EDI 5010 Documentation 837 Professional - Loop 2310A Referring Provider Name

2310A Referring Provider

        

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

 

Very important Note:

It is something funny. Sometime some payer will not accept without 2310A referring provider information even though if the patient is not referred by any provider. In that case, payer will ask to put the rendering provider information same as in the referring provider information loop.  I am not sure , still this rule exists. So we handle this in the insurance master setup screen by saying “Use Rendering provider information as Referring Provider information if claim does not have any referring provider”. If this option is selected, then if there is no actual referring provider in the claim, then we will just write the same information as of rendering provider in the 2310A Loop.

 

Now let’s start the detail implementation.

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2010BA	NM1	Referring Provider Name	ID	3		R	NM1
		Element Separator	AN	1			*
	NM101	Entity Identifier Code	ID	2/3	98	R	DN
		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	Referring Provider Last Name
		Element Separator	AN	1			*
	NM104	Name First	AN	1/35	1036	S	Referring Provider First Name
		Element Separator	AN	1			*
	NM105	Name Middle	AN	1/25	1037	S	Referring 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	Referring 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	Referring Provider NPI Number
		Segment Terminator					~

 

NM102 - Entity Type Qualifier

Code qualifying the type of entity

Code	Definition
1	Person

 

 2310A Referring Provider Secondary Identification

 

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2310A	REF	Referring 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

 

2310A Referring Provider  - Examples

 

Now let us some examples on this Loop
Assume that claim contains a referring Provider who’s Last Name is John and First Name is Smith and there is no Middle Name. And also there is no NPI and secondary identification Number.

NM1*DN*1*John*Smith****~

Now add a middle Name for the above Referring Provider such as ‘ms’
NM1*DN*1*John*Smith*ms***~

Now add NPI Number for the above Referring Provider such as 1234567890
NM1*DN*1*John*Smith*ms***XX*1234567890~

Now add a secondary identification number such as “1G - Provider UPIN Number” and let the number be “UPIN999” (Note; Secondary identification is next line)

NM1*DN*1*John*Smith*ms***XX*1234567890~
REF*1G*UPIN999~

 

Another Example with element structure.

NM1*DN*1*SOLOMON*ROBERT****XX*1902825870~

 

 

        

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