here is a discrepancy between the requirements for Billing Provider Name NM104, NM105, and NM107 in the PACDR 837 Implementation Guide (ASC X12N/005010X298, 299, 300) and 277CA Health Care Claim Acknowledgement (ASC X12N/005010X214) transactions. We are receiving data in the PACDR 837 2010AA NM104, NM105, and NM107 when NM102 ="2", but receive a validation error when creating the 277CA response with data in NM104, NM105, and NM107 when NM102 ="2". What is expected in the 277CA 2100C NM104, NM105, and NM107 when NM102 = “2” if data was submitted on the PACDR 837 2010AA NM104, NM105, and NM107?
The referenced PACDR guides use the following situational rule format for the Billing Provider First Name, Middle Name and Name Suffix:
"Required when available in the payer’s adjudication system. If not required by this implementation guide, do not send."
While that rule doesn't explicitly refer to the code value in NM102, it is assumed that the code will be consistent with the contents of the rest of the segment - code 1 (Person) would be present when a first, middle or name suffix is provided, since a non-person entity (code 2) doesn't have a first, middle or name suffix.
The situational rules in 005010X214 for NM104, 05 and 07 use the wording "Required when NM102 is "1" and supplied on the submitted claim. If not required by this implementation guide, do not send." The related NM102 element is Required, and there is no note identifying that this element is to match the related claim. Therefore, the contents of NM102 must be consistent with the Billing Provider, and the NM104, 05 and 07 elements must not be present when NM102 is equal to "2".