Section title: Requests for Interpretation
Supplemental IDs Post-NPI

In the 5010 278 Request, now that we are in a NPI only world, how can we handle a situation where we need more information to identify a provider than just NPI? Specifically we see this in the 2010B and 2010EA loops where an institutional provider such as a hospital which enumerated with only one NPI but has more than one subpart could send a request. As a payer we need to associate the request with the appropriate subpart (ie. burn center or neonatal intensive care unit) in order to properly process the request. In the past we would have done this with a value in the REF segment in the loop as in the 4010 version. The situational rules in the 5010 guide for the REF segments in the 2010B and 2010EA Loops mentioned above state that after the NPI mandate no 'Supplemental Identifiers' can be sent for a health care provider.


This issue is explicitly addressed in guide 005010X217. The proper location for this information is the 2010B and 2010EA loops, PRV segment. The Situational Rule for the segment reads "Required when request is for services of a specialist or specialty entity to indicate the provider’s specialty. If not required by this implementation guide, may be provided a the sender’s discretion but cannot be required by the receiver." When used, the PRV02 and PRV03 are used and provide the Taxonomy of the provider that would be providing the services.

Secondary IDs are not supported for this type of information.