Submit claims for atypical providers (no NPI)

An atypical provider delivers health-related services but isn't eligible for a National Provider Identifier (NPI). Examples include providers of:

• Personal care
• Home and vehicle modifications
• Respite care
• Adult foster care

Federal rules don't count these services as health care, so these providers can't get an NPI even if they submit claims. Instead, the payer or a related issuer assigns the provider an ID to use in place of an NPI.

Issuers call atypical provider IDs different names, including secondary identifiers and payer-assigned provider IDs. In most cases, the ID is only valid with the payer or program that issued it. For example, Medicaid Minnesota (payer ID: JSZHK) uses a Unique Minnesota Provider Identifier (UMPI).

You must register atypical providers with Stedi before you submit their claims. Without registration, these claims may be rejected.

Complete transaction enrollment

Transaction enrollment registers a provider to exchange a specific transaction type, like a claim submission, with a payer. Some payers require enrollment for claim submission, and all payers require enrollment for Electronic Remittance Advice (ERAs).

1. Check enrollment requirements using the Stedi Payer Network and our Payers API.
2. If the payer requires enrollment:
   • Use 1999999984 as a placeholder NPI when creating the provider record. Don't use another placeholder value. Include the provider's real Taxpayer Identification Number (TIN).
   • Submit an enrollment request through Stedi's API or the Stedi portal, which supports bulk CSV.
3. Submit an enrollment request for ERAs using the same placeholder NPI.

Register the provider

Some payer connections require an NPI unless Stedi registers the provider as atypical. Registration lets those connections accept the atypical provider ID.

Each combination of atypical provider ID, service location, and taxonomy code needs its own registration, even under the same TIN. For example, a provider who serves clients at two locations needs two registrations.

To register, send information about the provider to Stedi support through the Stedi portal, email, or your dedicated Slack or Microsoft Teams channel. For each registration, provide:

• The provider's TIN
• The atypical provider ID, the type of ID, and the authority that issued it, such as a UMPI issued by the Minnesota Department of Human Services (DHS)
• The notice from the issuing authority that lists the TIN and the atypical provider ID, if available
• The provider's taxonomy code
• The provider's service address
• The payer and its Stedi payer ID
• The enrollment request ID, if you submitted one

We'll let you know when the registration is complete.

Submit the claim

Before you submit claims for the provider:

• Complete transaction enrollment, if the payer requires it.
• Register the provider and wait one business day after Stedi confirms the registration is complete.

API and SFTP submission

You can submit claims for atypical providers through Stedi's JSON or Raw X12 API endpoints, or through SFTP. The following examples show where to put the atypical provider ID for each submission method.

CMS-1500 JSON

Use the Create Professional Claim (CMS-1500) JSON endpoint. Omit billing.billingProvider.identifiers.npi. Put the atypical provider ID in billing.billingProvider.identifiers.commercialNumber:

{
  "billing": {
    "billingProvider": {
      "name": { "organization": "Example Adult Day Services LLC" },
      "identifiers": {
        "commercialNumber": "A836117300", // Atypical provider ID
        "taxonomyCode": "310400000X"
      },
      ...
    },
    "taxId": { "ein": "820845106" }, // Provider's TIN
    ...
  },
  ...
}

To check the claim before you submit it, use the Validate Professional Claim (CMS-1500) JSON endpoint. It takes the same request body.

Manual submission

You can submit claims for atypical providers in the Stedi portal through the CMS-1500 form, which supports professional claims only, or by uploading an X12 EDI file.

CMS-1500 form

To submit a professional claim for an atypical provider in the Stedi portal:

1. Go to the claims view, click Submit claim, and select CMS-1500 form from the dropdown.
2. Enter the billing provider's TIN in Box 25 (Federal tax ID number).
3. If Box 33 (Billing provider info) prompts you to prefill from an NPI, click Or, enter manually.
4. Leave Box 33a (NPI) blank.
5. In Box 33b (Other identifiers), enter the atypical provider ID in G2 Provider Commercial Number and the provider's taxonomy code in ZZ Provider Taxonomy.
6. Complete the rest of the form and click Submit claim.

Visit Submit professional claims - Manual for details about the rest of the form.

Handle rejected claims

When you submit claims for atypical providers before registration is complete, they may be rejected. The rejection comes back in a 277CA claim acknowledgment. In the 277CA Report JSON response, the rejection error is in claimStatus.informationClaimStatuses[].statusMessage. In X12, it's in Loop 2200D (Claim Status Tracking Number) STC12 (Free-form Message Text).

The following example shows a typical error message:

Value of element NM108 is incorrect. Expected value is 'XX' for covered providers when National Provider ID is mandated for use.

To resolve the rejection:

1. Confirm that Stedi registered the provider for the claim's atypical provider ID, service location, and taxonomy code. If not, register the provider.
2. After registration is complete, wait about one business day.
3. Resubmit the claim as a new original claim, not a corrected or replacement claim. Set the Claim Frequency Code (CFC) to 1 (Admit thru Discharge Claim) for professional claims, or use the CFC from the original submission for institutional claims.

If the claim is rejected again with the same error, contact Stedi support.