How to submit claims for atypical providers

You can submit claims for atypical providers – providers who bill using a state- or payer-assigned ID instead of a National Provider Identifier (NPI) – through Stedi. These claims require an extra registration step. If you don't complete it, they may be rejected.

This guide explains what an atypical provider is and how to register the provider and submit their claims.

What is an atypical provider?

An atypical provider delivers health-related services but isn't eligible for an NPI. Examples include providers of:

• Personal care
• Home and vehicle modifications
• Respite care
• Adult foster care

Federal rules don't count these services as health care. As a result, these providers can't get an NPI, even if they submit claims.

Instead, the payer or a related issuer – like the state for a state Medicaid program – assigns the provider an ID to use in place of an NPI.

For example, Medicaid Minnesota (payer ID: JSZHK) uses a Unique Minnesota Provider Identifier (UMPI). In most cases, the ID is only valid with the payer or program that issued it.

Issuers call these IDs different names, like secondary identifiers or payer-assigned provider IDs. The rest of this guide calls them atypical provider IDs.

Why atypical providers require registration

Most claims identify the billing provider by NPI. Claims for atypical providers use an atypical provider ID instead, which the X12 HIPAA standard allows.

Some payer connections require an NPI unless Stedi registers the provider as atypical. Registration lets those connections accept the atypical provider ID.

How to submit claims for an atypical provider

1. Complete transaction enrollment, if the payer requires it.
   Transaction enrollment registers a provider to exchange a specific transaction type, like a claim submission, with a payer. Some payers require enrollment for claim submission.

   You can check enrollment requirements using the Stedi Payer Network and our Payers API. If the payer requires enrollment, you can submit a request through Stedi using our API or the Stedi portal, which supports bulk CSV.

   In the request, use 1999999984 as a placeholder NPI. Don't use another placeholder value. Include the provider's real Taxpayer Identification Number (TIN).

   All payers require enrollment for Electronic Remittance Advice (ERAs). Use the same placeholder NPI in the provider's ERA enrollment request.

2. Contact Stedi support to register the provider as atypical.
   Send us the information in the next section.

3. Submit the claim with the atypical provider ID.
   See Submit the claim.

What to send Stedi support

To register a provider as atypical, contact Stedi support through the Stedi portal, email, or your dedicated Slack or Microsoft Teams channel.

In your message, include:

• The provider's TIN
• The atypical provider ID, the type of ID, and the authority that issued it – for example, a UMPI issued by the Minnesota Department of Human Services (DHS)
• The notice from the issuing authority that lists the TIN and the atypical provider ID, if you have it
• The provider's taxonomy code
• The provider's service address
• The payer and its Stedi payer ID
• The enrollment request ID, if you submitted one

Each combination of atypical provider ID, service location, and taxonomy code needs its own registration, even under the same TIN.

We'll let you know once the registration is complete.

Submit the claim

After the provider has completed transaction enrollment (if required) and Stedi confirms the atypical registration, you can submit claims for the provider through Stedi.

Omit the billing provider's NPI in the claim. Instead, use the atypical provider ID.

The field to use depends on which Claim Submission API endpoint you use.

{
  "billing": {
    "billingProvider": {
      "name": { "organization": "Example Adult Day Services LLC" },
      "identifiers": {
        "commercialNumber": "A836117300", // Atypical provider ID, like a UMPI
        "taxonomyCode": "310400000X"
      },
      ...
    },
    "taxId": { "ein": "820845106" }, // Provider's TIN
    ...
  },
  ...
}

{
  "billing": {
    "organizationName": "Example Adult Day Services LLC",
    "employerId": "820845106", // Provider's TIN
    "commercialNumber": "A836117300", // Atypical provider ID, like a UMPI
    "taxonomyCode": "310400000X",
    ...
  },
  ...
}

{
  "billing": {
    "organizationName": "Example Adult Day Services LLC",
    "employerId": "820845106", // Provider's TIN
    "secondaryIdentificationQualifierCode": "G2", // Provider Commercial Number
    "secondaryIdentifier": "A836117300", // Atypical provider ID, like a UMPI
    "taxonomyCode": "310400000X",
    ...
  },
  ...
}

HL*1**20*1~
NM1*85*2*EXAMPLE ADULT DAY SERVICES LLC~
N3*123 MAIN ST~
N4*SAINT PAUL*MN*551011234~
REF*EI*820845106~
HL*2*1*22*0~
...
NM1*PR*2*MINNESOTA MEDICAID*****PI*JSZHK~
REF*G2*A836117300~

My claim for an atypical provider was rejected. What do I do?

Claims submitted before registration is complete may be rejected. The rejection comes back in a 277CA claim acknowledgment with an error like this:

Value of element NM108 is incorrect. Expected value is 'XX' for covered providers when National Provider ID is mandated for use.

In the JSON response from the Get 277CA Report endpoint, the error is in claimStatus.informationClaimStatuses[].statusMessage. In X12, it's in STC12 of the STC segment.

First, check that you've registered the provider as atypical with Stedi.

If registration wasn't complete when you submitted the claim, wait about one business day after registration before resubmitting. Then resubmit it as a new original claim, not a corrected or replacement claim.

Eligibility and claim status checks for atypical providers

Payer support for eligibility and claim status checks without an NPI varies. Test each payer before you rely on these checks. Contact Stedi support for payer-specific guidance.

Insurance discovery checks require an NPI.

Get started with Stedi

To get started with Stedi, sign up for a free sandbox account. It takes less than two minutes. No credit card is required.

When you're ready to submit claims, upgrade to production on our pay-as-you-go plan. There are no monthly minimums or setup fees. You only pay for the transactions you use.