Section title: Requests for Interpretation
Loop 2310D + E request

To ensure proper reimbursement, Maine Medicaid requires providers to submit their Service Location ID when more than one SL is associated with the Pay To NPI. We wanted to instruct providers to use 2310E loop for 837Is with LU qualifier to submit their Service Location IDs. NHIC ran test claims through their system and had claims rejected in their system for M395 and M419 when using LU and 1D. They were also concerned that if claims were submitted with procedure codes for Care Plan Oversight, those would deny when LU was included in that segment. We interpret the IG to read that this loop is situational and therefore could be populated with up to 30 characters with LU qualifier and that information would not be edited by Medicare but be passed through to Medicaid. Since those loops are repeatable up to 5 times, we also interpret that to mean that if Medicare did use another qualifier for Care Plan Oversight, providers could still use that loop for the dual eligibles.

RFI Response

Guide 004010X096A1 doesn’t exclude the usage of secondary proprietary IDs to identify the Service Facility when they are necessary for that identification, and supports up to five secondary identifiers. However, the intent of the ASC X12 837 workgroup was to allow only one occurrence of each allowable qualifier within the REF segment. Prior to NPI mandate each payer's identifier was accommodated by using the 2310E Loop for the destination payer and the 2330H Loop for the non-destination payers. When NM109 in Loop 2010AA contains the NPI and the Health Care Provider chose not to enumerate its subpart being sent in 2310E, then reporting primary and secondary identifiers in the Service Location in Loop 2310E is prohibited by CMS FAQ 5816. See HIR 1007 for guidance on Loop 2310D in the professional 837 004010X098A1.