We are needing clarification when sending the 276 claim status transaction. As it deals with the billing and rendering NPI’s.
We have been instructed that the 276 needs to match the information that was sent in the 837 transaction. When both the billing and rendering NPI’s have been included in the 837 that we must send both the Billing and Rendering NPI in the 276 in order for the transaction to work.
We have a customer that is insisting that they should be able to send only the billing NPI to get the information. We are looking for official documentation that shows the 276 must match what was sent in the claim. Hoping that you will be able to help us with this request.
In sending a 276 request, in order for the claim to be found we must send the billing and rendering NPI as shown in the claim.
Requiring a submitter of the Health Care Claim Status Inquiry (276) to send both the Billing Provider and Rendering Provider does not comply with the Health Care Claim Status Inquiry and Response (276/277) version 5010 implementation guide. The 276 can only support reporting either the Billing Provider or the Rendering Provider NPI.
This is supported via the 276 Loop 2100C NM1 Provider Name TR3 Notes. TR3 Note 1 states “Provider of Service is generic in that this could be the entity that originally submitted the claim (Billing Provider) or may be the entity that provided or participated in some aspect of the health care (Rendering Provider). The provider identified facilitates identification of the claim within a payer’s system.”
Additionally, TR3 Note 3 limits the Loop 2100C repeat to 1, “After the transition to NPI, for those health care providers covered under the NPI mandate, only one iteration of the 2100C loop must be sent with the NPI reported in the NM109 and NM108=XX.”