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837 Health Care Claim: Institutional - Louisiana Medicaid

837 Health Care Claim: Institutional - Louisiana Medicaid

837 Health Care Claim: Institutional - Louisiana Medicaid

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06/30/2014 <strong>Health</strong> <strong>Care</strong> <strong>Claim</strong>: <strong>Institutional</strong> - <strong>837</strong>NM1Referring Provider NamePos: 2500 Max: 1Detail - OptionalLoop: 2310F Elements: 9User Option (Usage): OptionalLA <strong>Medicaid</strong>:If present, the referring provider identified in this Loop applies to the entire claim, unless overridden at the line level bythe presence of Loop 2420D.Element Summary:RefNM101Id98NM108 66NM109 67Element NameEntity Identifier CodeReqMTypeIDMin/Max2/3LA-<strong>Medicaid</strong>: Use the value DN for this elementIdentification Code Qualifier X ID 1/2LA <strong>Medicaid</strong>: Use the qualifier XX for this element whenreporting an NPI.Identification Code X AN 2/80LA <strong>Medicaid</strong>: This loop is for NPI only. Enter the NPIregistered with <strong>Louisiana</strong> <strong>Medicaid</strong> that corresponds to the<strong>Louisiana</strong> <strong>Medicaid</strong> Provider being reported in this Loop.If an atypical provider who has registered an NPI with <strong>Louisiana</strong><strong>Medicaid</strong>, you should report the NPI in this Loop.If an atypical provider has not registered an NPI with <strong>Louisiana</strong><strong>Medicaid</strong>, you should not use this Loop, you should report thelegacy <strong>Louisiana</strong> <strong>Medicaid</strong> Provider number in 2310F REF02with qualifier G2.REFReferring ProviderSecondary IdentificationPos: 2710 Max: 3Detail - OptionalLoop: 2310F Elements: 2User Option (Usage): SituationalElement Summary:RefREF01Id128REF02 127Element NameReference Identification QualifierReqMTypeIDMin/Max2/3LA <strong>Medicaid</strong>: Use the value G2 for this elementReference Identification X AN 1/50LA <strong>Medicaid</strong>: This Loop is only for legacy <strong>Louisiana</strong> <strong>Medicaid</strong>Provider numbers (7 numeric positions) and is only used foratypical providers that do not have an NPI registered with<strong>Louisiana</strong> <strong>Medicaid</strong>. If an atypical provider has a registeredNPI, they should use Loop 2310F NM109 to submit their NPI.16

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