This error is most likely due to submitting a claim with the wrong billing NPI (the equivalent of Box 33 on the CMS-1500). Most payers have your NPI that you shared with them at some point on file. When they receive a claim, they look up the NPI in their system to see if they have the billing NPI on file. If they do not have it on file, then they will reject the claim. In addition to the NPI, they also have your Tax ID on file. Therefore, this error could also be referring to a claim submitted with the wrong Tax ID reported in (the equivalent of) Box 25 on the claim.
You should always submit claims to the payer using the same NPI and Tax ID that the payer has on file for you.
Are you submitting to Blue Cross Blue Shield?
You should always submit to your state's Blue Cross Blue Shield office. For example, if you are a Blue Cross Blue Shield of Tennessee provider, you should submit all Blue Cross Blue Shield claims through Blue Cross Blue Shield of Tennessee. The state that you are a BCBS provider in has your NPI on file. Other BCBS states do not have your NPI on file. You submit to your BCBS state and they will route it to the correct BCBS state based on the alpha prefix of the primary ID. If this is the case, then edit the insurance card in Therabill. Change the insurance company associated with the card to your state BCBS.
How to fix in Therabill
Therabill pulls your NPI for Box 33 (billing provider) and Tax ID for Box 25, by default, from the information you have on file under Admin in Therabill. However, there are several methods for changing where that information is coming from. For example, Groups and Insurance Company Specific Billing Provider Information.
From the error page, simply click the edit icon next to the billing provider (not the rendering provider). This will open up the appropriate edit form for where Therabill is pulling your billing provider information for this claim. For example, if it was pulling the billing provider information from Admin, then it will open up your Admin billing provider. If it was pulling your billing provider from a group, then it will open up the group information.
On the edit form that opens up, make sure you have the same NPI and Tax ID entered that you have on file for this payer. Remember to save your changes. You can then go back to the error page in Therabill and click the Resubmit Electronically button at the top of the page.
What if I need different billing provider information going out to just this payer?
Then you will want to use a feature of Therabill called Insurance Company Specific Billing Provider Information. For instructions on how to use this, please click here.
- Billing NPI is not valid as Rendering
- Billing NPI is not on file
- Provider ID not on File
- BILLING PROVIDER NPI: INVALID; MUST MATCH THE NPI REGISTERED WITH PAYER