Unfortunately, this is a rejection message from the payer that does not have much informational value. The question is, what are they talking about when they use the word entity. Below are some possible entities that they may be referring to. However, you may need to call the payer to find out exactly what entity they are referring to. Remember, when calling the payer, this claim came back as an EDI rejection, therefore, the first person you talk to (probably in the adjudication department) will not have a record of this claim. Let them know that you submitted electronically (EDI) and that it was rejected by EDI.
They could be referring to the patient. If it is the patient, below are some possible causes.
- The patient is not covered by this payer.
- Submitted to the wrong payer.
- You mistyped the primary ID on the insurance card or the first and last name.
The billing provider is the name and NPI that you have entered under Admin in Therabill (this is the default place, if you are using Groups or Insurance Company Specific Billing Provider Info, it may be going out with different information than what you have entered under Admin).
Most payers require that they have your billing NPI on file. It could be that you are submitting this claim with a different billing NPI than what you have on file with this payer.
The billing NPI is what goes in to Box 33 of the CMS-1500 and in Loop 2000A Segment PRV-03 of an EDI claim.
The rendering provider is the provider NPI that you have under Providers in Therabill. This is the NPI that goes out in Box 24J of the CMS-1500 and in Loop 2310B Segment NM1-09 on EDI claims.
Some payers require that you have each of your rendering providers registered with them under your billing NPI.