WARN: Using group NPI [XXXXXX] in the Rendering NPI field will cause the billing provider to be sent as an individual [XXXX].
  • 02 Aug 2024
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WARN: Using group NPI [XXXXXX] in the Rendering NPI field will cause the billing provider to be sent as an individual [XXXX].

  • Oscuro
    Ligero
  • PDF

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Resumen del artículo

These warnings inform you that the current method of entering data will not transmit to the payer as expected. To ensure X12 compliance for electronic claims:

  • Issue: Entering the same NPI in both block 31 (rendering provider) and block 33 (billing provider) causes issues.
  • Outcome: The payer will receive the provider information only as an individual in block 33, not as a group or organization.
  • Solution: To correctly submit an electronic claim without a rendering provider, leave block 31 (2310B) blank.
  • Non-compliance Impact: If the same NPI is used in both blocks, the payer will not receive the organization name, but rather an individual provider name. This may result in the NPI being misclassified as an individual rather than an organization.
  • Alternative: If the rendering provider is not required to have an NPI, request an A-typical provider number from the payer, which can be used in the "Prov ID" field.
  • Warning Disabling: If you wish to proceed against this guidance, the warning can be disabled. However, the data will still not be transmitted to the payer as entered. To request this warning be disabled open a support ticket from an example claim.

These measures ensure compliance with HIPAA X12 electronic claim rules and prevent errors in claim processing.


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