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N254 Remark Code: Attending Provider Secondary ID

N254 means the payer rejected the attending provider's secondary identifier. That is an additional ID beyond the NPI, such as a state license number or a payer-assigned provider number, which was absent, wrongly qualified, or not recognized.

Quick facts

Code
N254 (RARC N254)
Status
Active In use since December 2, 2004.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The facility must supply or correct the identifier. The amount is not the patient's responsibility.
Official description
Missing/incomplete/invalid attending provider secondary identifier.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N254 means

The attending provider is the clinician responsible for a patient’s facility care, and the NPI is that person’s primary identifier. Some payers also want a second number: a state license, a Medicaid provider number, or an ID the payer assigned when the physician enrolled. On the UB-04 that value goes in form locator 76 beside a qualifier; electronically it travels as a reference identifier with the attending provider.

N254 says that second number was missing, did not fit the payer’s format, or did not match its records. It is a data correction, typically paired with CARC 16, not a judgment about the care.

Where secondary IDs go wrong

  • Payer-specific requirement not configured. Your system sends only the NPI to every payer, but this payer’s companion guide requires a license or proprietary ID too.
  • Wrong qualifier. A license number was sent labeled as a payer-assigned ID, or the qualifier was left empty.
  • Stale number. The physician’s state license was renewed with a new number, or the payer reissued its provider ID.
  • Number from a different state. A physician licensed in several states had the license from the wrong state reported.

What to do

  1. Read the payer’s companion guide or provider manual to learn exactly which secondary identifier it wants for attending physicians and which qualifier to use.
  2. Collect the correct number from the physician’s credentialing file or the payer’s enrollment confirmation.
  3. Enter the identifier and qualifier in the attending provider setup for that payer only, so other payers do not receive an unwanted value.
  4. Resubmit as a corrected claim (frequency code 7) referencing the original claim number.
  5. If you believe the number already matched, call provider services and ask which value they have on file.

How to prevent it

Store secondary identifiers per payer, with an effective date, in your provider master. When a license renews or a payer revalidates enrollment, update the record the same week. Our overview of CARC and RARC pairings shows how to trend remarks like N254 by payer so a recurring requirement is caught once, not claim by claim.

Codes that may appear with N254

  • CO-16 (Claim/service lacks information or has submission/billing error(s).): Submission error; N254 identifies the attending provider's secondary ID as the missing or invalid element.
  • N253 (Missing/incomplete/invalid attending provider primary identifier.): Concerns the attending provider's primary identifier (NPI).
  • N259 (Missing/incomplete/invalid billing provider/supplier secondary identifier.): The same kind of secondary-ID problem, but for the billing provider.
  • N263 (Missing/incomplete/invalid operating provider secondary identifier.): The secondary-ID problem for the operating provider on a surgical claim.
  • N433 (Resubmit this claim using only your National Provider Identifier (NPI).): Tells you to resubmit using only the NPI, the opposite instruction from N254.

N254 FAQ

Aren't secondary identifiers obsolete now that everyone has an NPI?

For most Medicare claims, yes. But some Medicaid programs, workers' compensation carriers, and other payers still ask for a license number or proprietary provider ID next to the NPI.

What is the qualifier for?

The qualifier tells the payer what kind of number follows, for example a state license or a payer-specific provider number. The right number with the wrong qualifier can still trigger N254.

Should I just delete the secondary ID?

Only if the payer does not require one. Removing it when it is required will not fix N254; check the payer's companion guide first.