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~

 

 

        

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