BCBSTX has implemented a series of electronic edits in support of an NPI-only claims processing environment. Claims that are submitted with dual identifiers (BCBSTX provider number and NPI) can no longer be accepted, per the federal regulation. The NPI is the only primary provider identifier allowed (along with the "XX" qualifier), while the Tax Identification Number (with "EI" qualifier) or Social Security Number (with "SY" qualifier) is the only secondary provider identifier allowed, unless otherwise specified* in the tables below.
Providers will receive a three-digit error code with a message on their reports from BCBSTX when electronic claims are submitted incorrectly. The edits in the tables below were effective as of May 23, 2008. Please note that "LVL" indicates the level of severity for each error: "R" indicates that the claim has been Rejected; "W" indicates a Warning-only situation. The "XX" qualifier to identify the NPI and any other associated qualifier(s) must be included, as appropriate.
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 1-800-746-4614.
NPI-only Claim Submission Edits – Billing Provider Level |
Error Code |
Message |
Explanation |
LVL |
2G4 |
Billing provider NPI invalid |
The NPI submitted on the claim to identify the billing provider is not a valid NPI. |
R |
QGD |
NPI is not valid as billing |
The NPI submitted on the claim to identify the billing entity is not recognized by BCBSTX as a billing entity. |
R |
QGA |
Billing provider must have NPI |
No NPI was submitted in the billing loop. |
R |
QGC |
Billing NPI is not on file |
The NPI submitted on the claim to identify the billing entity is not on file with BCBSTX. |
W |
QHA |
Billing provider qualifier invalid |
An invalid secondary provider ID qualifier associated with the NPI of the billing provider was submitted on the claim. (Must use “EI” or “SY” qualifier.) |
W |
NPI-only Claim Submission Edits – Claim Level |
Error Code |
Message |
Explanation |
LVL |
BAJ |
Rendering provider loop (2310B) is missing |
If the NPI billing provider record is NOT established as “valid as rendering" or "billing always rendering,” then the claim rendering provider loop (2310B) is required. |
R |
BA4 |
Rendering provider NPI invalid |
The NPI submitted on the claim to identify the provider that rendered the services is not a valid NPI. |
R |
BA5 |
Rendering provider ID qualifier must = “XX” |
An invalid qualifier was used to identify the NPI of the provider that rendered services on the claim. |
R |
BA6 |
Rendering NPI is not on file |
The NPI submitted on the claim to identify the provider that rendered the services is not on file with BCBSTX. |
W |
BA7 |
NPI is not valid as rendering |
The NPI submitted on the claim to identify who provided the services is identified in our files as a billing entity, not a rendering provider. |
R |
BBA |
Rendering provider qualifier invalid |
An invalid secondary provider ID qualifier associated with the NPI of the rendering provider was submitted on the claim. (Must use “EI” or “SY” qualifier.) |
W |
BD4 |
Referring provider NPI invalid |
The NPI submitted on the claim to identify the referring provider is not a valid NPI. |
W |
BD5 |
Referring provider ID qualifier must = “XX” |
An invalid qualifier was used to identify the NPI of the provider that referred services on the claim. (When an ID qualifier is given, it must be “XX.”) |
W |
BEA |
Referring provider qualifier invalid |
An invalid secondary provider ID qualifier associated with the NPI of the provider that referred services was submitted on the claim. (Must use “EI” or “SY” qualifier.) |
W |
BG4 |
Primary care provider NPI invalid |
The NPI submitted on the claim to identify the primary care provider is not a valid NPI. |
W |
BG5 |
Referring provider ID qualifier must = “XX” |
An invalid qualifier was used to identify the NPI of the provider that referred services on the claim. (When an ID qualifier is given, it must be “XX.”) |
W |
BHA |
Referring provider qualifier invalid |
An invalid secondary provider ID qualifier associated with the NPI of the referring provider was submitted on the claim. (Must use “EI” or “SY” qualifier.) |
W |
BJ4 |
Purchased provider NPI invalid |
The NPI submitted on the claim is not a valid NPI. |
W |
BJ5 |
Purchased provider ID qualifier must = “XX” |
An invalid qualifier was used to identify the NPI of the provider. (When an ID qualifier is given, it must be “XX.”) |
W |
BKA |
Purchased provider qualifier invalid |
An invalid secondary provider ID qualifier associated with the NPI was submitted on the claim. (Must use “EI” or “SY” qualifier.) |
W |
BM4 |
Service facility NPI invalid |
The NPI submitted on the claim to identify the service facility provider is not a valid NPI. |
W |
BM5 |
Service facility qualifier must = “XX” |
An invalid qualifier was used to identify the NPI of the service facility. (When an ID qualifier is given, it must be “XX.”) |
W |
BNA |
Service facility provider qualifier invalid |
An invalid secondary provider ID qualifier associated with the NPI of the service facility was submitted on the claim. (Must use “TJ” qualifier.*) |
W |
|
Supervising provider NPI invalid |
The NPI submitted on the claim to identify the supervising provider is not a valid NPI. |
W |
|
Supervising provider qualifier must = “XX” |
The NPI submitted on the claim to identify the supervising provider is not a valid NPI. (When an ID qualifier is given, it must be “XX.”) |
W |
|
Supervising provider qualifier invalid |
An invalid secondary provider ID qualifier associated with the NPI of the supervising provider was submitted on the claim. (Must use “EI” or “SY” qualifier.) |
W |
|
Attending/Operating/Other/Service provider ID qualifier must = “XX” |
An invalid qualifier was used to identify the NPI of the provider. |
W |
|
Attending/Operating/Other/Service provider qualifier invalid |
An invalid secondary provider ID qualifier associated with the NPI was submitted on the claim. (Must use “EI” or “SY” qualifier.) |
W |
|
Attending/Operating/Other/Service NPI invalid |
The NPI submitted on the claim to identify the provider is not a valid NPI. |
W |
NPI-only Claim Submission Edits – Service Line Level |
Error Code |
Message |
Explanation |
LVL |
|
Rendering provider NPI invalid |
The NPI submitted on the service line to identify the provider that rendered the services is not a valid NPI. |
R |
|
Rendering provider ID qualifier must = “XX” |
An invalid qualifier was used to identify the provider that rendered services on the service line. |
R |
|
Rendering NPI is not on file |
The NPI submitted on the service line to identify the provider that rendered the services is not on file with BCBSTX. |
W |
|
NPI is not valid as rendering |
The NPI submitted on the service line is identified in our files as a billing entity, not a rendering provider. |
R |
|
Rendering provider qualifier invalid |
An invalid secondary provider ID qualifier associated with the NPI of the rendering provider was submitted on the claim. (Must use “EI” or “SY” qualifier.) |
W |
|
Referring provider NPI invalid |
The NPI submitted on the claim to identify the referring provider is not a valid NPI. |
W |
|
Referring provider ID qualifier must = “XX” |
An invalid qualifier was used to identify the NPI of the provider that referred services on the claim. (When an ID qualifier is given, it must be “XX.”) |
W |
|
Referring provider qualifier invalid |
An invalid secondary provider ID qualifier associated with the NPI of the referring provider was submitted on the claim. (Must use “EI” or “SY” qualifier.) |
W |
|
Referring provider NPI invalid |
The NPI submitted on the claim to identify the referring provider is not a valid NPI. |
W |
|
Referring provider ID qualifier must = “XX" |
An invalid qualifier was used to identify the NPI of the provider that referred services on the claim. (When an ID qualifier is given, it must be “XX.”) |
W |
|
Referring provider qualifier invalid |
An invalid secondary provider ID qualifier associated with the NPI of the referring provider was submitted on the claim. (Must use “EI” or “SY” qualifier.) |
W |
|
Purchased provider NPI invalid |
The NPI submitted on the claim to identify the provider is not a valid NPI. |
W |
|
Purchased provider ID qualifier must = “XX” |
An invalid qualifier was used to identify the NPI of the provider. (When an ID qualifier is given, it must be “XX.”) |
W |
|
Purchased provider qualifier invalid |
An invalid secondary provider ID qualifier associated with the NPI of the provider was submitted on the claim. (Must use “EI” or “SY” qualifier.) |
W |
|
Service facility NPI invalid |
The NPI submitted on the claim to identify the service facility is not a valid NPI. |
W |
|
Service facility qualifier must = “XX” |
An invalid qualifier was used to identify the NPI of the service facility. (When an ID qualifier is given, it must be “XX.”) |
W |
|
Service facility provider qualifier invalid |
An invalid secondary provider ID qualifier associated with the NPI of the service facility was submitted on the claim. (Must use “TJ” qualifier.*) |
W |
|
Supervising provider NPI invalid |
The NPI submitted on the claim to identify the supervising provider is not a valid NPI. |
W |
|
Supervising provider qualifier must = “XX” |
An invalid qualifier was used to identify the NPI of the supervising provider on the claim. (When an ID qualifier is given, it must be “XX.”) |
W |
|
Supervising provider qualifier invalid |
An invalid secondary provider ID qualifier associated with the NPI of the supervising provider was submitted on the claim. (Must use “EI” or “SY” qualifier.) |
W |
|
Ordering provider NPI invalid |
The NPI submitted on the claim to identify the ordering provider is not a valid NPI. |
W |
|
Ordering provider ID qualifier must = “XX” |
An invalid qualifier was used to identify the NPI of the ordering provider on the claim. (When an ID qualifier is given, it must be “XX.”) |
W |
|
Ordering provider NPI invalid |
The NPI submitted on the claim to identify the ordering provider is not a valid NPI. |
W |
|
Attending/Operating/Other/Service provider ID qualifier must = “XX” |
An invalid qualifier was used to identify the NPI of the provider on the claim. |
W |
|
Attending/Operating/Other/Service provider qualifier invalid |
An invalid secondary provider ID qualifier associated with the NPI of the provider was submitted on the claim. (Must use “EI” or “SY” qualifier.) |
W |
|
Attending/Operating/Other/Service NPI invalid |
The NPI submitted on the claim to identify the provider is not a valid NPI. |
W |
