Saturday, 15 September 2012

EDI 5010 Documentation 837 Professional - Loop 2310B Rendering Provider

2310B Rendering Provider

        


I strongly recommend to read this article or download this document to understand the Concept of NPI, Provider billing with Individual NPI and Provider Billing with Group NPI.
You can also look our Billing Provider loop details here.

This loop semantically same as Billing Provider Loop 2010AA. But there are conceptual difference between Billing Provider and Rendering Provider.

FAQ 1 : What is the difference between Billing Provider and Rendering Provider ?
The billing provider may be a practice or individual doctor who owns the business. But the rendering provider is the healthcare provider who actually performed (or rendered) the services. For a solo practice,usually the billing provider and the rendering provider are the same entity.  However,the two providers are still treated separately by the insurance companies when processing your claims.

FAQ 2 : What makes  the difference between Billing Provider and Rendering Provider in paper claims and EDI ?
In the paper filing, the Billing Provider information is found in box 33 of the CMS1500. For electronic filing its located in the 2010AA NM1 record of an 837 file.
In the paper filling, the rendering provider information is found in box 24j of the CMS1500. For electronic filling its located in the 2310B.

FAQ3: What need to be done in each carrier if we bill as part of group NPI ?
If we are billing as part of group, then we should ensure that  provider’s individual NPI is linked to the group NPI with each insurance carrier.
For example, say a provider is in network with their local BCBS but they are set up individually under their ss# and their individual NPI. Then they decide to work part time for another group. The group they are working for cannot simply bill BCBS with that provider’s individual NPI in the rendering provider field and their group NPI in the billing provider field and expect payment to be made to the group. Even if the provider is par with BCBS. The group must notify BCBS that the provider will be working for the group, in addition to their private practice. BCBS will link the provider’s individual NPI to the group’s NPI

If you are billing for a provider or group, and you are not sure if the all of the provider’s NPI’s are set up correctly, you should call the insurance carriers to confirm. It is always better safe than sorry

In this loop, all the information will be taken from Practice Provider Master. Take a look of our sample screen here how  provider information are stored in the system.

Now let’s start the detail implementation.
Loop Seg ID Segment Name Format Length Ref# Req Value
2310B NM1 Rendering Provider Name ID 3 R NM1
Element Separator AN 1 *
NM101 Entity Identifier Code ID 2/3 98 R 82
Element Separator AN 1 *
NM102 Entity Type qualifier ID 1/1 1065 R 1
Element Separator AN 1 *
NM103 Name Last or Organization Name AN 1/60 1035 R Rendering Provider Last Name
Element Separator AN 1 *
NM104 Name First AN 1/35 1036 S Rendering Provider First Name
Element Separator AN 1 *
NM105 Name Middle AN 1/25 1037 S Rendering Provider Middle Name
Element Separator AN 1 *
NM106 Name Prefix AN 1/10 1038 Not used
Element Separator AN 1 *
NM107 Name Suffix AN 1/10 1039 S Rendering Provider Suffix
Element Separator AN 1 *
NM108 Identification code Qualifier ID 1/2 66 R XX
Element Separator AN 1 *
NM109 Identification code AN 2/80 67 R Print NPI Number.
Segment Terminator ~
               
 
 
NM102 - Entity Type Qualifier
Code qualifying the type of entity
Code Definition
1 Person
2 Non-Person Entity
 

2310B Rendering Provider Secondary Identification
Loop Seg ID Segment Name Format Length Ref# Req Value
2310B REF Rendering Provider Secondary Identification ID 3 R REF
Element Separator AN 1 *
REF01 Reference identification ID 2/3 128 R See below for more information
Element Separator AN 1 *
REF02 Reference identification AN 1/50 127 R Print the Reference number
Segment Terminator ~

REF01 - Reference Identification Qualifier

Code qualifying the type of Reference
Code Definition
0B State License Number
1G Provider UPIN Number
G2 Provider Commercial Number
LU Location Number
 
2310B Rendering Provider – Example

NM1*82*1*Sean*Smith*K***XX*7575757575~
REF*0B*0B12853W23~
REF*1B*UA73823~
REF*G2*LM43322~
 
 
        

Questions or feedback are always welcome. You can email me at vbsenthilinnet@gmail.com. 

8 comments:

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  2. Sir, What is the difference between Rendering provider and attending provider ?

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  4. Who is Physician? Rendering Provider or Referring Provider?

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