Section title: Requests for Interpretation
RFI #
2355
Provider Secondary ID (837 P)
Description

We have a payer requiring us to send the Secondary ID in the REF segment with the G2 qualifier Based on how i read the second part of the situational rule in the 837 spec, it sounds like as long as we are sending the NPI, REF segment for the secondary id should not be sent. Can you clarify the second requirement in the situation rule? Required on or after the mandated NPI Implementation Date when NM109 in Loop 2010AA is not used and an identification number other than the NPI is necessary for the receiver to identify the provider. If not required by this implementation guide, do not send.

Response

The Billing Provider NPI must be submitted in the NM109 of the Loop 2010AA if the provider is eligible for an NPI. When the NPI is provided in the NM109, the provider has been identified so the REF segment should not be used. The Situational rule has two parts the first part no longer applies as the NPI has been mandated. The second part states the REF segment is required when the NM109 in the 2010AA is not used and another identifier must be used for the receiver of the transaction to identify the provider. Sending the secondary identifier in the REF segment when the NM109 is present is not a compliant use of this transaction.

DOCUMENT ID
005010X222