National Provider Identifier (NPI) - News

Current Edit Code

Message / Logic

Legacy Only

Dual Use

NPI Only

837P
837D

B061 Legacy
Reject
B061A  
NPI  Warning

Legacy Message - Rendering provider # not tied to Billing provider #.
NPI Message – Rendering NPI not tied to Billing NPI
Logic – The rendering provider number in 2310B-REF02 is a billing provider number, not a rendering provider number.

B061B
Reject

B061D Legacy Reject
B061C NPI
Warning

B061E Reject

837I

B064 Legacy Reject

Message - – Service facility information is required.
Logic - If 2310E-NM101 equal 'FA'  and  2010BC-NM109 equal '47163'  and  (2010AA-NM108 equal ‘24’ or ‘34’, one (1) occurrence of this 2310E-REF segment with '1A' in 2310E-REF01 must be present.

B064A Reject

NA

NA

837I

B222 Legacy Reject

Message - One occurrence must be 1A for this payer.
Logic - If 2010BC-NM109 equals '47163'  and  2010AA-NM108 equal ‘24’ or ‘34’ and :  Does 2000B-SBR09 equal 'BL', if so one (1) occurrence of the 2010AA-REF segment contain the value of '1A' in 2010AA-REF01.

B222A Reject

NA

NA

837P
837D

B257 Legacy Reject
B257A
NPI Warning

Legacy Message - Group provider # cannot be used as Rendering provider#.
NPI Message – Group NPI can not be used as rendering NPI
Logic - The 2310B-REF02 Rendering Provider Number value is a Kansas Blue Shield Common Pay Provider Number value that may not be submitted as a Rendering Provider Number.

B257B Reject

B257D
Legacy
Reject
B257C
NPI Warning

B257E
Reject

837P
837D

B258 Legacy Reject
Note: This is a new edit for Dental

Message - Line Ren Prov # can not = Claim Ren Prov #
Logic – If 2010AA NM108 = '24' or '34', the 2420A-REF02 value cannot equal the 2310B-REF02 value.

B258A Reject

NA

NA

837P
837D

B258
Legacy Reject

Message - Line Ren Prov NPI can not = Claim Ren Prov NPI.
Logic – If 2010AA NM108 = 'XX', the 2420A-NM109 value cannot equal the 2310B-NM109 value.

NA

B258B Reject

B258C Reject

837P 837I 837D

B274
Reject

Message - Claim filtering indicator code must equal BL.
Logic - If 2010BB-NM109 (2010BC-NM109 for 837I) equals '47163' and 2010AA-NM108 equal ‘24’ or ‘34’ then the 2000B-SBR09 must equal 'BL'.

B274A Reject

NA

NA

837P 837I 837D

B274
Reject

Message - Claim filtering indicator code must equal BL.
Logic - If 2010BB-NM109 (2010BC-NM109 for 837I) equals '47163' and 2010AA-NM108 equal ‘XX’ then the 2000B-SBR09 must equal 'BL' 

NA

274B Reject

274B Reject

837P
837D

B275 Legacy Reject

Message - Rendering provider number value is required.
Logic – If 2010AA-NM108 = '24' or '34', then 2310B-REF segment must have one occurrence of the value of '1B' in 2310B-REF01.

B275A Reject

NA

NA

837P
837D

B275 Legacy Reject

Message - Rendering provider number value is required.
Logic – If 2010AA-NM108 = '24' or '34' and 2420A NM101 = '82', then one occurrence of the value of '1B' in 2420A-REF01 is required.

B275A Reject

NA

NA

837P
837D

B344 Legacy Reject

Message - 2310B Rendering provider loop required with Billing provider.
Logic – If the provider number in 2010AA NM109 is a group provider number, then a rendering provider number is required in the 2310B NM109.

B344A Reject

B344B Warning

B344C Reject

837P
837D

B351 Legacy Reject

Message - One occurrence must be 1B for this payer.
Logic – If 2010BB-NM109 equals '47163' and 2010AA-NM108 equal ‘24’ or ‘34’, then one occurrence of the 2010AA-REF segment must contain the value of '1B' in 2010AA-REF01.

B351A Reject

NA

NA

837P 837I 837D

B376
Warning

Message - Billing NPI not tied to Trading partner.
Logic – The billing NPI located in the 2010AA NM109 must be setup for the Trading Partner submitting the claim.

NA

B376A Warning

B376B Reject

837P 837I 837D

B377, B378,
B379
Warning

Message - EDI Authentication failed.
Logic - Is the combination of (the ISA06 [Trading Partner] value and the 2010AA-NM109 [Billing Provider NPI] value using the proper Test/Production indicator and version?

NA

B379A Warning

B379B Reject

837P
837D

NA

Message - Rendering NPI value is required
Logic – If 2010AA NM108 = 'XX' and no legacy provider number is submitted in 2010AA REF01 and 2310B is present, then the 2310B must have 'XX'.

NA

NA

B382 Reject