CMS-1500 Claim Form Practice Test

What is the likely outcome if the billing provider's NPI is missing on a CMS-1500 claim?

The claim may be denied or delayed due to missing NPI. The claim will automatically be paid. The claim will be sent to the patient for payment. The claim is canceled automatically.

Correct Answer:

The claim may be denied or delayed due to missing NPI.

Explanation:

Missing the billing provider’s NPI means the payer cannot identify who is billing, so the claim is typically denied or held for resubmission. The NPI is the unique identifier used to associate the claim with the correct provider and contract terms, so without it the claim can’t be properly adjudicated. This isn’t paid automatically, and it isn’t automatically sent to the patient or canceled; the usual path is a denial or a request to resubmit with the correct NPI. To fix it, resubmit the claim with the billing provider’s valid NPI in the appropriate place and ensure all required provider identifiers are present.

Access more questions from this quiz

Continue to CMS-1500 Claim Form Practice Test for more practice questions and the full quiz experience.

Access More Questions