Knowledgebase: Claim Rejections
Subscriber not eligible for DOS
Posted by Will Morrow, Last modified by Charmagne Williams on 25 May 2017 08:37 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 medical benefits for submitted dates of service.

What happened: Based on the patient information the claim, the patient was not eligible for benefits on the date 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. If this has been verified, please obtain proof of the patient's eligibility from the payer and contact Customer Service at 360-975-7000 option 1.