Regarding the 837 professional 005010X222A1 TR3.
Could we receive a claim with the N3, N4 and DMG segments in both the subscriber name loop (2010BA) and the patient name loop (2010CA)?
We have never received a claim with those three segments in both loops. We receive lots of claims where the NM1 IL segment is present in loop 2010BA and the NM1 QC segment is present in loop 2010CA, but the address is always in loop 2010CA when NM1 QC segment is used. On the CMS-1500 claim form, there is a box (5) for the patient address and a box (7) for the insured’s address, so it seems like we could receive a claim with a subscriber address and a patient address.
The documentation (page 124) for the N3 Subscriber Address segment contains a Situational Note that says, “Required when the patient is the subscriber or considered to be the subscriber. If not required by this implementation guide, do not send.”. Does this note prohibit using the N3 segment in loop 2010BA if the N3 segment is used in loop 2010CA?
This issue is explicitly addressed in the 005010X222A1 TR3. The Loop 2010BA segments, N3 - Subscriber Address and DMG – Subscriber Demographic Information are “Required when the patient is the subscriber or considered to be the subscriber. If not required by this implementation guide, do not send.” Therefore, if the patient is the subscriber or considered to be the subscriber, the patient address and demographic information must be sent in the 2010BA Loop. If the patient is not the subscriber or considered to be the subscriber, the patient address and demographic information must be sent in the 2010CA Loop.