Change Request Detail
No.
1059
Date
2/12/2007
Submitter
Type of Request
Professional Claim (HCFA 1500)
Status
DSMO Process Completed
Business Reason
Referring number not needed to process claims.
Suggestion
Current IMP guide is interpreted as REF segment required in loop 2310A (Referring Provider Secondary Identification). The following link supports this:

ASC X12N/TG2 Interpretations Portal

But, note #1, for this REF segment states: Reguired if NM108/109 in this loop is not used or if a secondary number is necessary to identify the provider. We disagree with the imterpretation that, "OR", means required. Referring number is not required in order for us to pay claims. We need a name, OR, a number, but not both. We intrepret the IMP guide, with OR, as meaning name OR number required but not both. Request this be reviewed and current compliance editing for this loop and segment be changed.
DSMO Category
D
Recommendation
Disapprove. Your request is appealing a response to a X12N HIPAA Implementation Guide Interpretation Request (HIR). Questions regarding HIR responses should be directed to X12N website (http://www.x12n.org/portal/), not through the DSMO process. Additionally, this request is to review and change compliance editing for this loop/segment. This is outside the purview of X12N and needs to be addressed directly with the submitter's vendor(s).
Appeal Recommendation