Currently X12 5010 837I, P and D transactions do not contain a PRV segment for the following NPI/provider Loops: Referring, Ordering and Supervising. What loop/segment/data element can providers use to submit their taxonomy code?
When a provider is enrolled with CMS to practice multiple specialties under one NPI (ex: an individual can be a nurse practitioner and a nurse mid-wife) and the provider is billed on the claim as a Referring, Ordering, or Supervising provider, our system is not able to identify the correct provider-type without a reported taxonomy code. The absence of a taxonomy code for the Referring, Ordering, or Supervising loops impacts how our system is able to process the claim resulting in delayed payment.
We agree that there is no current way to submit taxonomy codes for Referring, Ordering, or Supervising providers.
If this is functionality that is needed for your business, please enter a maintenance request at https://x12.org/resources/forms/maintenance-requests