I was hoping to get some clarification on the TR3 notes for loop 2010AA segment NM1 of the 837P standard (page 87). Note 4 states "The Billing Provider may be an individual only when the health care provider performing services is an independent, unincorporated entity. In these cases, the Billing Provider is the individual whose social security number is used for 1099 purposes."
Is the use of the phrase "social security number" intentional? I believe an individual can obtain an EIN as an independent, unincorporated entity - for example, a sole proprietor. Supporting the idea that an EIN be appropriate even for an individual, Page 43 has a very similar paragraph, except it replaces "social security number" with "Tax Identification Number", which is a term that encompasses both SSN and EIN. "...In these cases, the Billing Provider is the individual whose Tax Identification Number (TIN) is used for IRS Form 1099 purposes."
Is it compliant with the 837P standard to bill with 2010AA NM102 = 1 and REF01 = EI?
TR3 Note 4 of the NM1 – Billing Provider Name segment reads: "The Billing Provider may be an individual only when the health care provider performing services is an independent, unincorporated entity. In these cases, the Billing Provider is the individual whose social security number is used for 1099 purposes. That individual’s NPI is reported in NM109, and the individual’s Tax Identification Number must be reported in the REF segment of this loop. The individual’s NPI must be reported when the individual provider is eligible for an NPI. See section 1.10.1 (Providers who are Not Eligible for Enumeration)."
The TR3 note clearly indicates the individual’s Tax Identification Number must be reported in the REF segment of this loop. Therefore, it is compliant with the 005010X222A1 TR3 to bill with 2010AA NM102 = 1 and REF01 = EI.
In the course of this RFI review ASC X12 acknowledges that this part of Note 4 “the Billing Provider is the individual whose social security number is used for 1099 purposes.”, may be confusing. ASC X12 will give consideration to changing this note in future TR3’s.