Claim edit: Missing last name

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include a person entity with no last name.

How the edit works

In a claim, each entity, such as the billing provider or subscriber, is identified as either a person or a non-person using an entity type qualifier.

When an entity is a person, both a first name and last name are required. In X12, this is the entity’s NM1-03 element. If a person’s last name 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.

How entity type qualifiers are specified

If you use Stedi's JSON Claim Submission API endpoints, Stedi sometimes infers the entity type qualifier. For example, if you provide a firstName and lastName for the billing provider in a JSON 837P Professional Claims API request, the entity is treated as a person.

If you use X12, you set the entity type qualifier in NM1-02 (Entity Type Qualifier). 1 indicates a person and 2 indicates a non-person entity, such as a hospital or billing organization.

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 Last Name. Last name is required when Billing Provider is reported as a person by the entity type qualifier 1. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Missing Last Name. Last name is required when Billing Provider is reported as a person by the entity type qualifier 1. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Missing Last Name. Last name is required when Billing Provider is reported as a person by the entity type qualifier 1. 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>504>85*[DATE]*U*[AMOUNT]********Missing Last Name. Last name is required when Billing Provider is reported as a person by the entity type qualifier 1. Correct and resubmit

STC*A6>504>85*[DATE]*U*[AMOUNT]********Missing Last Name. Last name is required when Billing Provider is reported as a person by the entity type qualifier 1. Correct and resubmit

STC*A6>504>85*[DATE]*U*[AMOUNT]********Missing Last Name. Last name is required when Billing Provider is reported as a person by the entity type qualifier 1. Correct and resubmit

Related claim edits

Stedi has a companion edit for missing first names. See Claim edit: Missing first name.