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NPI-Only Readiness Survey
Please respond by Monday, March 31, 2008.
Fax your completed survey to: HCSC E-Commerce Center,
312-938-6463.
Date: _________________________
Company Name: _________________________________________
Submitted by (Contact Name): _____________________________
Phone Number: __________________________________________
E-mail Address: __________________________________________
I. Are you prepared to submit only the NPI in all Required* loops as of May 23, 2008?
*Remember: Situational (S) fields may be Required, depending upon the circumstance. Please refer to the ANSI 837 Implementation Guide for an explanation of when a Situational field is Required.
Professional (837P)
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Loop |
Name |
Usage |
2010AA |
Billing Provider Name |
R |
2010AB |
Pay-to Provider Name |
S |
2310A |
Referring Provider Name |
S |
2310B |
Rendering Provider Name |
S |
2310C |
Purchased Service Provider Name |
S |
2310D |
Service Facility Location |
S |
2310E |
Supervising Provider Name |
S |
2420A |
Rendering Provider Name |
S |
2420B |
Purchased Service Provider Name |
S |
2420C |
Service Facility Location |
S |
2420D |
Supervising Provider Name |
S |
2420E |
Ordering Provider Name |
S |
2420F |
Referring Provider Name |
S |
Institutional (837I)
|
Loop |
Name |
Usage |
2010AA |
Billing Provider Name |
R |
2010AB |
Pay-To Provider Name |
S |
2310A |
Attending Physician Name |
S |
2310B |
Operating Physician Name |
S |
2310C |
Other Provider Name |
S |
2310E |
Service Facility Name |
S |
2420A |
Attending Physician Name |
S |
2420B |
Operating Physician Name |
S |
2420C |
Other Provider Name |
S |
II. If you answered "No," please tell us why (include the date you will be ready to submit only the NPI in all fields):
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
Fax your completed survey to: HCSC E-Commerce Center,
312-938-6463. Thank you for responding by Monday, March 31, 2008!
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