because the service was rendered by a staff member of the group, and their name is different than the group, would the staff member's name be expected in Loop 2310B? If so, with or without an associated NPI? If an NPI were included, it would be the same as the billing provider NPI and it was my understanding that was not a valid way to report in the 837 I/P. Or would the rendering provider loop be omitted because the staff member is a part of the billing entity and they do not qualify for their own NPI?

RFI Recommendation

There are business conventions that as the service is being done by a technician (for example) within a group practice, the rendering provider reported is the provider who is overseeing the care of the patient. If a laboratory or ambulance provider was the billing provider, then the rendering provider loop would not be used.

DOCUMENT ID
005010X222