Currently, for both the EOB Inpatient Institutional and EOB Outpatient Institutional profiles, the provider reference (for party responsible for the claim) is limited to Organizations.

Working with a state medicaid program, I have encountered many situation where Inpatient and Outpatient claims are being submitted by individual Practitioners, and not just Organizations. Given this operational reality, I recommend the incremental restrictions on the provider reference for both of these EOB profiles be removed, allowing such references to be to either a Practitioner or an Organization.