Claim edit: Invalid provider UPIN format

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include a Unique Physician Identification Number (UPIN) in an invalid format.

What is a UPIN?

A Unique Physician Identification Number (UPIN) is a legacy identifier previously assigned to providers by the Centers for Medicare & Medicaid Services (CMS).

UPINs were replaced by National Provider Identifiers (NPIs) in 2007. Some payers, including certain state Medicaid payers, still accept a UPIN as an alternate provider identifier. Payers may also populate the UPIN in secondary or tertiary claims they generate for coordination of benefits (COB).

How the edit works

When you submit a claim, you can specify a UPIN for any provider listed on the claim, such as the rendering provider or supervising provider.

All valid UPINs are exactly six characters in one of two layouts:

• One letter followed by five digits, like A12345 (X99999)

• Three letters followed by three digits, like ABC123 (XXX999)

If a claim includes a UPIN with an invalid format, 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 includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Provider UPIN Number. UPINs must follow one of these formats: X99999 (one letter followed by five digits) or XXX999 (three letters followed by three digits). The submitted value '123456789' does not match either format. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Provider UPIN Number. UPINs must follow one of these formats: X99999 (one letter followed by five digits) or XXX999 (three letters followed by three digits). The submitted value '123456789' does not match either format. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid Provider UPIN Number. UPINs must follow one of these formats: X99999 (one letter followed by five digits) or XXX999 (three letters followed by three digits). The submitted value '123456789' does not match either format. 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>133>DN*[DATE]*U*[AMOUNT]********Invalid Provider UPIN Number. UPINs must follow one of these formats: X99999 (one letter followed by five digits) or XXX999 (three letters followed by three digits). The submitted value '123456789' does not match either format. Correct and resubmit

STC*A7>133>DN*[DATE]*U*[AMOUNT]********Invalid Provider UPIN Number. UPINs must follow one of these formats: X99999 (one letter followed by five digits) or XXX999 (three letters followed by three digits). The submitted value '123456789' does not match either format. Correct and resubmit

STC*A7>133>DN*[DATE]*U*[AMOUNT]********Invalid Provider UPIN Number. UPINs must follow one of these formats: X99999 (one letter followed by five digits) or XXX999 (three letters followed by three digits). The submitted value '123456789' does not match either format. Correct and resubmit