In this article, we will discuss the following questions about Loop 2310B:
- When is the PRV segment generated?
- When is the REF segment generated?
In order to answer these questions, we will look at four settings under Billing > Insurance List > Info & Settings. Important: These options will be referenced in the tables below using the corresponding A, B, C, and D letters.
Master Rule
If option B is ever checked, neither the PRV or REF segments will generate in the 837 file.
PRV Segment
Time-Saving Tip: If option A is ever checked, the PRV segment will not generate in the 837 file.
Definition: The PRV*PE*PXC segment contains the Rendering Provider's Taxonomy but does not populate a box on a CMS-1500. However, the Medicaid plan-type will populate this into Box 24j Shaded.
Example: PRV*PE*PXC*225100000X~
Population: This segment is populated if the Billing NPI ≠ Rendering NPI AND
Checked |
None |
D |
Population: This segment can also be populated if the Billing NPI = Rendering NPI AND
Checked |
CD |
D |
Note: If the insurance settings do not meet one of the four options listed above, the PRV segment will not be generated in the 837 EDI file.
REF Segment
Time-Saving Tip: If option B is ever checked, the REF segment will not generate in the 837 file.
Definition: The REF segment contains the Rendering Provider's Secondary Identification (Non-NPI) and populates Box 24j Shaded on a CMS-1500. The REF qualifier code (G2, 0B, 1G) will populate Box 24i. This is only required by certain insurances.
Example: REF*G2*998855~
Population: This segment is populated if the Billing NPI ≠ Rendering NPI AND
Checked |
None |
A |
AD |
D |
Population: This segment is populated if the Billing NPI = Rendering NPI AND
Checked |
AD |
ACD |
CD |
D |
Note: If the insurance settings do not meet one of the eight options listed above, the REF segment will not be generated in the 837 EDI file.
Comments
0 comments
Article is closed for comments.