Claims will be rejected if the NPI is not present in the correct location on the claim form or if there is a mismatch between the information in the National Plan and Provider Enumeration System (NPPES) and our claims system (claims for ABA providers and Corporate Service Providers (CSP) are the exceptions).
To correct the issue, include the rendering provider NPI in the correct location on the claim form and contact your clearinghouse to ensure they are placing it in the correct location.
If there is a mismatch, call NPPES at (800) 465-3203 to update your information. NPPES is used as the resource for validating NPI data, so it is important that providers review their NPPES records for accuracy. The NPPES resourced data will be updated monthly, by the 22nd of each month.
Edits will be applied to 837 professional claims only when:
Note: The rendering provider NPI will not be required at this time, but the segment must be provided with the rendering provider name.
As a reminder, the billing provider Address Loop 2010 must have a physical address. If the services rendered were not at this address, then the Service Facility Loop 2310C must be submitted. If there is more than one service facility for the claim, then use the Service Facility Loop 2420C.
*Please note, claims may have previously pended and processed (including payment).