Knowledgebase: Claim Rejections
Payer Claim Control Number
Posted by Will Morrow, Last modified by Charmagne Williams on 25 May 2017 08:30 AM
Rejection: Acknowledgement/Returned as unprocessable claim | Payer Assigned Claim Control Number~MSG: H25390 The 'Payer Claim Control Number' was not found but was expected because the 'Claim Submission Reason Code' (CLM05-3) is 7 or 8.

What happened: UB04: The last digit in the type of bill (box 4) is either a 7 or 8, therefore the original claim number from the payer needs to be sent in box 64.

HCFA: 7 or 8 was sent as the resubmission code in box 22, but the original claim number was not sent in the Orig. Ref. No. box of box 22.

Resolution: UB04: User needs to either update box 64 with the payer's original claim number, or change the last digit of box 4 to something other than 7 or 8.

HCFA: Need to either add the original claim number in box 22 or remove the 7 or 8 from box 22.