Section title: Requests for Interpretation
RFI #
2283
Service Lines 837 vs 835
Description

Providers can’t submit an institutional bill type code on a professional claim.
We have a plan conducting internal audits and for a 277 response we have a Inst bill type code on a Prof claim. They are stating this is making the transaction non-compliant but we disagree.
The Segment identified in the request is:
REF - INSTITUTIONAL BILL TYPE IDENTIFICATION

Submitter was asked for additional clarification. This their response.

Yes, this is for the 276/277 (005010X212). No, the 276 did not contain a 2200D REF*BLT segment. Based on information reviewed it appears that the NASCO system sometimes moves/maps the 837P reported professional place of service code to the institutional Bill Type field. This then results in the 277 Health Care Claim Status Response for a professional claim to include an institutional REF*BLT segment.

REF02-SEGMENT SYNTAX: R0203
Can you clarify the standard for us?

Response

The Loop 2200D Institutional Bill Type Information is used to report data for institutional claims only. Although the segment situational rule allows the segment to be sent at the sender’s discretion, when sent, the segment can still only contain data that originated on an institutional claim. Data in REF02 is limited to the concatenation of code sources 236 Uniform Billing Claim Form Bill Type and 235 Claim Frequency Type Code. Therefore, place of Service codes from the 837 Professional claim are not compliant with the TR3.

DOCUMENT ID
005010X221