1000A — PAYER IDENTIFICATION TR3 Notes: 1. Use this N1 loop to provide the name/address information for the payer 100019 2. The payer’s secondary identifying reference number is provided in N104, if necessary. As the sender of an 835, is it acceptable to insert a Payer ID into N104 if National Plan ID is not available for the health plan?
If not, where is it acceptable to insert the Payer ID?
CMS had audited one of our Health Plan's that we process electronic 835s for. This Health Plan does not have a Health Plan ID, so we are inserting the Payer ID in N104 to communicate Health Plan information.
CMS advised in the audit: Value of element N104 is incorrect. Expected value is Health Plan ID (format is '10 digits with optional '80840' prefix and last check digit') when N103='XV'. Segment N1 is defined in the guideline at position 0800.
However, because Health Plan ID was never mandated, we interpret the spec in a way that this segment can include discretionary data, and we can use N104 to communicate Payer ID.
The 5010 TR3 guide explicitly defines these data elements for reporting a Center for Medicare and Medicaid Services PlanID. These data elements cannot be used for other payer or health plan IDs.
The appropriate location for a Payer ID or Health Plan ID is Loop 1000A Additional Payer Identification REF segment using qualifier 2U - Payer Identification Number.
Related RFIs 2245