Section title: Requests for Interpretation
RFI #
2383
Loop 2200D -REF 02 Prof vs Inst
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
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 the segment 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
05010X12.22