For certain services or types of facilities, payers enroll only the facility. In these instances, the claim requires only the 2010AA Billing loop. The 2310A Attending and 2310B Rendering loops are not required and could cause the claim to reject if they are present. You can suppress the Attending and Rendering loops at the group, location, payer, and SIM levels in 2310A for the Institutional file and in 2310B for the Professional and dental files. For all levels, the resulting claims only contain a 2010AA Billing loop with no subsequent 2310A loop (837I file) or 2310B loop (837P or 837D files). Suppression only applies to group billing (the loops do not exist to suppress for individual billing).
The loop suppression can be set at multiple levels, the following list priority applies. The list is organized from the most specific to the most general settings:
- SIM/Payer (and Location optional)
- Group with Specific Location and Specific Payer
- Group with Specific Location and Default Payer
- Group with Default Location and Specific Payer
- Group with Default Location and Default Payer
- Group (no location or payer)
- Location - Practice
- Location - System
- Payer
The available options for suppressing the rendering and attending loops are:
- <none>
- 2310B Rendering & 2310A Attending – This option suppresses the entire 2310A loop in institutional files (837I) and the entire 2310B loop in professional files (837P) based on the appropriate claim type.
- 2310A Attending (Inst Only) – This option suppresses the entire 2310A loop in institutional files only (837I).
- 2310B Rendering (Prof/Dent Only) – This option suppresses the entire 2310B loop in professional files (837P) and dental files (837D).
To suppress either the rendering provider loop in a professional or dental file or the 2310A attending loop in an institutional file:
- To suppress the loops in all claims for a specific payer, open a payer in the Payers master file. On the Modify Payer Information window, select , and then select the appropriate option in the Suppress Rendering/Attending Loop field.
Defaults 2 Tab on the Locations Master File
- To suppress the loops in all claims for a location across the enterprise, open a location in the Locations master file.
- On the Location Information window, select the Defaults - 2 tab. In the Suppress Rendering/Attending Loop field, select 2310A Attending & 2310B Rendering, 2310A Attending (Inst Only), or 2310B Rendering (Prof/Dent only).
Practice Tab on the Locations Master File
- To suppress the loops for a location under an individual practice, open a location in the Locations master file. On the Location Information window, select the Practice tab. Enable the Use practice level claims data check box, and then select the appropriate option for the Suppress Rendering/Attending Loop field. The selected loop will be suppressed on all claims for that location and practice.
Payer Tab on the Service Item Library
- To suppress the loops based on the SIM, open a SIM in the Service Items library. On the Payer tab, select a payer, and then select the appropriate option for the Suppress Rendering/Attending Loop field.
The loop is suppressed for this SIM/Payer combination whenever this SIM is used. These settings only apply for claims for that payer with those specific SIMs.
This setting causes a claim break whenever encounter charges exist in which some SIMs have this option enabled and other SIMs do not. Since the provider loop is only added at the claim level in the 837, to suppress it for some SIMs and not for others necessitates a claim break.
For encounters with a combination of SIMs, all SIMs with the suppress option enabled split onto one claim while all SIMs without this setting remain on the other claim.
If other claim breaks apply, they should apply in conjunction with this break. For example, a claim has four charges. Two of the SIMs do not have the suppress option enabled and two do. The first break splits the two SIMs without this setting onto one claim and the two SIMs with this setting onto a different claim. The two SIMs set to suppress the 2310B rendering loop have different rendering providers, so the two SIMs would further split into two claims – one for each provider. This scenario produces a total of three claims.
