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----- 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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