RFI #
1321
834 Provider ID in 2310\NM1
Description
In light of situational rule for elements NM108/09 and TR3 note 1 for segment NM1 in loop 2310:
1. Is it compliant with the TR3 not to send NPI in 2310/NM1 segment when such NPI is not available to sender of the transaction even though provider might have an NPI issued ?
2. Is it compliant with the TR3 to send other IDs except NPI for atypical / not-covered providers such as payer assigned ID ?
RFI Response
When the provider is mandated to obtain a National Provider ID, the NPI must be sent. NPI’s are publicly available through the NPPES.
When a provider is atypical, an alternate identification number as assigned by the payer may be sent.
DOCUMENT ID
005010X220