Claim edit: Missing first name

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include a person entity with no first 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, a first name is required. If the first 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 are slower 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 provide an organizationName, the entity is treated as an organization. Other entities, such as otherPayerBillingProvider, have an explicit entityTypeQualifier field.

If you use X12, you set the entity type qualifier directly in NM1-02 (Entity Type Qualifier), where 1 indicates a person and 2 indicates a non-person entity.

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 First Name. When the Billing Provider entity is a person, as identified by the entity type qualifier 1, the entity first name is required. 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>505>85*[DATE]*U*[AMOUNT]********Missing First Name. When the Billing Provider entity is a person, as identified by the entity type qualifier 1, the entity first name is required. Correct and resubmit.~