Greg, First, there are a couple of typos in N103 and N104, where it says "Required if the National PlanID is not transmitted in N104." Obviously the word "not" should not be there, or it would conflict with X12 syntax (N103) or not make any sense (N104). So, that needs to be corrected. It has been corrected in the Addenda.
When the 835 IG was written, the National PlanID was expected to be the "primary" payer identifier. We don't have it yet. So, here is how you use it until we have a National PlanID: N101 = "PR" N102 = payer name, like "BCBS of XX" N103 = not used N104 = not used REF01 = "2U" REF02 = payer ID number, like "00303" or REF01 = "NF" REF02 = NAIC co-code, like "60054" for Aetna The code used with qualifier 2U does not need to be 5 digits. It could be just "303" if that is what the payer uses to identify itself. But it should be consistent. Given that there are multiple ways to identify a payer, there could be two payers that invent the same ID code for themselves. So, that is why the preferred use is to use the NAIC code. But not all payers have an NAIC code... Also, be aware that the way a payer identifies itself in the 835 (both in the 1000A loop as well as in the BPR10/TRN03) may be different from the way that a clearinghouse identifies a payer. So when you talk with a provider, they may not understand the payer ID you are using and they could know the payer by a different ID. Is this fun yet? Kepa On Thursday 26 September 2002 01:10 pm, Bard, Greg wrote: > > > > > Greg Bard > > NASCO > > HIPAA Privacy and Security Project Manager > > (W) 678.441.6059 > > (F) 678.441.6359 > > [EMAIL PROTECTED] > > > > > > ________________________________________________________________________ > ______________ > > CONFIDENTIALITY NOTICE > > The information in this message (and the documents attached to it, if > any) is confidential and may be legally privileged. It is intended > solely for the addressee. Access to this message by anyone else is > unauthorized. If you are not the intended recipient, any disclosure, > copying, distribution or any action taken, or omitted to be taken in > reliance on it is prohibited and may be unlawful. If you have received > this message in error, please delete all electronic copies of this > message (and the documents attached to it, if any), destroy any hard > copies you may have created and notify me immediately. Thank you. > > > > > > > > > > > > -----Original Message----- > From: Bard, Greg > Sent: Thursday, September 26, 2002 2:58 PM > To: '[EMAIL PROTECTED]' > Subject: 835 TRNSACTION QUESTION > > > > In the IG, there is a reference to the Payer Identifier in Loop 1000A. > N101 Entity Identifier Code is required, value = PR > > N102 is Situational and indicates that this is required if the National > Plan ID is not identified in N104. > > > > N103 is Situational but indicates this element is expected to be sent. > However, the value for N103 is XV to indicate the HCFA National Plan ID > and further states that this is required if the national Plan ID is > mandated - otherwise, one of the other codes listed may be used. Does > this reference codes from External Source 540 or are additional values > besides "XV" supposed to be listed? > > > > This Loop is causing test claims to fail and I am not sure of the > resolution. Can someone help with an explanation of how they see this > Loop working? > > > > Thanks! > > > > Greg Bard > > NASCO > > HIPAA Privacy and Security Project Manager > > (W) 678.441.6059 > > (F) 678.441.6359 > > [EMAIL PROTECTED] > > > > > > ________________________________________________________________________ > ______________ > > CONFIDENTIALITY NOTICE > > The information in this message (and the documents attached to it, if > any) is confidential and may be legally privileged. It is intended > solely for the addressee. Access to this message by anyone else is > unauthorized. If you are not the intended recipient, any disclosure, > copying, distribution or any action taken, or omitted to be taken in > reliance on it is prohibited and may be unlawful. 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