Section title: Requests for Interpretation
RFI #
2760
Interpreting X12 997 Group and Transaction Reconciliation Status Ambiguities.
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?

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

Recommendation:  If you would like your payments to be grouped by TIN only; suppress affiliated NPI(s) (Loop 1210A).  
If you would like your payments to be grouped by NPI, then also submit the affiliated NPI(s) (Loop 1210A).  This is the temporary solution until further versions of the implementation guide are available.

DOCUMENT ID
005010X230