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electroniclaims

 

electroniclaims

I am getting error messages from my payer that
includes an NM1 qualifier. How do I tell where they come from?

 

Hierarchical Levels are placeholders to indicate where we are in a transaction set. They allow the reader of a claim file to find his place after missing segments. They should be absolute placeholders. They are as follows:

     

HL

20

Billing Provider

2000A

HL

22

Subscriber

2000B

HL

23

Dependent

2000C

NM1

40

Receiver

1000B

NM1

41

Submitter

1000A

NM1

77

Service Location

2310D

NM1

77

Service Location Other Payer

2330G

NM1

77

Service Location

2420C

NM1

82

Rendering Provider

2310B

NM1

82

Rendering Provider Other Payer

2330E

NM1

82

Rendering Provider

2420A

NM1

85

Billing Provider

2000AA

NM1

87

Pay to Provider

2000AB

NM1

DK

Ordering Provider

2420E

NM1

DN

Referring

2310A

NM1

DN

Referring Provider Other Payer

2330D

NM1

DN

Referring

2420F

NM1

DQ

Supervising Prov

2310E

NM1

DQ

Supervising Prov Other Payer

2330H

NM1

DQ

Supervising Prov

2420D

NM1

FA

Service Facility

2310D

NM1

FA

Service Facility Other Payer

2330G

NM1

FA

Service Facility

2420C

NM1

IL

Subscriber

2000BA

NM1

IL

Other Subscriber

2330A

NM1

LI

Independent Lab

2310D

NM1

LI

Independent Lab Other Payer

2330G

NM1

LI

Independent Lab

2420C

NM1

PR

Other Payer

2330B

NM1

PR

Other Payer

2420G

NM1

P3

Primary Care Provider

2310A

NM1

P3

Primary Care Provider Other Payer

2330D

NM1

P3

Primary Care Provider

2420F

NM1

QB

Purchased Service Provider

2310C

NM1

QB

Purchased Service Provider Other Payer

2330E

NM1

QB

Purchased Service Provider

2420B

NM1

QC

Patient

2000C

NM1

QC

Patient Other Payer

2330C

NM1

TL

Test Lab

2310D

NM1

TL

Test Lab Other Payer

2330G

NM1

TL

Test Lab

2420C

 

The 2000 A, B; and C loops identify the Primary Billing Provider and the Primary Payer identification numbers for the Subscriber and Patient.

The 2300 and 2310 loops identify claim level entities and individuals whose numbers are usually assigned by the primary payer.

The 2330 loops identify entities and individuals as they are known to the secondary and tertiary payers.

The 2400 loops identify entities and individuals who are applicable to a specific detail line instead of the entire claim. Sometimes they are assigned numbers by the secondary and tertiary payers also.

 

 

 

Empire Medical Review Services, Inc
11357 North Port Washington Road
Phone: 262.240.9700
Mequon, Wisconsin 53092