--- You are currently subscribed to wedi-testing as: [email protected] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- --- I believe NM108 and NM109 are co-requisites for most loops. Wanted to throw that out there just in case.
Patricia Hamby Project Manager, HIPAA Compliance XANTUS Health Plan of Tennessee, Inc. 3401 West End Ave., Suite 470 Nashville, TN 37203 (615) 463-1612, Office (615) 279-1301, Facsimile -----Original Message----- From: Sue Ryder [mailto:sryder@;empirebcbs.com] Sent: Tuesday, October 22, 2002 3:09 PM To: WEDI SNIP Testing Subworkgroup List Cc: joyce cianciola Subject: Fw: Loop 2330B NM109 (Other Payer Primary ID) --- You are currently subscribed to wedi-testing as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- --- FYI, here is a response to the question sent to our list serv from one Medicare contractor's perspective. ----- Original Message ----- From: "Joyce Cianciola" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Cc: "Sue Ryder" <[EMAIL PROTECTED]> Sent: Tuesday, October 22, 2002 9:11 AM Subject: Fw: Loop 2330B NM109 (Other Payer Primary ID) > Caterina......It is technically true that Medicare contractors do not > require the secondary Payer information for crossover purposes. We are > required to identify the crossover payer based on the eligibility files > provider by our trading partners. While we had previously instructed our > providers that it was not necessary to provide this data, we have never > prevented the providers from sending this data and will process this data > accordingly if it is received on a 837 v4010 claim. > > As for the NM109 Payer Identifier, if you are sending this loop it is > required and we will edit for the requirement. We will not edit that it is > a valid payer ID. > > I hope this helps. Please let me know if I can be of any further > assistance. > > Joyce Cianciola > Project Manager, Institutional EDI > Empire Medicare Services > 315-442-4782 > > > >----- Original Message ----- > >From: "Snyder, Caterina" <[EMAIL PROTECTED]> > >To: <[EMAIL PROTECTED]> > >Sent: Friday, October 04, 2002 3:28 PM > >Subject: Loop 2330B NM109 (Other Payer Primary ID) > > > > > >> I represent a clearinghouse that is encountering some difficulty in > >> implementation of the ANSI 837 4010 with some Medicare contractors and am > >> looking to see if anyone else has experienced this issue and can offer > >their > >> advice. We have come across an impasse with interpretation of the 837 IG > >in > >> relation to submission of a Medicare Primary claim with a supplemental > >> payer. Note 1 of the 2330B NM109 in the IG states the following: > >> > >> 1. Submitters are required to send all known information on other payers > >in > >> this Loop ID-2330. > >> > >> If this segment is used, the NM109 (Payer Identifier) is a required > >element. > >> We have identified that the Medigap number for the Medigap payer to a > >> Medicare Primary claim will populate this element. The problem we are > >> encountering is related to non-Medigap payers on a Medicare Primary > claim. > >> We are being advised by a couple contractors to not report the other > >> insurance on the claim even though it is known for complimentary cross > >over > >> situations. It has been stated that if it is a payer in which the > Medicare > >> contractor has a complimentary crossover contract, they do not want to > see > >> the other payer reported on the claim at all. This seems to be in direct > >> contradiction to the above statement in the IG. > >> > >> When we queried further to determine if the other payer was to be > reported > >> on the claim, as per the IG requirement, what value would be > >> allowed/required in the NM109. The response was that no default value > >would > >> be allowed and essentially would cause the claim to reject if a value was > >> sent that was not valid. It has also been stated by another contractor to > >> leave this element blank. This poses a problem since a blank value does > >not > >> meet ANSI syntax requirements. > >> > >> Has anyone else encountered this issue in testing and how is it being > >> handled? Are you > >> just not reporting/suppressing the other payer on the claim even though > it > >> is known? Can the claim be rejected if the data is being sent by another > >> covered entity per IG requirements? Can CMS provide clarification on this > >> point? > >> > >> Thank you. > >> > >> To be removed from this listserv, please email [EMAIL PROTECTED] > >> <P>The WEDI SNIP listserv to which you are subscribed is not moderated. > >The > >> discussions on this listserv therefore represent the views of the > >individual > >> participants, and do not necessarily represent the views of the WEDI > Board > >of > >> Directors nor WEDI SNIP. If you wish to receive an official opinion, > post > >> your question to the WEDI SNIP Issues Database at > >> http://snip.wedi.org/tracking/. > >> Posting of advertisements or other commercial use of this listserv is > >> specifically prohibited. > >> > >> > >> > >> > > > > > > > > > "Empire Health Choice Inc." made the following annotations on 10/22/02 16:12:46 ---------------------------------------------------------------------------- -- [INFO] -- Access Manager: Attention! 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