PROV - PERFORMING / RENDERING PROVIDER NUMBER IS REQUIRED NPI

The rejection message from the payer is mentioning the rendering providers NPI and saying it is required.  This could mean several things.

• You did not enter an NPI for the rendering provider in Therabill.  If this is the case, then you will want to edit the provider (under Providers->Provider List) in Therabill to include the rendering providers type 1 (individual) NPI.
• The NPI you supplied as the rendering provider NPI is not valid.
• The payer does not have the rendering provider's NPI that you supplied on file as a valid NPI for your billing NPI (your clinic).
• The rendering provider loop was left off of the claim because the rendering NPI you supplied is the same as the billing NPI on the claim (see below).

Rendering NPI is the same as the Billing NPI

The standards for electronic claims (EDI claims) is that, if the rendering provider NPI is the same as the billing provider NPI, then the rendering provider loop is to be left off of the claim.  The receiver of the claim (e.g. the payer) is then to assume that the rendering provider is the same as the billing provider.   Errors can occur when you supply a type 2 (organizational NPI) as the rendering providers NPI.  The rendering provider should have a type 1 (individual NPI) entered.

Resubmitting the claim

Once you have identified the issue and have it fixed within Therabill, you can resubmit the claim from the EDI rejection page in Therabill by clicking the Resubmit Electronically button at the top of the page.