I am a payer and I am trying to find out if my interpretation of the Subpart rules and the segment specific rules are correct.
1. A claim submission is considered invalid if the NPI submitted for the Rendering Provider (2310B) is the same as the NPI submitted for the Billing Provider (2010AA?)
2. A claim submission is considered invalid if the NPI submitted for the Service Facility (2310C) is the same as the NPI submitted for the Billing Provider (2010AA?)
Based on the Subpart rules and the Loop specifications.
The situational rule for 2310B/NM1 states "Required when the Rendering Provider Information is different than that carried in Loop ID-2010AA Billing Provider. If not required by this implementation guide, do not send." Therefore, if the rendering provider information, which is inclusive of the NPI and provider taxonomy, is the same as the billing provider, and the 2310B information is submitted, this does not comply with the TR3.