A payer is denying claims when the Service Facility Location Number, Loop 2310C Segment REF*LU is missing on an 837P claim. Loop 2310C is not transmitted by the Clearinghouse to the Payer since the NPI’s in both the Service Location and the Billing Provider (2010AA) are the same. The Payer has stated that the only information they require in the 2310C to be present is the Service Facility Location Number in Segment REF*LU. They are not requiring their hospitals to have different NPI’s for each line of business. Can this segment be required in any situation when the Service Facility Location and the Billing Provider are the same?
Example of the Payers requirements:
2010AA NM1*85*2*ABC Hospital*****XX*1234567890~
N3*Address~
N4*City*ST*Zipcode~
REF*EI*123456789~
2310C NM1*77*2*ABC Hospital~
N3*Address~
N4*City*ST*Zipcode~
REF*LU*1234567890-000~
There is no condition which would require that the 2310C be submitted when the service facility provider and the billing provider are the same. The situational rule for the 2310C states “Required when the location of the healthcare service is different that that carried in the loop ID 2010AA (Billing Provider)” The TR3 note states “It is not permissible to report an organization heath care provider NPI as the Service location if the entity being identified is a component (for example subpart) of the Billing provider. In that case the submit must be the Billing Provider.” In the example supplied only the 2010AA would be submitted. The address fields in the 2010AA would contain the physical address where the service was rendered. A billing provider location number can be submitted in the 2010BB REF. However, the use of secondary provider IDs is limited to providers that do not have a NPI. In this case the provider has a NPI so it would not be compliant with the guide to submit the value in the 2010BB. For the same reason, it would not be compliant to submit the service facility location number if the service facility provider has a NPI.