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Grace,
First, I humbly suggest not to use
the SSN code... a whole other
hornets nest could be opened by using it. To ID the
doctor in the
NM1
segment 2310A..D loops, I suggest using the 24 code
and
supply a Fed
Tax ID in the NM109 element until the NPI is final.
What ID to
use would depend on the relationship the doctor has
with you and
their practice, (i.e. single, group, Contract, FTE, etc.).
If the doctor
is a
FTE physician, then you would be supplying your
Medical Center's FEIN. Otherwise, I think it
would be an ID to be
gained from
the doctor.
It has been
my experience from LTC Medicare and Medicaid FI testing
and
production claim processing that the NM108 and NM109 elements
are not
really used right now. Other than to ensure they are
filled
and the ID is
valid and matches the qualifier type. In my cases so far...
the providers
are using their FEIN for the doctor loops. If this is
wrong,
I think it is
overlooked because the FIs are using the REF
segment in
the
same loops to ID the
doctor. I believe its overlooked because the
REF segment
allows the use of the UB claim UPIN, State Lic., etc.
ID,
while the NM1 segment does
not.
Granted I
have a limited experience scope and this might not be your
actual
experience, but that is what I can relate to you.
Suspect others
may know more
or have other experiences and may give a better or even
an
exact answer. However... one sure fire way to get
clarity on the issue
for yourself
is to make it part of your Q&A process with each payer.
Add
the information to your your TPA document.
This
will
certainly begin the
process of
clarification.
BCY
Brian C. Young
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