guides:claim-rules:service-facility-override
Table of Contents
Service Facility Override
Override or add the service facility (Loop 2310C) on claims for specific payers.
Applies to: Professional (837P), Dental (837D)
When to Use This
- A payer requires a specific service facility NPI and address on all claims
- The source system doesn't populate the service facility and a payer rejects without it
- You need to override the facility for a specific payer while keeping it different for others
Fields
| Field | Required | Description |
|---|---|---|
| Start Date | Yes | When this rule becomes active |
| End Date | No | When this rule expires |
| Payer Number | No | Only apply for a specific payer. Blank = all payers |
| Facility NPI | Yes | The service facility's NPI |
| Facility Name | Yes | The facility name |
| Address 1 | No | Street address. Leave blank to skip address |
| Address 2 | No | Suite, floor, etc. |
| City | No | City |
| State | No | 2-letter state code |
| Zip | No | Zip code |
| Notes | No | Your reference notes |
Examples
Example 1: Add Facility for Medicare
Medicare requires a service facility on all professional claims.
| Field | Value |
|---|---|
| Payer Number | 00882 |
| Facility NPI | 1234567890 |
| Facility Name | MAIN STREET MEDICAL CENTER |
| Address 1 | 100 MAIN ST |
| City | TULSA |
| State | OK |
| Zip | 74103 |
Example 2: Override Facility for Specific Payer
Cigna requires claims to show a different facility NPI.
| Field | Value |
|---|---|
| Payer Number | 62308 |
| Facility NPI | 9876543210 |
| Facility Name | CIGNA PREFERRED FACILITY |
What Happens on the Claim
- If Loop 2310C (Service Facility) already exists, it is updated with the new NPI, name, and address
- If Loop 2310C does not exist, it is created and inserted into the claim
- Address segments (N3, N4) are only modified if address fields are provided
- A note is added to the claim documenting the change
- Shows in Applied Validation Modules as “ServiceFacilityOverrideModule”
guides/claim-rules/service-facility-override.txt · Last modified: by brad.sharp
