Section title: Requests for Interpretation
RFI #
2426
835 5010 Member ID suffix
Description

Loop 2100, NM109 (Member ID and Insured ID) with qualifiers QC and IL, value returned was not the same as submitted on the 837 in 2010BA NM109 with Qualifier IL. 835 X12 guidelines for Patient Name in TR3 NOTE 2 states "When used and the information was submitted with the original claim"
Our company does not use the suffix for the member id in any processing of claims and we do not return suffix if supplied on the 837 claim. Our interpretation is that since we do not use the suffix we are not required to return it. Please advise.

Response

In the 835 transaction, the TR3 notes for the 2100 Insured Name segment states: ‘This segment contains the same information as reported on the claim (for example 837 2010 BA loop Subscriber name NM  segment when the patient was reported in the 2010 CA loop Patient Name NM1 segment’

 In the 835 transaction the TR3 note in the 2100 Patient Name segment states:  ‘This segment must provide the information from the original claim.  For example, when the claim is submitted as ASCX12 837 transaction, this is the 2010CA loop NM1 Patient Name Segment unless not presented on the original claim, then it is the 2010BA Loop NM1 Subscriber name segment’

 If the insured identification number suffix is submitted on the original claim as part of the subscriber id, it is required to be sent back in the 835. This allows the provider to match back to the original claim submission and post accordingly.  If the suffix is not required or is not used in the adjudication process, the 2100 NM1 Corrected Patient/Insured would identify the adjudicated Patient name and ID if different than what was submitted. In your example only the ID used would be sent back in the Corrected/Patient/Insured segment.

DOCUMENT ID
005010X221