Billing Entity refers to a relationship, Limited Liability Company or other entity whose only significant duty is generating medical bills and codes for the patient’s visit to their physician and collecting payments for professional medical technician services on behalf of an affiliated medical group or a subordinate and which transfers all of its revenue on a regular basis to such affiliated medical group

Entity code error in a billing claim:

This entity code error is most likely to occur due to submitting a medical claim with the wrong billing NPI (the equivalent of Box 33 on the CMS-1500). Most payers have the NPI that you shared with them at some point on file. When they receive a medical claim, they verify the NPI in their system to see if they have the billing NPI on file. If they do not recorded it on file, then it would result in claim denials. There is also your Tax ID in addition to the NPI, on file. Therefore, this error also occurs due 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 third party or secondary party payer has recorded on file for you.

You may want to browse through the information of entity coding error while submitting a claim to see if you can find anything that stands out as being wrong. If you may not find appropriate information, you may need to call the third party payers to get additional information (remember to let them know that you forwarded the claim electronically and it was EDI rejected).

The various types of 'Entities codes error' that can be on a medical claim are listed below.

• Billing Provider.

• Rendering Provider (address, phone, do not go on claim, however, they may be referencing the NPI).

• Patient.

• Insured.

• Referring Physician.

Rejection Reasons:

1. The claim was issued to the wrong payer ID.

Note: This denial of the clams occur, if the claim is submitted against the multiple number of patients.

2. The patient’s demographics or insurance policy included on the claim was not adequate for the date when the bill of the service is generated.

3. The patient is a newborn or added to the guarantor’s insurance policy recently.

Resolution of entity code errors:

Resolution steps will vary depending on the cause:

1. The claim is submitted to the wrong payer ID:

If the claim is submitted to the wrong payer ID then primarily verify and edit the payer ID.

2. The patient demographics or policy is incorrect:

If the error negotiates that patient’s demographics are incorrect, then verify the patient's admissibility criteria.

3. The patient is a newborn or recently added to the guarantor’s insurance policy:

If it is found that the patient is a newborn or recently added to the guarantor’s policy then don’t feel reluctant to contact the payer to verify the patient is active under the insured’s policy.

When all corrective actions are completely validated by medical technicians, rebill and resubmit all affected claims.