Denial Code 207 means that the National Provider Identifier (NPI) provided on the claim is in an invalid format. Below you can find the description, common reasons for denial code 207, next steps, how to avoid it, and examples.
2. Description
Denial Code 207 is a claim adjustment reason code (CARC) that indicates the National Provider Identifier (NPI) provided on the claim is in an invalid format. The NPI is a unique identification number assigned to healthcare providers by the Centers for Medicare and Medicaid Services (CMS). It is used to identify providers in electronic transactions and is crucial for accurate and efficient claims processing. When the NPI is not in the correct format, the claim is denied, and payment is not made.
2. Common Reasons
The most common reasons for denial code 207 are:
- Incorrect NPI Format: Denial code 207 may occur if the NPI provided on the claim is not in the correct format. The NPI should consist of ten digits, with no spaces, dashes, or other special characters. Any deviation from this format will result in the claim being denied.
- Missing or Incomplete NPI: Another reason for denial code 207 is when the NPI is missing or incomplete on the claim. It is essential to ensure that the NPI is accurately entered and included in the appropriate field of the claim form.
- Invalid NPI: Denial code 207 may also occur if the NPI provided is not a valid NPI. The NPI must be a unique identifier assigned to a healthcare provider by the CMS. If an incorrect or non-existent NPI is used, the claim will be denied.
- Transposition Errors: Transposing numbers or entering the NPI incorrectly can lead to denial code 207. It is crucial to double-check the NPI for accuracy before submitting the claim to avoid this denial.
- Outdated NPI: If the NPI provided on the claim is outdated or no longer valid, the claim will be denied under code 207. It is essential to regularly update and verify the NPI to ensure accurate claims processing.
3. Next Steps
You can fix denial code 207 as follows:
- Verify NPI Format: Check the NPI format to ensure it meets the required criteria. The NPI should consist of ten digits, with no spaces, dashes, or special characters. If the format is incorrect, correct it and resubmit the claim.
- Complete NPI Information: Ensure that the NPI is complete and accurately entered on the claim form. Double-check that it is included in the appropriate field and that no digits are missing or transposed.
- Validate NPI: Verify that the NPI provided is a valid NPI assigned to the healthcare provider by the CMS. If it is not a valid NPI, obtain the correct NPI and update the claim accordingly.
- Review for Errors: Thoroughly review the claim for any errors or typos in the NPI. Transposing numbers or entering the NPI incorrectly can lead to denial code 207. Correct any errors and resubmit the claim.
- Update Outdated NPI: If the NPI provided is outdated or no longer valid, update it with the current NPI assigned to the healthcare provider. Ensure that the updated NPI is accurately entered on the claim form.
4. How To Avoid It
You can prevent denial code 207 in the future as follows:
- Education and Training: Ensure that billing and administrative staff are educated and trained on the correct format and requirements for the NPI. Provide ongoing training to keep them updated on any changes or updates related to the NPI.
- Double-Check NPI: Implement a process to double-check the NPI for accuracy before submitting claims. This can include using software or tools that validate the NPI format and alert users if any errors are detected.
- Regular NPI Verification: Regularly verify the NPI assigned to healthcare providers to ensure it is up to date and valid. This can be done by checking the CMS NPI Registry or contacting the provider directly.
- Quality Assurance: Implement a quality assurance process to review claims before submission. This can help identify and correct any errors or issues, including incorrect or invalid NPIs.
5. Example Cases
Below are two examples of denial code 207:
- Example 1: A healthcare provider submits a claim with an NPI that consists of nine digits instead of the required ten digits. The claim is denied under code 207 due to an invalid NPI format.
- Example 2: A billing staff member accidentally transposes two digits in the NPI when entering it on the claim form. The claim is denied under code 207 because the NPI is not in the correct format.
