www.eMedNY.org

Home | Glossary | Site Map

Search

NYHIPAADESK

	eMedNY Overview
	NPI
	Archived Items
	Edit/Error Knowledgebase
	Crosswalks
	eMedNY Companion Guides and Sample Files
	FAQ's
	NEWS DOH CSC / eMedNY
	Provider Training Material
	Registration Information Trading Partner Resources
	Useful External Links
	Vendor Information
	Issues Form
	NYS Medicaid eMedNY Compliant Transactions
	ePACES General Information and Enrollment
	NYS Medicaid: POS Device
	eMedNY Quick Reference
	Other New York State Department of Health HIPAA Related Websites

Frequently Asked Questions (FAQs)

NPI, National Provider Identifier – Where does the NPI go (in which loops and segments) on the X12 837 electronic claim?

The following tables list the loops and segments that are designated for the NPI. This is only a guide for locating the NPI and is not intended to replace the Companion Guides (CG’s). Updated CG’s are available on the eMedNY.org web site on the NYHIPAADESK tab. The following information is not for use with ePACES or paper claim forms. At the present time the NYS Medicaid Provider ID and Locator Code are still required for claims processing.

NYSDOH and CSC will notify providers when the eMedNY system is ready to receive the NPI as the primary provider identifier.

The 837I Institutional claim transaction can have NPI data mapped from 8 different locations. The NPI data will be captured in the NM1 Provider Name segment of the following Loops when NM108 = (XX) Qualifier and NM109 = (Healthcare Financing Administration National Provider Identifier).

837I (Institutional)
LOOP ID 2010AA	Billing Provider Name
LOOP ID 2310A	Attending Physician Name
LOOP ID 2310B	Operating Physician Name
LOOP ID 2310C	Other Provider Name (used for referring provider)
LOOP ID 2310E	Service Facility Name
LOOP ID 2420A	Attending Physician Name
LOOP ID 2420B	Operating Physician Name
LOOP ID 2420C	Other Provider Name

The 837P Professional claim transaction can have NPI data mapped from 13 different locations. The NPI data will be captured in the NM1 Provider Name Segment of the following Loops when NM108 = (XX) Qualifier and NM109 = (Healthcare Financing Administration National Provider Identifier).

837P (Professional)
LOOP ID 2010AA	Billing Provider Name
LOOP ID 2010AB	Pay-to Provider Name
LOOP ID 2310A	Referring Provider Name (Referring Physician ‘DN’ iteration)
LOOP ID 2310A	Referring Provider Name (Primary Care Provider ‘P3’ iteration)
LOOP ID 2310B	Rendering Provider Name
LOOP ID 2310D	Service Facility Location
LOOP ID 2310E	Supervising Provider Name
LOOP ID 2420A	Rendering Provider Name
LOOP ID 2420C	Service Facility Location
LOOP ID 2420D	Supervising Provider Name
LOOP ID 2420E	Ordering Provider Name
LOOP ID 2420F	Referring Provider Name (Referring Physician ‘DN’ iteration)
LOOP ID 2420F	Referring Provider Name (Primary Care Provider ‘P3’ iteration)

The 837D Dental claim transaction can have NPI data mapped from 6 different locations. The NPI data will be captured in the Provider Name Segment of the following Loops when NM108 = (XX) Qualifier and NM109 = (Healthcare Financing Administration National Provider Identifier).

837D (Dental)
LOOP ID 2010AA	Billing Provider Name
LOOP ID 2010AB	Pay-To Provider Name
LOOP ID 2310A	Referring Provider Name
LOOP ID 2310B	Rendering Provider Name
LOOP ID 2310D	Assistant Surgeon Name
LOOP ID 2420A	Rendering Provider Name

Notes and Comments
Created:	May 2, 2007
Last Modified:	August 8, 2007

	New York State Department of Health	Home \| Glossary \| Site Map
		webmaster@emedny.org \| Privacy Policy