837 Prof Version 5010X222A1 Loop 2320 SBR, TR3 stated "Required prior to mandated use of HIPAA NPI". We received a claim with Loop 2320 SBR without SBR09. Our translator erred out because the SBR09 was missing. Does it mean SBR 09 should always be present when Loop 2320 SBR segment is present?
Yes, the claim filing indicator code (loop 2320 SBR09) is required when the other subscriber information segment (loop 2320 SBR) is present, until additional guidance is issued from CMS.
CMS developed the Health Plan ID (HPID) to serve as the National Plan ID. At this time, CMS does not require that the HPID be used in claim transactions. Questions on the status of National Plan ID mandate should be directed to CMS
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The situational rule for the 2320 SBR09 reads “Required prior to mandated use of the HIPAA National Plan ID. If not required by this implementation guide, do not send.” Within the healthcare industry, the acronym NPI refers to the National Provider ID not the National Plan ID.