Tuesday, November 2, 2010

facility name and location of EDI loop 2310C , 2310A

Electronic Data Interchange - Institutional & Dental Claims


837 Health Care Claim Submissions




INSTITUTIONAL
Loop
 Segments/Data Elements
Billing Provider
Loop 2010aa
 NPI: NM108 = XX and NM109 = NPI
Tax ID: REF01 = EI and REF02 = Tax ID Legacy ID not mandated for use.
Pay-To Provider
Loop 2010ab
 NPI: NM108 = XX and NM109 = NPI
Tax ID: REF01 = EI and REF02 = Tax ID Legacy ID not mandated for use.
Attending Provider
Loop 2310a
 NPI: NM108 = XX and NM109 = NPI Tax ID not mandated for use.
Legacy ID not mandated for use.
Operating Physician Name
Loop 2310b
 NPI: NM108 = XX and NM109 = NPI Tax ID not mandated for use.
Legacy ID not mandated for use.
Other Provider Name
Loop 2310c
 NPI: NM108 = XX and NM109 = NPI Tax ID not mandated for use.
Legacy ID not mandated for use.
Service Facility Name
Loop 2310e
 NPI: NM108 = XX and NM109 = NPI Tax ID not mandated for use.
Legacy ID not mandated for use.
Attending Physician Name
Loop 2420a
 NPI: NM108 = XX and NM109 = NPI Tax ID not mandated for use.
Legacy ID not mandated for use.
Operating Physician Name
Loop 2420b
 NPI: NM108 = XX and NM109 = NPI Tax ID not mandated for use.
Legacy ID not mandated for use.
Other Provider Name
Loop 2420c
 NPI: NM108 = XX and NM109 = NPI Tax ID not mandated for use.
Legacy ID not mandated for use.
DENTAL
Loop
 Segments/Data Elements
Billing Provider
Loop 2010AA
 NPI: NM108 = XX and NM109 = NPI
Tax ID: REF01 = EI and REF02 = Tax ID Legacy ID not mandated for use
Pay-To Provider
Loop 2010AB
 NPI: NM108 = XX and NM109 = NPI
Tax ID: REF01 = EI and REF02 = Tax ID Legacy ID not mandated for use
Rendering Provider
Loop 2310B
 NPI: NM108 = XX and NM109 = NPI Tax ID not mandated for use
Legacy ID not mandated for use
Referring Provider
Loop 2310A
 NPI: NM108 = XX and NM109 = NPI Tax ID not mandated for use
Legacy ID not mandated for use
Service Facility Location
Loop 2310C
 NPI: NM108 = XX and NM109 = NPI Tax ID not mandated for use
Legacy ID not mandated for use
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download