Important Reminder: Claims Will Deny if Rendering NPIs are not on File with BCBSTX

August 7, 2018

The following information does not apply to government programs (Medicare Advantage and Texas Medicaid claims)

It is important that your provider record on file with Blue Cross and Blue Shield of Texas (BCBSTX) is accurate and up-to-date. In addition to the National Provider Identifier (NPI) and other demographic information for your group, your provider record must be updated to include the rendering NPIs of all individual providers associated with your group. If claims are submitted for services rendered by providers who are not associated with your provider group according to our records, those claims will be denied.

Beginning Sept. 1, 2018, when a claim is denied due to not having an NPI on file or if the rendering NPI on file is not associated with the billing provider’s NPI on file, a denial message will appear on the Electronic Payment Summary (EPS) or paper Provider Claim Summary (PCS). The denial message will include a reminder that updates to the billing provider’s record on file must be completed prior to resubmitting the claim.

For providers who receive Electronic Remittance Advice (ERA), they will see the following Claim Adjustment Group Code (CAGC), Claim Adjustment Reason Code (CARC) and the Remittance Advice Remark Code (RARC):

  • CO – Claim Adjustment Group Code
  • A1 – Claim/Service Denied
  • N290 – Missing/Incomplete/Invalid rendering provider primary identifier

How to Update Your NPI Information on File with BCBSTX

To update your provider record on file or to add a provider to your current group with BCBSTX, visit the Network Participation section of our provider website.

If you have questions, contact your BCBSTX Network Management Representative for assistance.