Per the situational rule found under Loop 2310C, pg.269 of the 5010 IMP guide dated May 2006, which reads: Required when the location of health care service is different than that carried in Loop ID-2010AA (Billing Provider); we are trying to determine if claims we are receiving without the servicing facility NPI should actually be rejecting, since the services being performed are being performed in an actual facility that is NOT the office, and, is not a subpart of the Billing provider. For example: when the Place of service code sent in the CLM05-1 = 21=Inpatient hosp., 22-outpatient hospital, 23 Emergency room, does that then make the servicing facility 2310C loop name, ADDRESS, CITY, STATE, ZIP AND NPI all required?
If so, which WEDI-SNIP validation levels should this be part of please so we can implement it into our software? We were thinking either level 4 due to the Place of service situational or Level 2 for the missing NPI. We need your help please. Thanks
The purpose of the service facility (loop 2310C) is to identify where the services were rendered. If the services were not rendered at the location specified in the billing provider (loop 2010AA) then the service facility information is required. This requirement is based on actual location and not specific place of service codes.
The submitter is asking if they may reject a transaction if the they do not believe that the service was in fact rendered at the location specified in the 2010AA loop of the claim and no 2310C loop is present. The ASC X12 doesn’t dictate when a transaction should or should not be rejected. See RFI # 1512 for additional information. Any use of WEDI SNIP validation levels is outside the scope of ASC X12.