Claim edit: Deactivated NPI
Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include a provider NPI that's deactivated in the National Plan and Provider Enumeration System (NPPES).
How the edit works
A National Provider Identifier (NPI) is a unique, 10-digit identifier for US healthcare providers. The Centers for Medicare & Medicaid Services (CMS) issues NPIs and tracks their status in the NPPES.
CMS may deactivate an NPI if, for example, a provider dies, an organization disbands, or a fraud or regulatory review warrants it. Deactivated NPIs are not valid for use in a claim.
If a claim includes a provider NPI that the NPPES has deactivated, the payer may reject the claim. This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which take longer to resolve and delay payment for the provider.
Rejection errors
If you submit a claim using Stedi's Claim Submission API endpoints and the claim fails the edit, you'll get back an error response in real time. The response describes the NPI as inactive and includes details in the errors array:
{
"errors": [
{
"code": "33",
"description": "Provider NPI is inactive. The NPI submitted, 1255328415, is inactive according to the National Plan and Provider Enumeration System (NPPES). An active NPI is required for claim submission. Correct and resubmit.",
"followupAction": "Please Correct and Resubmit"
}
]
}If you submit a claim using SFTP and the claim fails the edit, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will include a related claim status category code, claim status code, entity identifier code, and error message:
STC*A7>562>85*[DATE]*U*[AMOUNT]********Provider NPI is inactive. The NPI submitted, 1255328415, is inactive according to the National Plan and Provider Enumeration System (NPPES). An active NPI is required for claim submission. Correct and resubmit.~Related claim edits
Stedi has another edit that checks the NPI format. See Invalid NPI format.