The payer is rejecting stating that you have provided an nvalid Entity's Commerical Provider ID.
A claim can have up to three providers on it. The three possible providers are as follows.
- Billing Provider: This is your clinic (this is equivalent to Box 33 on the CMS-1500 claim form).
- Rendering Provider: This is the therapist that performed the services.
- Referring Provider: This is the physician who referred the patient to your clinic.
Unfortunately, they did not indicate why provider they are referring to. They also did not indicate which provider ID they are referring to. Possible ID's are as follows.
- The NPI (make sure you are submitting with the same billing NPI that they have on file for you).
- The Tax ID (make sure you are submitting with the same Tax ID that they have on file for you).
- Legacy ID's (if you set them up under Billing->Insurance List for this insurance company).
- The NPI (some payers require that you share each rendering provider NPI with them, as being under your billing provider NPI).
- Legacy ID (if you have any entered on the edit provider form, by clicking the Legacy ID tab at the top of the edit provider form).
- The NPI: You can view and edit this by going to Providers->Referring and clicking the edit icon associated with the referring provider.
- Legacy ID: You can view and edit this by going to Providers->Referring and clicking the edit icon associated with the referring provider and changing the information in the text box labeled Box 17A.