Electronic claim rejections for missing NPI

If you have been fighting your clearinghouse on claim denials for NPI issues is to identify you have the NPI number setup in all areas of your medical billing software. Depending on your PM (practice management) software and your clearinghouse (and how well both parties work with each other) you may think you have the NPI setup in all areas when in fact it's possible you are missing 1-2 areas.

1st Recommendation - Identify the exact claim denial and contact your PM software to identify you have that "loop" filled in correctly.
2nd Recommendation - If you are not on speaking terms with your PM software try contacting the clearinghouse to identify what "fields or loops" are missing on the claim. Try and identify where these areas would be in your PM software so you can add them correctly.
Third Recommendation - Take deep breathes if none of these recommendations will help you.

It is still coming down from insurance carriers that doctors are not attaching NPI numbers to claims when submitting electronically. For some clients it sounds like a reasonable fix but for those who don't understand their medical billing software (or those that find the medical billing software is not setup to submit NPI's in all fields) this may be a time consuming fix.

RelayHealth has been notified that these 9 insurance carriers are getting a high volume of claim rejections due to missing NPI information. For this reason they are setting up new edits to alert users to attach the NPI.

CPID 2400 MED3000 MD Medicare Choice
CPID 4718 MED3000 HFN Health Options
CPID 4719 MED3000 HFN Vista
CPID 4720 MED3000 HFN Healthy Kids
CPID 4721 MED3000 HFN Wellcare Choice
CPID 4722 MED3000 HFN Healthease
CPID 4723 MED3000 Pedicare
CPID 4724 MED3000 Health Select IPABCBS
CPID 4725 MED3000 South West IPABCBS


EDIT HU 0019C:INVALID BILLING PROVIDER NPI IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0020C:INVALID PAY-TO PROVIDER NPI IN LOOP 2010AB, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0022C:INVALID CLAIM RENDERING PROVIDER NPI IN LOOP 2010B(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0028D:INVALID SRV LINE RENDERING PROVIDER NPI - IN LOOP 2420A(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0044C:INVALID CLAIM PURCHASED SERVICE NPI IN LOOP 2310C(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0046C:INVALID CLAIM SERVICING PROVIDER NPI IN LOOP 2310E(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0047D:INVALID CLAIM SRV LINE PURCHASED SERVICE NPI IN LOOP 2420B(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0048D:INVALID SRV LINE SERVICE FACILITY NPI: IN LOOP 2420C(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0049D:INVALID SRV LINE SUPERVISING PROVIDER NPI IN LOOP 2420D(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0050D:INVALID ORDERING PROVIDER NPI IN LOOP 2420E(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0051D:INVALID SVR LINE REFERRING PROVIDER NPI IN LOOP 2420FE(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

Confused by Electronic Medical Claim billing then read these articles on Billing Health Insurance medical claims

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