EOB

EOB Description

Explanation for denial

Correction Guidelines

1601

Billing provider NPI/Atypical Provider Identifier (API) to Texas Provider Identifier (TPI) combination or NPI/API information is invalid.

The billing provider’s NPI is missing or in an invalid format. The combination of the NPI, taxonomy code, physical address, ZIP+4 Code, and benefit code does not have a one-to-one match to a TPI.

Providers should verify that the billing provider’s NPI and taxonomy code matches the information that was submitted to TMHP during attestation.

Providers should also verify that the address listed in the billing provider field or loop matches their current TMHP account information.

1603

Performing Provider NPI/API to TPI combination or NPI/API information is invalid.

The performing provider’s NPI is missing or in an invalid format. The combination of the NPI, taxonomy code, physical address, ZIP+4 Code, and benefit code does not have a one-to-one match to a TPI.

Providers should verify that the performing provider’s NPI and taxonomy code matches the information submitted to TMHP during attestation.

Providers should also verify that the ZIP+4 Code listed in the performing provider loop for electronic claims matches the ZIP+4 Code submitted to TMHP during attestation.

1604

Billing provider taxonomy is missing.

The billing provider’s taxonomy code is missing.

Provider must submit their claim with the billing provider’s taxonomy code submitted to TMHP during attestation.

1606

Performing provider taxonomy is missing.

The performing provider’s taxonomy code is missing.

Provider must submit their claim with the performing provider’s taxonomy code submitted to TMHP during attestation.