Claim edit: Missing billing provider identifier
Stedi now rejects 837P professional and 837D dental claims where the billing provider has no identifier.
Billing provider identifiers
The billing provider is the person or organization, like a clinic or group practice, that will receive payment (if any) for the claim from the payer.
X12 standards require the billing provider's National Provider Identifier (NPI) whenever the provider is eligible for one. Atypical providers – providers without an NPI – are identified by a secondary identifier instead, like a state license number or a payer-assigned provider number.
The billing provider's tax ID doesn't count. A tax ID identifies the business for payment reporting, not the provider that delivered care. A claim carrying only a tax ID still can't be matched to a provider.
Billing identifiers in 837P professional claims
| Identifier | JSON API field | X12 element |
|---|---|---|
| NPI | billing.npi | NM109 of Loop 2010AA (Billing Provider Name), where NM108 = "XX" (Centers for Medicare and Medicaid Services National Provider Identifier) |
| State license number | billing.stateLicenseNumber | REF02 of Loop 2010AA (Billing Provider Name), where REF01 = "0B" (State License Number) |
| Payer-assigned commercial number | billing.commercialNumber | REF02 of Loop 2010BB (Payer Name), where REF01 = "G2" (Provider Commercial Number) |
| Payer-assigned location number | billing.locationNumber | REF02 of Loop 2010BB (Payer Name), where REF01 = "LU" (Location Number) |
| UPIN (deprecated) | billing.providerUpinNumber | REF02 of Loop 2010AA (Billing Provider Name), where REF01 = "1G" (Provider UPIN Number) |
Billing identifiers in 837D dental claims
| Identifier | JSON API field | X12 element |
|---|---|---|
| NPI | billing.npi | NM109 of Loop 2010AA (Billing Provider Name), where NM108 = "XX" (Centers for Medicare and Medicaid Services National Provider Identifier) |
| State license number | billing.stateLicenseNumber | REF02 of Loop 2010AA (Billing Provider Name), where REF01 = "0B" (State License Number) |
| Payer-assigned commercial number | billing.commercialNumber | REF02 of Loop 2010BB (Payer Name), where REF01 = "G2" (Provider Commercial Number) |
| Payer-assigned location number | billing.locationNumber | REF02 of Loop 2010BB (Payer Name), where REF01 = "LU" (Location Number) |
| UPIN (deprecated) | billing.providerUpinNumber | REF02 of Loop 2010AA (Billing Provider Name), where REF01 = "1G" (Provider UPIN Number) |
How the edit works
Any one of the identifiers above is enough. The edit rejects the claim only when all of them are missing.
If you submit a claim without an identifier for the billing provider, 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": "Missing Billing Provider identifier. The billing provider must be identified by an NPI when required after the HIPAA NPI mandate, or an applicable secondary provider identifier. 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*A6>562>85*[DATE]*U*[AMOUNT]********Missing Billing Provider identifier. The billing provider must be identified by an NPI when required after the HIPAA NPI mandate, or an applicable secondary provider identifier. Correct and resubmit.~Related claim edits
Stedi has another edit for a missing billing provider tax ID. See Missing billing provider tax ID.