ClaimRev Support Documentation

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====== Rendering Provider Swap ======

Automatically replace a rendering provider's NPI and name on claims when a specific NPI is found.

**Applies to:** Professional (837P), Dental (837D)

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===== When to Use This =====

  * A provider has left your practice and claims still come in with their old NPI
  * A locum tenens provider is filling in and you need their claims billed under a different NPI
  * A provider's NPI was entered incorrectly in the source system and you need to correct it
  * A payer requires a specific rendering NPI for certain states

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===== Fields =====

^ Field ^ Required ^ Description ^
| Start Date | Yes | When this rule becomes active |
| End Date | No | When this rule expires. Leave blank for no expiration |
| Payer Number | No | Only apply this swap for a specific payer. Leave blank to apply for all payers |
| Subscriber State | No | Only apply when the subscriber's state matches (2-letter code, e.g., TX). Leave blank for all states |
| Original NPI | Yes | The NPI to look for on the claim's rendering provider |
| Replacement NPI | Yes | The new NPI to put on the claim |
| Entity Type | Yes | **Person** (individual provider) or **Organization** |
| Replacement Last Name | Yes | The new provider's last name (or organization name) |
| Replacement First Name | No | The new provider's first name (leave blank for organizations) |
| Taxonomy Code | No | If set, also updates the rendering provider's taxonomy code |
| Notes | No | Your reference notes — why this rule exists, who requested it |

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===== Examples =====

=== Example 1: Provider Left Practice ===

Dr. Smith (NPI 1234567890) has left your practice. All claims should now show Dr. Jones (NPI 9876543210) as the rendering provider.

^ Field ^ Value ^
| Original NPI | 1234567890 |
| Replacement NPI | 9876543210 |
| Entity Type | Person |
| Replacement Last Name | JONES |
| Replacement First Name | SARAH |
| Start Date | 04/01/2026 |

=== Example 2: Payer-Specific NPI for Texas ===

Aetna (payer 60054) requires a different rendering NPI for Texas claims.

^ Field ^ Value ^
| Payer Number | 60054 |
| Subscriber State | TX |
| Original NPI | 1234567890 |
| Replacement NPI | 5555555555 |
| Entity Type | Person |
| Replacement Last Name | SMITH |
| Replacement First Name | JOHN |
| Taxonomy Code | 207Q00000X |

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===== What Happens on the Claim =====

When a claim is processed and the rendering provider NPI matches:

  - The NPI in Loop 2310B (Rendering Provider) NM1 segment is replaced
  - The provider name is updated
  - If a taxonomy code is specified, the PRV segment is updated
  - A note is added to the claim: "Swapped rendering provider NPI {old} to {new}"
  - The change appears in the claim's Applied Validation Modules as "RenderingProviderSwapModule"

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