Claim edit: Missing billing provider taxonomy code in dental claims

Stedi now rejects 837D dental claims that are missing a billing provider taxonomy code when no rendering provider or assistant surgeon is reported.

How the edit works

A taxonomy code identifies a provider's type and specialty, such as general dentistry or orthodontics.

A dental claim can name a rendering provider or an assistant surgeon for the whole claim or for individual service lines. If the claim names neither at any level, the billing provider is the one who rendered the service. In that case, X12 standards require the claim to include the billing provider's taxonomy code.

Billing provider taxonomy code

If the billing provider taxonomy code is missing, 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

How you get the error depends on how you submit the claim.

{
  "errors": [
    {
      "code": "33",
      "description": "Missing Billing Provider taxonomy code. This code is required when no rendering provider or assistant surgeon is reported. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

STC*A6>145>85**U*[AMOUNT]******A6>732~

Related claim edits

Stedi has other edits that check the taxonomy code when it's present. See:

• Invalid taxonomy code
• Taxonomy code not in the NUCC code set