CARC 207 Active

PR-207: National Provider Identifier - Invalid Format

TL;DR

Patient charges for an NPI format error are incorrect. Correct the NPI and request reprocessing.

Action
Review & Decide
Who Pays
Patient
Appeal
No
Patient Impact
Direct Financial
Disclaimer
This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues.

What Does PR-207 Mean?

With PR (Patient Responsibility), the patient was assigned charges due to an invalid NPI format. This is incorrect — NPI format errors are provider data issues. Correct the NPI and request reprocessing.

CARC 207 indicates that the NPI submitted on the claim does not conform to the required format. A valid NPI must be exactly 10 numeric digits and must pass the Luhn algorithm check digit validation. This denial occurs when the NPI contains letters, special characters, or spaces, when it has too few or too many digits, when it fails the check digit validation, or when a legacy provider number was entered in the NPI field.

This is a data entry or system configuration error, not a coverage denial. The fix is to correct the NPI to the proper format and resubmit.

How to Resolve

  1. Correct the NPI and resubmit Fix the format error and request the patient charges be reversed.
Do Not Appeal This Code

The NPI on the claim has an invalid format. This is a data entry error. Correct the NPI to the proper 10-digit numeric format and resubmit the claim.

How to Prevent PR-207

Also Filed As

The same CARC 207 may appear with different Group Codes:

CO-207 OA-207

Related Denial Codes

PR-16 — Missing Information or Billing Error PR-146 — Diagnosis Invalid for Date of Service PR-148 — Information from Another Provider Not Provided or Incomplete PR-175 — Prescription Is Incomplete PR-181 — Procedure Code Invalid on Date of Service

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.mdclarity.com/denial-code/207
  3. https://med.noridianmedicare.com/web/jeb/topics/claim-submission/reason-code-guidance/missing-incorrect-req-npi-info
  4. Codes maintained by X12. Visit x12.org for official definitions.