Payer Rejection BILLING NPI SUBMITTER ID COMBO NOT ON FILE FOR BL OR HM
Should you see this rejection from the payer:
BILLING NPI SUBMITTER ID COMBO NOT ON FILE FOR BL OR HM
This is the payer's way of indicating that these claims need to be dropped to paper mail. The payer is requiring mailed medical attachments along with the submitted paper claim. The claim will not go electronically with the correct payer id or the TriZetto paper product (00010). It is the payer that is requiring a hard copy for these specific claims based on the PPUR program (Prepayment Utilization Review), and what services are being sent on the claim that would indicate there should be a claims attachment included in order for the payer to process.
At this time, TriZetto has a limited ability to reject the claim, and does not have more catered verbiage to output on the 277 file to indicate they want the claims mailed with attachments.