====== Subscriber ID Override ====== Modify subscriber/member IDs on claims. Strip dashes or spaces, add prefixes or suffixes, or replace the ID entirely. **Applies to:** Professional (837P), Institutional (837I), Dental (837D) ---- ===== When to Use This ===== * A payer rejects claims because the member ID has dashes (e.g., "123-456-789" should be "123456789") * A payer requires a specific prefix on all member IDs (e.g., "WPA" + member ID) * You need to strip spaces from member IDs that come in with extra whitespace * A payer's member ID format changed and you need to transform the old format ---- ===== Fields ===== ^ Field ^ Required ^ Description ^ | Start Date | Yes | When this rule becomes active | | End Date | No | When this rule expires | | Payer Number | No | Only apply for a specific payer. Blank = all payers | | Match Pattern | No | Only modify IDs that **contain** this text. Blank = apply to all IDs. Example: entering "WPA" will only match IDs like "WPA12345" | | Replacement Value | No | Replace the entire ID with this value. If set, this overrides strip/prefix/suffix | | Strip Dashes | No | Remove all dashes (-) from the member ID | | Strip Spaces | No | Remove all spaces from the member ID | | Prefix to Add | No | Text to prepend to the member ID | | Suffix to Add | No | Text to append to the member ID | | Notes | No | Your reference notes | ==== Processing Order ==== When multiple options are set, they apply in this order: - Strip dashes (if checked) - Strip spaces (if checked) - If **Replacement Value** is set → replaces the entire ID - Otherwise → applies Prefix + current ID + Suffix ---- ===== Examples ===== === Example 1: Strip Dashes for Aetna === Aetna rejects claims with dashes in the member ID. ^ Field ^ Value ^ | Payer Number | 60054 | | Strip Dashes | ✓ Checked | Result: "123-456-789" becomes "123456789" === Example 2: Add Prefix for Medicaid === State Medicaid requires "MCD" prefix on all member IDs. ^ Field ^ Value ^ | Payer Number | 77043 | | Prefix to Add | MCD | Result: "12345678" becomes "MCD12345678" === Example 3: Replace ID Entirely === A specific payer always needs the same subscriber ID format. ^ Field ^ Value ^ | Payer Number | 00621 | | Match Pattern | WPA | | Replacement Value | NEWID999 | Result: Any ID containing "WPA" (like "WPA12345") becomes "NEWID999" ---- ===== What Happens on the Claim ===== - The subscriber ID in Loop 2010BA (Subscriber) NM1 element 9 is modified - A note is added to the claim documenting the change - Shows in Applied Validation Modules as "SubscriberIdOverrideModule" ---- **[[guides:claim-rules|← Back to Claim Rules Engine]]**