Knowledgebase: Claim Rejections
Aetna 60054 - Subscriber not eligible for benefits
Posted by Will Morrow, Last modified by Charmagne Williams on 11 May 2017 10:55 AM
Rejection: Acknowledgement Returned as unprocessable claim-The claim encounter has been rejected and has not been entered into the adjudication system. Subscriber not eligible for benefits for submitted dates of service.

What happened: Based on the patient information listed on the claim, the patient was not eligible for benefits on the date(s) of service.

Resolution: Verify insured ID, patient name, and date of birth, as well as verify if they are the primary insured or a dependent (see attached picture below).

 all insured info.jpg (67.17 KB)