CMS 1500 Reminder: Billing Rendering Provider
Date: 02/13/26
A Message for Medicaid Providers. Please share with your administrative team.
Reminder for Providers Submitting Claims through a Clearinghouse
To support accurate claims processing and ensure compliance with HIPAA electronic transaction standards, it is essential that providers correctly report National Provider Identifiers (NPIs) within the appropriate loops of the 837 claim format. Proper identification of rendering providers—whether at the claim level or the service-line level—helps validate who performed each service and ensures alignment with state-specific policy requirements.
The guidance below outlines when to use Loop 2310B versus Loop 2420A to accurately reflect rendering provider information, particularly in situations where multiple clinicians contribute to services billed on a single claim.
- Loop 2310B: Rendering Provider (Claim Level)
Under 5010 standards, Loop 2310B is used only when the rendering provider is the same for every service line on the claim and is different from the Billing Provider. If the billing NPI is the same as the rendering NPI for each service line, loop 2310B should be left blank.
When to Use: Mandatory when the Billing Provider (Loop 2010AA) is an organization/group practice and the clinician who performed all services is an individual member of that group.
- Loop 2420A: Rendering Provider (Service Line Level)
Loop 2420A is used to provide line-specific overrides when clinicians differ across services on a single claim.
When to Use: Mandatory when the clinician for a specific service line is different from the clinician identified in Loop 2310B.
In short, the 2310B is the default of the entire claim, and 2420A is used as an exception for specific service lines where the rendering provider changes or is different than the billing NPI.
Example: CCBHC claims – service codes performed by different rendering providers should utilize loop 2420A for each applicable service. Billing an NPI in Loop 2310B will indicate every service line was rendered by the listed billing NPI. While the main trigger code (T1040) may leave the 2420A loop blank if it matches the billing entity, additional services provided by a different NPI must include the specific clinician's NPI in Loop 2420A to ensure accurate reporting of the individual who performed the service. For more details, see the CCBHC Manual on the KMAP Provider Manual website.
For full implementation guides and other 5010 standards go to the x12 store.
If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call us at the number below: