The 5010 837 Payto Plan loop 2010AC REF segment for the Tax Id number is required. However, the 2010AA Billing provider loop Billing Provider Tax Identification segment, which is also required, contains a TR3 note indicating “This is the tax identification number (TIN) of the entity to be paid for the submitted services.”. If the Payto plan loop is being used either for subro or Factoring Agent and represents the actual payee, does the TR3 2010AA note still apply and if so, what value is placed in the Payto Tax Id REF02? 2010AA Tax Id REF02? What value would be used to populate the required NM109 in 2010AC prior to the implementation of National Plan Id?
When the Pay-to-Plan loop is used, the Billing Provider 2010AA loop must contain the identical information as was submitted in the original claim. That includes the Billing Provider Tax Identification REF segment. The TR3 note on that 2010AA REF segment is intended to reference the entity which is paid for rendering the services. The Tax Identification (TIN) in the Pay-to-Plan loop 2010AC REF segment is for the entity to be paid for the subrogation, and is the TIN associated with the Plan listed in the NM103 of that 2010AC loop. We will consider restating the TR3 note on the 2010AA REF in a future version to eliminate any confusion.
As recommended by HIR 772, factoring agent information is submitted as the Pay-to-Plan, and follows the corresponding notes and guidelines, including the guidance in this response regarding Tax identification Numbers.