Ever wondered what an entity code really means in billing? Discover its role, types, and why getting it right is crucial for faster reimbursements and fewer claim denials.

1. ENTITY CODE
IN MEDICAL
BILLING
By I-MED CLAIMS LLC

2. 1
An entity refers to a
provider, patient, or billing
company involved in the
claim.
2 3
4
WHAT IS AN ENTITY CODE
IN MEDICAL BILLING?
Entity Code identifies
which party is responsible
for specific portions of a
medical bill.
Accurate entity coding
ensures correct claim
submission and proper
reimbursement.
Accurate entity coding
ensures correct claim
submission and proper
reimbursement.

3. IMPORTANCE OF USING CORRECT
ENTITY CODES
• Ensures each stakeholder is correctly identified (provider, payor,
subscriber, dependent).
• Prevents overpayments, underpayments, or claim disputes.
• Enhances revenue cycle efficiency by reducing claim errors.
• Supports compliance with Medicare, Medicaid, and insurance
guidelines.

4. COMMON ERRORS &
DENIAL REASONS
• Incorrect or missing entity codes lead to claim
rejections.
• These errors cause resubmission delays, appeal
issues, and revenue loss.
Frequent issues:
• Incorrect NPI or Tax ID (CMS-1500 Box 33)
• HICN mismatches
• Wrong or outdated Member ID
• Missing patient or provider info
• Invalid ZIP code

5. • Regularly update entity code data in
your system.
• Cross-check codes with HICNs, NPIs,
and insurance data.
• Use billing software that validates
codes before submission.
• Provide ongoing training for staff on
coding and documentation accuracy.
• Consider outsourcing to experts like I-
Med Claims to reduce errors and
improve reimbursements.
How to Prevent Entity Code Errors

6. THANK YOU
You can read more about this on the blog publised by
I-Med Claims Link is provided below
Link: https://imedclaims.com/what-is-an-entity-code-
in-medical-billing/