guides:claim-rules:subscriber-id-override
Table of Contents
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/subscriber-id-override.txt · Last modified: by brad.sharp