Claim edit: Invalid name for a non-person entity

Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include a first name, middle name, or suffix for a non-person entity.

How the edit works

In a claim, each entity – such as the submitter or billing provider – is marked as either a person or a non-person. Non-person entities include hospitals, billing organizations, and similar groups.

In X12, the entity type is set using the NM1-02 qualifier: 1 for a person, 2 for a non-person entity.

For non-person entities, you should only provide an organization name. The organization name goes where the last name would for an individual. In X12, this is the NM1-03 element.

If a claim includes a non-person entity with a first name, middle name, or suffix, 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.

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": "Invalid Name Elements. When the Billing Provider entity is not a person, as identified by the entity type qualifier 2, then the following name elements should not be submitted: [first name, middle name, suffix]. 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*A7>505>85*[DATE]*U*[AMOUNT]*******Invalid Name Elements. When the Billing Provider entity is not a person, as identified by the entity type qualifier 2, then the following name elements should not be submitted: [first name, middle name, suffix]. Correct and resubmit.~