Section title: Requests for Interpretation
Service Facility Loop usage for Medicaid Subrogation (837)

I am confused on the usage of the Service Facility Loop.  Do we send the service facility information when the Billing Provider is the same as the Facility where services are rendered?  Are we required to send a value in NM109 of the Service Facility Name if the Billing Provider NPI is billing on behalf of the Service Facility or do we leave just NM108 and NM109 off?

I am asking because we are submitting claims for Medicaid subrogation which is recouping money on behalf of Medicaid but the service facility where services were rendered is different however the Medicaid client is the one billing to recoup the money from a payer that was already paid by Medicaid.



Medicaid (Entity A) is recouping payment from Payer A after Medicaid (Payer B) paid first, however Payer A was primary at the time services were rendered at Facility A (Service Facility)

RFI Response

Medicaid should send the billing provider information and service facility information as it was received on the original claim.   Medicaid would enter their information in the 2010AC Pay-To Plan Name loop.

RFI Recommendation

Related RFIs: 2355, 2288