NPI-related Errors to Result in Electronic Claim Rejection as of Sept 6, 2010

In June 2008, we published a complete listing of electronic claim edits that were implemented in support of an NPI-only claims processing environment. This document provided the three-digit error code along with a defining message indicating the severity level of the error and the resulting impact on the claim (“W” for Warning and “R” for Rejection).

An updated NPI-only Electronic Claim Submission Edits  listing has been posted in the Electronic Commerce Alerts section of our website. Please be advised that most of the edits/error listings that were formerly set at the Warning level will be set to Reject as of Sept. 6, 2010.

The only two error types that will continue to remain at the Warning (“W”) level are as follows:

 

Error Code

Message

Status

BA6

Rendering NPI is not on file (Claim Level Error Message)

W

CA6

Rendering NPI is not on file (Service Line Level Error Message)

W

If you are currently receiving Warning message(s) on your electronic claim reports denoting a lack of NPI-related information, it is imperative that you make the necessary correction(s) immediately, as most of these claims will reject commencing Sept. 6, 2010. 

It is important to ensure that you and/or all of your electronic trading partners (billing services, clearinghouses and software vendors) are aware of and responsive to these messages. If you have any questions on these edits, please contact our Electronic Commerce Center at (800) 746-4614.

Note: If your office refers to a printed copy of the 2008 NPI-only Electronic Claim Submission Edits listing, please replace it with the updated version posted in the Electronic Commerce Alerts section of our website.