New claim edit: Missing billing provider ID

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that don’t contain one of the following IDs for the billing provider:

• National Provider Identifier (NPI), a unique 10-digit identifier for the provider assigned by the Centers for Medicare & Medicaid Services (CMS)

• Tax identification number (TIN), such as an Employer Identification Number (EIN) or Social Security Number (SSN)

• A secondary identification number, such as a:

  • Payer Identification Number

  • Employer's Identification Number

  • Claim Office Number

  • National Association of Insurance Commissioners (NAIC) Code

The billing provider is the person or organization, such as a clinic or group practice, that will receive payment from the payer.

Rejection errors

If you submit a claim that fails the edit using Stedi’s JSON or X12 Claim Submission API endpoints, you’ll get back an error response in real time. The response includes error details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "A Billing Provider Identification is missing. This is required when the Billing Provider NPI is not present and an identification is necessary to identify the provider. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim that fails the edit using SFTP, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will include a related claim status category code, claim status code, and error message:

STC*A6:N560*[DATE]*85*[AMOUNT]********A Billing Provider Identification is missing. This is required when the Billing Provider NPI is not present and an identification is necessary to identify the provider. Correct and resubmit