A provider's validation vendor is interpreting the 5010 835 TR3 rules to state that the 1000A REF Additional Payer Identification can only be present when TRN03, TRN04, AND 1000A N104 are all present. Is this an accurate interpretation, or can the 1000A REF be present even if one of those elements is not present?
The 1000A REF is required when additional identification beyond what is included in the TRN and N1 is needed. The TRN03 includes the payer’s EIN or TIN, and TRN04 is a supplemental code used if information beyond the TIN is needed by the payee to identify the source of the payment (such as identification of the payer by division or region).
The 1000A N104 is only allowed to contain the National PlanID when mandated for use. Therefore, at the time of this RFI, the National PlanID is not mandated for use and will not be present unless the sender chooses to send it.
The 1000A REF includes other types of identifiers. For example, with qualifier 2U, the REF can include a Medicare carrier or intermediary ID number or BCBS association plan code. With qualifier EO, the REF could include a clearinghouse identifier if the original sender is not the payer. It can also include a Health Industry Number, or NAIC identifier for the payer.
Because the TRN04 contains only additional specific identification for the payer’s division or region, and the REF contains different types of identifiers, a 1000A REF Additional Payer Identification can be present when TRN04 is not present.