Section title: Requests for Interpretation
RFI #
2304
X12 005010X221A1 - Payee REF
Description

The Health Care Claim Payment/Advice (835) Technical Report Type 3 (TR3) version 005010X221 April 2006 had completed the X12 publication process in advance of the National Provider Identifier (NPI) Final Rule transition timeframe. Subsequent 005010X221 TR3 Errata are listed in the X12 TR3 Registry, specifically, E1 dated January 2009, E2 dated June 2014 and A1 dated June 2010. This will be the first part of the Request but all components should be processes as one RFI due to limitation of the Portal. Please clarify the component(s) that can be used as "Additional Identifiers" in REF segment – PAYEE ADDITIONAL IDENTIFICATION when qualifier "PQ" is used and the N1 PAYEE IDENTIFIFCATION contains the following information:
1. First scenario, the N103/04 contains the Federal Taxpayer's Identification Number, qualifier "FI".
2. Second scenario, the N103/04 contains the Centers for Medicare and Medicaid Services National Provider Identifier "XX".
Finally, what if any consideration(s) would have been required prior to the NPI Transition period, and now that the transition period has concluded, what impact would this have on the use of the REF segment – PAYEE ADDITIONAL IDENTIFICATION when use of the "PQ" qualifier is employed?
The authors included a capability to further identify information about the Payee by use of the 1000B REF segment – PAYEE ADDITIONAL INDENTIFCATION. This REF segment provides the capability to indicate
- State License Number "0B" or
- Qualifier "D3", Code Source 307 – National Council for Prescription Drug Programs Pharmacy Number
- Qualifier "PQ" Payee Identification, or
- Qualifier "TJ" Federal Taxpayer's Identification Number, which also includes a note Pg 107+ E2 Errata

The authors chose to include the above capability, linking it to the 1000B N1 segment - PAYEE IDENTIFICATION, which includes one of the following:
- Federal Taxpayer's identification number, qualifier "FI",
- Code Sources 540 - Centers for Medicare and Medicaid Services PlanID and Code Source, qualifier "XV",
- Code Source 537 - Centers for Medicare and Medicaid National Provider Identifier qualifier "XX".

Response

The situational rule for the Payee Additional Identification explicitly states “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.”  Regardless of if the N103/104 contains TIN or NPI, the PQ would contain any ID the payer feels would be beneficial to the Payee. There is no different rules for the Ref segment for before, during, or after the NPI Adoption Date

DOCUMENT ID
005010X221A1