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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.

Prior to NPI compliance, the legacy IDs are sent in the REF Segment within the corresponding loops. When submitting NPI-only claims, the REF Segment containing the legacy ID must be omitted completely.

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. Note that the NYS Medicaid Provider ID and Locator Code are still required when filing claims for atypical (non-HIPAA-regulated) providers.

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 = (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 = (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 = (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:	December 22, 2008

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