Claim edit: Missing organization name
Stedi now rejects 837P professional, 837D dental, and 837I institutional claims that include a non-person entity with no organization name.
Entity types and organization names
In a claim, each entity, such as the billing provider or submitter, is identified as either a person or a non-person using an entity type qualifier. Non-person entities include hospitals, billing organizations, and similar groups.
X12 standards require the organization name when an entity is a non-person. In X12, this is the entity's NM1-03 element. If the organization name is missing, the payer may reject the claim.
This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which take longer to resolve and delay payment for the provider.
How entity type qualifiers are specified
If you use Stedi's JSON Claim Submission API endpoints, Stedi sometimes infers the entity type qualifier. For example, if you provide an organizationName for the billing provider in a JSON 837P Professional Claims API request, the entity is treated as a non-person.
If you provide a firstName and lastName, the entity is treated as a person. Other entities, such as otherPayerBillingProvider, have an explicit entityTypeQualifier field.
If you use X12, you set the entity type qualifier in NM1-02 (Entity Type Qualifier). 1 indicates a person and 2 indicates a non-person entity, such as a hospital or billing organization.
Rejection errors
If you submit a claim using Stedi's Claim Submission API endpoints and the claim fails the edit, you'll get back an error response in real time. The response includes details in the errors array:
{
"errors": [
{
"code": "33",
"description": "Missing Organizational Name. The organizational name is required when Billing Provider is reported as a non-person by the entity type qualifier 2. Correct and resubmit.",
"followupAction": "Please Correct and Resubmit"
}
]
}If you submit a claim using SFTP and the claim fails the edit, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will include a related claim status category code, claim status code, entity identifier code, and error message:
STC*A6>125>85*[DATE]*U*[AMOUNT]********Missing Organizational Name. The organizational name is required when Billing Provider is reported as a non-person by the entity type qualifier 2. Correct and resubmit.~Related claim edits
Stedi has companion edits for missing person names. See Claim edit: Missing last name and Claim edit: Missing first name.
Stedi also has an edit for person name fields sent on a non-person entity. See Claim edit: Invalid name for a non-person entity.
