Joanne
Yes, that (for better or for worse) that is what we intended.
We had no idea the NPI was going to be so delayed in implementation.
So, you send the tax ID in the NM108/09 and any proprietary provider identifiers
in the REF. Once the NPI kicks in, the tax ID moves to the REF (and
hopefully, the proprietary provider numbers stop.....)
j
Joanne Weingarth wrote:
Jan,
In the institutional guide, Loop 2010AA NM108 only has 24 (Employer Identification
Number), 34 (Social Security Number) and XX National Provider ID.
There really is no qualifer in the NM1 segment for submitting current provider
numbers. So you are really forced to use the REF segment until the
national provider id is implemented. Applies to both guides
if your number for the provider is not thier social security or employer
ID. joanne -----
Original Message -----
Sent: Friday, September 07, 2001 10:52
AM
Subject: Re: Situational Data Elements
Candice
For things like secondary patient identification numbers (actually
any secondary/additional identification numbers), yes, payers may require
that the provider submit that information (hopefully you've got some easy
way for the provider to get that information in the first place!). The
requirement here is not a syntax requirement (these secondary ID REFs are
situational as you point out). The requirement here is a business
requirement. Secondary ID REFs are situational in the imp guide because
not all payers use more than one ID. Payers may require this information
as a business decision if they need it to find the patient in their adjudication/eligibility/whatever
files. This is one of the key pieces of information that payers should
be telling providers: "Put this number in the NM109 and this other number
in the REF using (you pick) qualifier." The guide is meant to encompass
many different situations. In many ways it is a floor upon which
you build your business decisions.
[Also, remember, the primary patient identification number goes
in NM108/09. The REF is only used if you require more than one number
to identify the patient (recalling that Plan/Group Name/Number are carried
in SBR03 & 04).]
I always like to think of implementation has having three levels of
control
1: Imp guide syntax: this varies from guide to guide, but generally
speaking, if an element is required, then it must be sent. If there
is a syntax problem with a transaction, then it can be rejected on those
grounds. Basically, this means that if something is required then
it is sent (realizing that it's not always easy to figure out when an element
is required).
2. Business decisions: If you need 2 numbers to identify a patient
or a provider, then you can make a business decision to require two numbers
in your adjudication process. There is usually room in the 837 (and
other transactions) for more than one identifier for many entities.
Here, if a transaction comes in with only one number and you need two,
then it can be rejected as not meeting your business needs (you can't locate
the patient). Just make sure your provider base knows which two numbers
you need and where to put them in the imp guide (and which qualifier(s)
you prefer)
The guide does limit the scope of certain
business decisions. For example your system might be able to handle
100 lines on a professional claim. The 837P is limited to 50 lines.
Hence, all your 100 line claims will now come in on two claims. You
are not allowed to make a business decision to accept 100 line claims.
However, you can still make the business decision that "these services
must be split out this way and these other services must be split out another
way, and these must be lumped, etc., etc.".
3. Customary practices. These are of necessity vague and
vary from region to region, but they still exist and most contracts have
something in them about following customary billing practices.
Hope this helps.
j
Candice Craig wrote:
The 837 Professional IG states (page 49) if no
rule appears in the notes for
a situational element, the item should be sent if available to the
sender.
As a payer (receiver) can we require the provider (sender) to collect
and
therefore transmit the information? For example, using Loop 2010CA
-
Patient Secondary Identification (page 166). This loop is situational
if
additional information is required to adjudicate the claim/encounter.
If we
require social security numbers for reporting to the state, can we
require
that this loop be always used to collect social security numbers?
It is not
necessary to process the claim, but we must use it when reporting encounters
to the state.
Thanks for any input!
Candice Craig
GUI Designer/HIPAA Implementation Team
Kent County Community Mental Health
[EMAIL PROTECTED]
This message has been prepared on resources owned by Kent County, MI.
It is
subject to the Acceptable Use Policy of Kent County. Candice
Craig, CMH,
616-336-8930.
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