Section title: Requests for Interpretation
RFI #
2631
EFT/835 Enrollment Grouping Preference (838)
Description

CAQH CORE Operating Rules allow for the collection of a "grouping preference" (bundling/packaging/bulking/linkage) for during EFT and 835 enrollment to determine whether payments should be grouped by TIN or NPI(s). The 838 does not appear to support the transmission of this information. How can this be accounted for by a payer desiring to utilize this transaction? 

Is your question asking how the 838 transaction and send grouping preferences with a TIN grouping,  a multi-NPI grouping, etc.?

 

That is correct. In the 008030X305 TR3, I can see where the requesting provider’s NPI and TIN can be transmitted in Loop 1100C N1 and N9 segments; I can also see where affiliated provider NPI(s) could be transmitted in Loop 1210A N1 segment, but there does not appear to be a segment/data element to indicate whether the requesting provider wants to group payments & remittances by TIN or NPI. I suppose the presence of one or more 1210A Loops could be used to indicate grouping by NPI, but that seems a little ambiguous unless another situational rule or TR3 note is added to the N1 segment.

Scenario

Scenario 1: A provider wants all claim payments associated with a specific TIN to be bundled into a single EFT (and 835).

Scenario 2: A provider has multiple NPIs and wants claim payments for NPIs 1, 2, & 3 bundled into a single EFT (and 835) and NPIs A, B, & C bundled into a separate EFT (and 835)

RFI Response

The 008030X305 838 transaction is not a financial transaction.  It is a provider data transaction.  There are segments to report banking information and those segments can be repeated to collect all banking information the provider uses.  However, there is an additional/separate 835 and/or EFT enrollment between the provider and payer to specify how the provider wants their banking information to be grouped.  The 838 will pass the banking information but not how it should be grouped. 

RFI Recommendation

The 008030X305 838 transaction is not a financial transaction.  It is a provider data transaction.  There are segments to report banking information and those segments can be repeated to collect all banking information the provider uses.  However, there is an additional/separate 835 and/or EFT enrollment between the provider and payer to specify how the provider wants their banking information to be grouped.  The 838 will pass the banking information but not how it should be grouped. 

DOCUMENT ID
005010X221