“This Code Requires Use of an Entity Code”: What It Means and How to Fix It

If your clearinghouse report says “This code requires use of an Entity Code,” the claim never reached the payer’s claims system. It was stopped at the door. Something about one of the parties on the claim, like a provider, the patient, the subscriber or the payer, is missing or doesn’t match what the payer has on file. The good news: it’s a data fix, not an appeal.

Where this message comes from

After you send a claim (the 837), you get two electronic responses. The 999 says the file was built correctly. The 277CA claim acknowledgment says whether each claim was accepted into the payer’s system. This message comes from the 277CA, where a rejection is reported as a status category code plus a status code:

• A3: returned as unprocessable
• A6: rejected for missing information
• A7: rejected for invalid information

When the status code points to a party on the claim, the payer also sends an entity code. That code is the part that tells you where to look.

“Additional information requested from entity. Usage: This code requires use of an Entity Code.”

Many clearinghouse reports print the full status code description, so the rejection often reads like the heading above. The sentence before “Usage” describes the problem. The “Usage” note comes from the code list itself: it means this status code is only complete when an entity code is sent with it, naming the party the problem belongs to. If your report shows only the message and no entity code, open the raw 277CA (the STC segment) or ask your clearinghouse for it. Without the entity code you are guessing which part of the claim to fix. The wording of every status code is published in the X12 Claim Status Codes list (opens in a new tab), and the category codes (A3, A6, A7) in the X12 Claim Status Category Codes list (opens in a new tab).

Common entity codes and what to check

Entity code	Who it is	What to check first
85	Billing provider	Group NPI, tax ID, taxonomy, a physical address (not a PO box) and the 9-digit ZIP
82	Rendering provider	Individual NPI and whether that provider is enrolled with the payer under your group
87	Pay-to provider	Pay-to address and whether it differs from the billing address
77	Service location	Facility name, address and 9-digit ZIP
DN	Referring provider	Referring NPI and name, when the payer requires a referral
IL	Insured or subscriber	Member ID, name spelling, date of birth and relationship to the patient
QC	Patient	Patient name and date of birth, exactly as the payer has them
PR	Payer	Payer ID in your clearinghouse’s current payer list
41	Submitter	Your EDI enrollment and submitter ID with the clearinghouse or payer

How to fix it

1. Open the 277CA or the clearinghouse rejection report and write down the status category, status code and entity code.
2. Match the entity code to the part of the claim it points to, using the table above.
3. Check the data against its source: the NPPES NPI Registry (opens in a new tab) for NPIs and taxonomy, the payer’s enrollment records for providers, and an eligibility check for patient and subscriber details.
4. Correct it in your practice management system itself, not only on this one claim, or the next claim will fail the same way.
5. Resubmit it as a new original claim. The payer never accepted the rejected one, so a corrected claim or an appeal is the wrong tool here.

Keep an eye on timely filing while you fix it. In most cases a rejected claim does not count as received, so the filing deadline keeps running.

X12 has also answered a formal question about which entity codes belong on a 277CA: see X12 RFI 1751 (opens in a new tab). Medicare contractors publish their own lookup tools for 277CA edits, such as the CGS 277CA edit lookup (opens in a new tab).

How to stop it happening again

• Keep provider NPIs, taxonomy codes and addresses in one place and update them whenever something changes.
• Finish EDI enrollment before sending the first claim to a new payer.
• Run eligibility checks before visits, so member IDs and names match.
• Work clearinghouse rejections every day. They are the cheapest problems to fix.

Our claims management and eligibility verification services catch most of these before the claim is sent.

Other common 277CA rejections

Entity codes come with many status codes. Our 277CA guide explains how to read the whole acknowledgment, and these guides cover the most common rejections: NPI (562), tax ID (128), taxonomy (145), subscriber not found (33), incorrect payer (116) and submitter not approved (496).