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guides:claim-rules:service-facility-override

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

  1. If Loop 2310C (Service Facility) already exists, it is updated with the new NPI, name, and address
  2. If Loop 2310C does not exist, it is created and inserted into the claim
  3. Address segments (N3, N4) are only modified if address fields are provided
  4. A note is added to the claim documenting the change
  5. Shows in Applied Validation Modules as “ServiceFacilityOverrideModule”

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guides/claim-rules/service-facility-override.txt · Last modified: by brad.sharp

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