Can we send a N101=PE, N103=FI for an atypical provider and a REF*TJ whether or not they are an individual provider or not?
Wondering if the interpretation needs to be weighed in between the TR3 and RFI #740.
Worded another way, are either one of these examples acceptable?
N3*123 MERRY LN~
N3*123 MERRY LN~
The format of your Example 2 is the preferred way to identify the payee when the provider is an atypical, i.e. not eligible for an NPI. The example provider name, however, implies a NPI eligible provider. A better representation is included in the recommendation below.
The 1000B Loop N103 element note with the qualifier of FI - Federal Taxpayer’s Identification Number states, “Required if provider is not mandated by NPI. For individual providers as payees, use this qualifier to represent the Social Security Number.”
The 1000B Loop REF - PAYEE ADDITIONAL IDENTIFICATION segment is “Required when identification of the payee is dependent upon an identification number beyond that supplied in the N1 segment. If not required by this implementation guide, may be provided at the sender's discretion, but cannot be required by the receiver.” Within this segment the REF01 TJ - Federal Taxpayer’s Identification Number element note states “This information must be in the N1 segment unless the National Provider ID or the National Health Plan Identifier was used in N103/04. For individual providers as payees, use this number to represent the Social Security Number. TJ also represents the Employer Identification Number (EIN). According to the IRS, TIN and EIN can be used interchangeably.”
In the situation described, the first part of the 1000B REF situational rule fails. The information is not “beyond” that supplied in the 1000B N104. The next sentence of the situational rule then comes into play, “may be provided at the sender’s discretion, but not required by the receiver.” That said, it does not make business sense to provide the same TIN/SSN in both the 1000B N104 and 1000B REF*TJ, if the sender decides to send both segments.
N3*125 MERRY LN~