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8Accounting
3Claim Attachments
580Claim Rejections
4Credit Card Processing
2Data Import
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1Easy Print
3EHR 24/7
Labs and Radiology (Coming Soon)
1Maintenance
55Meaningful Use (ARRA)
6Office Ally (Online Entry)
4Patient Ally
9Practice Mate
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Release Notes
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Knowledgebase : Claim Rejections
Below are the most common ICD-9 and ICD-10 Office Ally claim
rejections.
Instructions for using the Office Ally code search: Practice Mate [1]
or Service Center [2]
REJECTION: Date of Service FROM and TO dates cannot span 10/1/2015.
Before 10/1 mus...
REJECTION: Accident Date cannot be in the future. (FP05)
WHAT HAPPENED: Accident date in box 15 or the Additional Fields is a
future date.
RESOLUTION: Update the accident date to a date that is not in the
future (Additional Fields under box 25, see atta...
REJECTION: Accommodation rate must be included for all Accommodation
revenue codes (100 - 219) (FE75)
WHAT HAPPENED: When the Rev Code in box 42 falls between 100-219, the
rate must be sent in box 44.
RESOLUTION: Verify the Rev Code used in box 42 and u...
REJECTION: Diagnosis code reference, on line (will be specified) is
invalid.
WHAT HAPPENED: The diagnosis code pointer in box 24e of the line
specified is pointing to a position in box 21 where there is no
diagnosis code.
RESOLUTION: Verify the diagnos...
REJECTION: Diagnosis Codes must not contain gaps (LC171)
WHAT HAPPENED: In box 21, there's a gap between 2 of the diagnosis
codes.
RESOLUTION: Need to move the diagnosis codes so there are no gaps
between the codes. If no gaps are present, please contac...
REJECTION: Element SV111 is used. It should not be used when claim is
not for Medicaid. Segment SV1 is defined in the guideline at position
3700. This error was detected at: Segment Count: 26 Element Count: 11
C
WHAT HAPPENED: Info was sent in box 24h.
...
REJECTION: Invalid Facility NPI Format (Box 32A) (RC81)
WHAT HAPPENED: The information in box 32a does not meet the criteria
of being 10 digits in length.
RESOLUTION: Verify the information in box 32a and update the claim as
necessary.
REJECTION: Modifier __, on line __ is invalid.
WHAT HAPPENED: The specified modifier in box 24d on the listed
line is invalid.
RESOLUTION: Verify the modifier in box 24d and update the claim as
necessary.
REJECTION: Invalid Supervising Physician NPI Format (RC83)
WHAT HAPPENED: An NPI was sent that did not fit the format of 10
digits in additional fields section under box 25.
RESOLUTION: The number of digits may look correct on the claim image,
so check ...
REJECTION: Subscr: (AZBlue) Claim failed Pre-Membership Validation
WHAT HAPPENED: The incorrect group number was sent in box 11.
RESOLUTION: Need to verify the patient ID card and update the claim
as necessary.
REJECTION: (HEW) This claim is a duplicate of a claim or part of a
claim submitted on
WHAT HAPPENED: Payer is stating that this is a duplicate claim on
their end.
RESOLUTION: Claim has already been sent to the payer. If this is
supposed to be a correc...
REJECTION: 01 - INVALID MBR DOB
WHAT HAPPENED: Patient date of birth in box 3 is not what the payer
has on file.
RESOLUTION: Double check the insured ID card and verify the date of
birth.
REJECTION: 24.(A) DATE(S) OF SERVICE From (Invalid Type / Missing
Value) (RC23)
WHAT HAPPENED: No date of service was sent in box 24a.
RESOLUTION: Need to add date of service in box 24a and update the
claim.
REJECTION: 24.(B)(1) Place of Service (Invalid Type / Missing Value)
(RC24)
WHAT HAPPENED: No place of service was sent in box 24b on the inbound
file.
RESOLUTION: We automatically make the place of service '11' when we
receive box 24b blank. If place o...
REJECTION: 24.(D)(1) CPT/HCPCS (Invalid Type / Missing Value) (RC25)
WHAT HAPPENED: No CPT code was sent in box 24d.
RESOLUTION: Need to add CPT code in box 24d and update the claim.
REJECTION: 24.(F)(1) $ CHARGES (Invalid Type / Missing Value) (RC27)
WHAT HAPPENED: No charges were sent in box 24f.
RESOLUTION: Need to add charges in box 24f and update the claim.
REJECTION: 24.(G)(1) DAYS OR UNITS (Invalid Type / Missing Value)
(RC28)
WHAT HAPPENED: Box 24g is either missing days/units or contains an
invalid number.
RESOLUTION: Need to add/correct the units in box 24g and update the
claim.
REJECTION: 24J - Rendering ID (Invalid Type / Missing Value) (RC30)
WHAT HAPPENED: No NPI/Provider ID was sent in box 24j.
RESOLUTION: Need to add NPI/Provider ID in box 24j and update the
claim.
REJECTION: 3. PATIENT BIRTH DATE (Invalid Type / Missing Value) (RC21)
WHAT HAPPENED: A valid date was not sent in box 3.
RESOLUTION: Verify date of birth and put a valid date in box 3.
REJECTION: Secondary Claims Submission Unsupported for this Payer
(FE213)
WHAT HAPPENED: An electronic secondary claim was attempted to be sent
to a payer we cannot send secondary claims to yet.
RESOLUTION: Send by paper or wait until we send to this pa...
REJECTION: Claim contains more than 8 diagnosis codes - Payer is not
yet accepting over 8 diagnosis codes. (RC149)
WHAT HAPPENED: More than 8 diagnosis codes were sent on the inbound
file.
RESOLUTION: Though the claim form only shows 8 diagnosis codes, ...
REJECTION: ACKNOWLEDGEMENT/RETURNED AS UNPROCESSABLE CLAIM IF THE
SELECTED CONDITION CODE IS RELATED TO AN ACCIDENT, AN ACCIDENT DATE
MUST ALSO BE PROVIDED.
Missing or invalid information. IF THE SELECTED CONDITION CODE IS
RELATED TO AN ACCIDENT, AN ACC...
REJECTION: Accident Date Required on Accidents and Workers Comp Claims
(FE134)
WHAT HAPPENED: Information was sent in box 10, an accident date was
not sent (box 15 / Additional Fields) or claim was sent to a work comp
payer and accident date was not sent...
REJECTION:PAYER RESPONSE: SERVICE UNIT COUNT- REQUIRED; MUST BE
ENTERED FOR SERVICE LINE REVENUE CODE
PAYER RESPONSE: ACCOMMODATIONS SERVICE LINE- REQUIRED; MUST BE ENTERED
ON INPATIENT CLAIMS
WHAT HAPPENED: This claim is rejecting because the provide...
REJECTION: Billing Provider City,State,Zip Invalid (1896)
WHAT HAPPENED: There is an incorrect city/state/zip combination in box
48.
RESOLUTION: Verify the information in box 48 and update the claim.
REJECTION: Invalid Billing Provider NPI (1872)
WHAT HAPPENED: The NPI in box 49 is not valid.
RESOLUTION: Verify the NPI in box 49 and update the claim as
necessary.
REJECTION: Invalid Billing Provider State License (1891)
WHAT HAPPENED: An incorrect billing provider state license number was
sent in box 50. A number is required.
RESOLUTION: Verify the information in box 50 and update as necessary.
REJECTION: Invalid Billing Provider TaxId (1877) (DE105)
WHAT HAPPENED: Tax ID in box 51 is not a valid tax ID.
RESOLUTION: Verify the number in box 51and update the claim as
necessary (see attached picture below).
REJECTION: Invalid PayTo Provider NPI (1876) (DE104)
WHAT HAPPENED: Pay-To NPI in the inbound file is not correct.
RESOLUTION: Need to update in billing software to send correct NPI.
REJECTION: Invalid Referring Provider NPI (1874)
WHAT HAPPENED: Referring NPI in the inbound file is not correct.
RESOLUTION: Need to make update in billing software to send correct
NPI.
REJECTION: Leave Date Of Service Blank for PreDetermination Claims
(2068)
WHAT HAPPENED: Box 1 was marked as Request for
Predetermination/Preauthorization so a date of service cannot be sent.
RESOLUTION: Need to either update box 1 or remove the date of...
REJECTION: Rendering Provider City,State,Zip Invalid (1897)
WHAT HAPPENED: There is an incorrect city/state/zip combination in box
56.
RESOLUTION: Verify the information in box 56 and update the claim.
REJECTION: Subscriber City,State,Zip Invalid (1899)
WHAT HAPPENED: There is an incorrect city/state/zip combination in box
12.
RESOLUTION: Verify the information in box 12 and update the claim.
REJECTION: SubscriberId and Plan-Group Can Not be The Same (2075)
WHAT HAPPENED: The information in box 15 and box 16 was the same and
it cannot be.
RESOLUTION: Need to verify the the insured ID and the group number
and update the claim as necessary.
REJECTION: Tooth Number Letter Invalid (2079)
WHAT HAPPENED: One of the tooth letters in box 27 is not valid.
RESOLUTION: Verify the information in box 27 and update the claims as
necessary.
REJECTION: Adjustment Amount (CAS03,06,09,12,15,18) - Cannot be zero
dollars. (FE366)
WHAT HAPPENED: One of the group codes at the bottom of the claim had a
zero dollar charge.
RESOLUTION: If there is not going to be a charge, a group code does
not need...
REJECTION: Admission Date required for this Type of Bill (FE124)
WHAT HAPPENED: Type of bill in box 4 (UB) is for inpatient services
but the admission date was not sent in box 12; or the place of service
in box 24b (HCFA) requires an admission date to be...
REJECTION: Acknowledgement Returned as unprocessable claim-The claim
encounter has been rejected and has not been entered into the
adjudication system. Billing Provider National Provider Identifier
(NPI).
WHAT HAPPENED: A valid NPI was not sent.
RESOLUT...
REJECTION: Acknowledgement Returned as unprocessable claim-The claim
encounter has been rejected and has not been entered into the
adjudication system. Processed according to contract provisions
(Contract refers to provisions that exist between the Health...
REJECTION: Acknowledgement Returned as unprocessable claim-The claim
encounter has been rejected and has not been entered into the
adjudication system. Dependent not eligible.
WHAT HAPPENED: Based on the patient information listed on the claim,
the patie...
REJECTION: ~Acknowledgement/Returned as unprocessable claim | Entity
not eligible.
WHAT HAPPENED: Based on the patient information the claim, the patient
was not eligible for benefits on the date(s) of service.
RESOLUTION: Verify insured ID, patient nam...
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 patie...
REJECTION: Acknowledgement Returned as unprocessable claim-The claim
encounter has been rejected and has not been entered into the
adjudication system. Subscriber Policy canceled.
WHAT HAPPENED: Based on the patient information listed on the claim,
the p...
REJECTION: 24d. PROCEDURE CODE INVALID UNKNOWN
WHAT HAPPENED: This is a rejection most likely for the X-codes. We
need to be update our system with which certain codes each payer will
accept.
RESOLUTION: Please contact our customer service department
(...
REJECTION: Provider not enrolled for EDI. Please contact Anet
Quiambao at 510-747-6153 or aquiambao@alamedaalliance.org to join
Alameda Alliance`s EDI network.
WHAT HAPPENED: Information needs to be updated at the payers end.
RESOLUTION: If the followin...
REJECTION: Acknowledgement Rejected for Invalid Information - The
claim encounter has invalid information as specified in the Status
details and has been rejected. Future date.
WHAT HAPPENED: A date(s) on the claim was in the future. There should
be anot...
REJECTION: Acknowledgement Rejected for Invalid Information - The
claim encounter has invalid information as specified in the Status
details and has been rejected. Submitted charges.
WHAT HAPPENED: This will vary from payer to payer.
RESOLUTION: See the...
REJECTION: ~Acknowledgement/Returned as unprocessable claim | Line
information.~Acknowledgement/Rejected for Missing Information |
Allowable/paid from other entities coverage NOTE: This code requires
the use of an entity code.~MSG: HB0117
WHAT HAPPENED:...
REJECTION: Rejected - Unprocessable Claim Billing Provider FedID not
found in Our System. FedID:
WHAT HAPPENED: Payer requires pre-enrollment to be done before sending
electronically. Pre-enrollment has not yet been completed.
RESOLUTION: Need to fax in...
REJECTION: Payer Specific Edit: Ambulance Drop-off Location is
required on ambulance claims. (FE379)
WHAT HAPPENED: Ambulance drop off is required.
RESOLUTION: This information can be sent in box 19 in the following
format:
AMBD;NAME;ADDRESS1;ADDRESS2...
REJECTION: Ambulance dropoff address state code invalid (FE446)
WHAT HAPPENED: The city/state/zip combination in the ambulance dropoff
field in the additional fields section under box 25 is not correct.
RESOLUTION: Verify the city/state/zip is present a...
REJECTION: Ambulance dropoff address ZipCode - Invalid or not valid in
state (FE448)
WHAT HAPPENED: The city/state/zip combination in the ambulance dropoff
field in the additional fields section under box 25 is not correct.
RESOLUTION: Verify the city/s...
REJECTION: Ambulance Dropoff Invalid
AMBD;Name;Addr1;Addr2;City;State;Zip (FE370)
WHAT HAPPENED: Drop-off information was not sent correctly.
RESOLUTION: If the information was sent in box 19, the format needs to
follow the above format. If it was sent ...
REJECTION: Payer Specific Edit: Ambulance Pick-up Location is required
on ambulance claims. (FE378)
WHAT HAPPENED: The pick-up information was not sent.
RESOLUTION: Pick-up information can be picked up from what is in box
32. Update the address in box 3...
REJECTION: Ambulance PickUp Location Invalid
AMBP;Name;Addr1;Addr2;City;State;Zip (FE371)
WHAT HAPPENED: The ambulance pick up information in the Additional
Fields section is invalid.
RESOLUTION: Verify the ambulance pick up information in the Additiona...
REJECTION: Contact Clearinghouse Support Services
WHAT HAPPENED: Claim failed for a reason that needs to be discussed
directly at the payer.
RESOLUTION: Need to contact our customer support department
(360-975-7000 opt 1) so they can give you the refer...
REJECTION: Incorrect Address
WHAT HAPPENED: The billing provider address was not sent EXACTLY as it
is on file.
RESOLUTION: Need to verify the exact address the payer has on file for
the billing provider, including any suite numbers, and resend the
cla...
REJECTION: Entitys commercial provider id.
WHAT HAPPENED: The rendering provider's taxonomy code was not sent.
RESOLUTION: Need to add the rendering provider's taxonomy code (see
attached picture below) and resend the claim.
REJECTION: The Amount Paid (2430/SVD-02) should not exceed the Amount
Approved (2400/AMT-01=AAE). (FE350)
WHAT HAPPENED: The primary amount paid amount is more than the allowed
amount.
RESOLUTION: A payer cannot pay more than they allow. Need to double
...
REJECTION: Anesthesia CPT must have MJ measurement code or Start/Stop
times in line comments (RC172)
WHAT HAPPENED: The wrong unit qualifier in loop 2400, SV103 was sent
for the anesthesia CPT code used in box 24d.
RESOLUTION: The unit qualifier in loop...
REJECTION: Clm: The Diagnosis Code XXXX has been used more than once.
WHAT HAPPENED: One of the diagnosis codes were sent more than once.
Error message will specify the code in question.
RESOLUTION: Remove the duplicate diagnosis code and resubmit.
REJECTION: ACKNOWLEDGEMENT/RETURNED AS UNPROCESSABLE CLAIM The
required field TS837Q1_2310D_NM104__SupervisingProviderFirstName in
the TS837Q1_2310D_NM1_SupervisingProviderName record was not found in
the inbound document. -- Not editable.
WHAT HAPPENED...
REJECTION: Missing/Invalid Attachment Control Number (AT003)
WHAT HAPPENED: Attachment Control Number in the Additional Fields
section is either incorrect or missing.
RESOLUTION: Attachment Control Number is a required field. Verify the
information in t...
REJECTION: Missing/Invalid Attachment Report Type Code (AT001)
WHAT HAPPENED: Attachment Report Type Code in the Additional Fields
section is either incorrect or missing.
RESOLUTION: The Attachment Report Type Code is a required field.
Verify the inform...
REJECTION: Missing/Invalid Attachment Transmission Code (AT002)
WHAT HAPPENED: Attachment Transmission Code in the Additional Fields
section is either incorrect or missing.
RESOLUTION: Attachment Transmission Code is a required field. Verify
the informa...
REJECTION: ATTENDING PROVIDER NAME IS INVALID (NOT OTHER)
WHAT HAPPENED: The rendering provider was not sent.
RESOLUTION: Need to add the rendering provider and resend the claim.
REJECTION: Auto Accident State (Invalid Type / Missing Value) (FE334)
WHAT HAPPENED: State not sent in box 10b.
RESOLUTION: When marking box 10b as 'yes' a state is required to be
sent. Update the claim as necessary.
REJECTION: Service Dates Spanning 01/01/2012 Must Be Sent On Separate
Claims. (FE365)
WHAT HAPPENED: Dates from 2011 and 2012 were sent in box 24.
RESOLUTION: This payer does not accept dates that span 2011-2012, need
to bill the dates on separate claim...
REJECTION: Bad Address, returned to Office Ally by Post Office. Please
check the insurance mailing address on file and resubmit
WHAT HAPPENED: This claim was sent by paper but returned due to an
invalid address.
RESOLUTION: Needs a valid address on the...
REJECTION: IDENTIFICATION CODE SHOULD NOT BE USED IN SERVICE FACILITY
LOCATION NAME.
WHAT HAPPENED: The facility NPI and the billing NPI were the same.
RESOLUTION: An edit has been put in place to not send the facility
loop when the facility NPI is the...
REJECTION: 60072 InvalidData: Location: 2010AA - NM109 Subscr: HIPAA
Mandates use of NPI for NPI eligible providers. Provide NPI in 2010AA
NM109 and refile.
WHAT HAPPENED: NPI is missing from box 33a.
RESOLUTION: Add NPI in box 33a and resubmit.
REJECTION: Segment PER (Service Facility Contact Information) is used.
It is not expected to be used when segment REF (Property and Casualty
Claim Number) is not used. Segment PER is defined in the guideline at
position 2750.
WHAT HAPPENED: The PER segme...
REJECTION: 41253 InvalidData: 33 Location: 2300 - CLM05-01 Clm: The
Facility code 33 (Loop 2300, CLM05.01) was not valid as of transaction
date 20131002.
WHAT HAPPENED: National Uniform Billing Committee (NUBC) has decided
to discontinue the use of type ...
REJECTION: ~Acknowledgement/Rejected for Invalid Information |
Entity's health industry id number. | Invalid character. Note: At
least one other status code is required to identify the data element
in error.~Acknowledgement/Returned as unprocessable claim...
REJECTION: Svc: The EPSDT Indicator (Loop 2400, SV111) is only
required when applicable for Medicaid claims, otherwise, do not send.
WHAT HAPPENED: Information was sent in box 24h.
RESOLUTION: Box 24h needs to be blank unless it's a Medicaid claim and
M...
REJECTION: 60111 InvalidData: Location: 2400 - SE00 Clm: If one
Service Line (Loop 2400 SV1) contains a GY modifier, then all Service
Lines must contain a GY mod fier.
WHAT HAPPENED: At least 1 line item contained the GY modifier, but it
was not sent fo...
REJECTION: 60001 InvalidData: Location: 2010BA - NM109 Clm: Member ID
(Loop 2010BA, NM109) is invalid.
WHAT HAPPENED: The patient ID does not match the other patient info on
the claim.
RESOLUTION: Verify insured ID, patient name, and date of birth, as
...
REJECTION: Rejected - Unprocessable Claim SUB-ELEMENT SV101-04 IS
USED. IT IS NOT EXPECTED TO BE USED WHEN SUB-ELEMENT SV101-03 IS NOT
USED. SEGMENT SV1 IS DEFINED IN THE GUIDELINE AT POSITION
3700.{BR}{BR}THIS ERROR WAS DETECTED AT|{BR}{TAB}SEGMENT COUNT...
REJECTION: Rejected - Unprocessable Claim Submit to local plan where
specimen was drawn
WHAT HAPPENED: Claim was not sent to the correct state.
RESOLUTION: This is one of the few cases where claims should not be
sent to the local BCBS. Needs to be sent...
REJECTION: ~Acknowledgement/Returned as unprocessable claim | Missing
or invalid information. | Subscriber and policy number/contract number
not found.
WHAT HAPPENED: The patient ID does not match the other patient info on
the claim.
RESOLUTION: Verify...
REJECTION: Value of element NM109 is incorrect. It should be different
from value of element SBR03. Segment NM1 is defined in the guideline
at position 0150.
WHAT HAPPENED: The information in box 1a is the same as 11.
RESOLUTION: Insured ID and group n...
REJECTION: 2010BA:NM104 Subscriber First Name Cannot Be Validated
WHAT HAPPENED: Did not send in the correct patient first name.
RESOLUTION: Needs to verify the paitent's insured ID card and call the
payer if necessary.
REJECTION: Clm: (AZBlue) Future dates not allowed. Please correct and
resubmit
WHAT HAPPENED: One of the dates on claim is in the future.
RESOLUTION: Verify all dates on the claim and update as necessary.
REJECTION: Svc: (AZBlue) Resubmit with description of
unclassified/unlisted procedure.
WHAT HAPPENED: At least one of the CPT codes needs a line item note.
RESOLUTION: Normally this has to do with J-codes. It is best to verify
with the payer on the CPT...
REJECTION: Svc: The Initial Treatment Date (2400, DTP01=454) is only
required when different than the information at the claim level.
Otherwise, do not send.
Svc: The Last X-Ray Date (2400, DTP01=455) is only required when
different than the information...
REJECTION: CONTRACT NOT EFFECTIVE FOR SERVICE DATE
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 v...
REJECTION: NO COVERAGE LOCATED ON MEMBERSHIP
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 ...
REJECTION: 043:Billing provider Tax ID/EIN submitted does not match
BCBSF files. Correct and resubmit the claim or complete and submit the
form located at
http://www.bcbsfl.com/DocumentLibrary/Providers/Content/ProviderInformationUpdateForm.pdf
[1] to upd...
REJECTION: 040:Billing Provider Number is not found. Please correct
and resubmit electronically.
WHAT HAPPENED: NPI in box 33a is not on file at the payer.
RESOLUTION: Verify the NPI in box 33a and update at the payer if
necessary. To verify provider ...
REJECTION: 91077: Claim submitted without Medicare adjudication
information; Medicare must process this claim first.
WHAT HAPPENED: Medicare is the primary payer and was not identified as
the primary payer on the claim.
RESOLUTION: If this is a primary...
REJECTION: 90496: Medicare Report Number is required.
WHAT HAPPENED: The claim is failing because they were expecting other
payer claim control number, the Medicare claim number (ICN) (loop
2330B REF*F8).
RESOLUTION: Add the Medicare claim ID in box 2...
REJECTION: 030:The member number cannot be found. Please verify using
the ID card and resubmit electronically including the alpha prefix.
For assistance, call the 800 number on the card or BCBSF (800)
727-2227.
WHAT HAPPENED: According to the informatio...
REJECTION: 031:member number and date of birth do not match. Please
verify and resubmit electronically. For assistance, call the 800
number on the card or BCBSF (800) 727-2227.
WHAT HAPPENED: Date of birth on the claim does not match the other
patient in...
REJECTION: Location: 2400 - DTP03 Svc: Date of Service (Loop 2400,
DTP03) can not be a future date.
WHAT HAPPENED: The date of service that was sent was a future date.
RESOLUTION: Usually our system catches this, but date of service needs
to be updated ...
REJECTION: Payer Specific Edit: Initial Treatment Date cannot be sent
on the claim and line level. (FE397)
WHAT HAPPENED: The date of intial treatment was sent in both the 2300
and 2400 loops.
RESOLUTION: Need to update the software to only send those s...
REJECTION: Value of element NM108 is incorrect. Expected value is XX
for covered providers when National Provider ID is mandated for use.
Segment NM1 is defined in the guideline at position 0150.
WHAT HAPPENED: An NPI number was required, but not sent.
...
REJECTION: Value of element DTP03 (Service Date) is incorrect. Value
for date or start period date is expected to be a date earlier than
the Transaction Creation Date. Segment DTP is defined in the guideline
at position 4550.
WHAT HAPPENED: The date of ...
REJECTION: ~Acknowledgement / Rejected for relational field in error.
| Date of the last x-ray. | Patient Reason for Visit
WHAT HAPPENED: We are not creating the CR208 segment based off the
letter in box 10d. If you have questions on the patient conditi...
REJECTION: CLAIM IS LEGACY, PLEASE FILE HARDCOPY
WHAT HAPPENED: Member ID is no longer valid.
RESOLUTION: Patient will need to get a copy of the new patient ID (see
attached picture below).
REJECTION: N70005 Member Identification Number is not formatted
correctly.
WHAT HAPPENED: The insured ID in box 1a is not valid.
RESOLUTION: Verify insured ID, patient name, and date of birth, as
well as verify if they are the primary insured or a depen...
REJECTION: Rejected - Unprocessable Claim N70004 Submitter is not
authorized to submit on behalf of Billing Provider.
WHAT HAPPENED: Not set up at the payer's end to send electronically
through Office Ally.
RESOLUTION: Need to do pre-enrollment and cal...
REJECTION: A3 164 P615 CONTRACT ALPHA PREFIX IS REQUIRED
WHAT HAPPENED: There are a few possibilities:
* 1: The insured ID in box 1a did not contain the alpha prefix from
the subscriber ID.
* 2: The patient is a member of the _Federal Employee Plan...
REJECTION: A3 164 P445 CONTRACT IS MEDICARE ADV AND SOP IS BL
WHAT HAPPENED: A qualifier other than _"MB" _was sent in loop 2000B
SBR09.
RESOLUTION: Depending on the submission method, the resolution will
vary:
Office Ally Online Entry, Practice Mate/E...
REJECTION: Category: Acknowledgement/Returned as unprocessable claim
The Claim/Encounter has been rejected and has not been entered into
the adjudication system Status: Entity's National Provider Identifier
(NPI) Entity: Billing Provider
WHAT HAPPENED: ...
REJECTION: Category: Acknowledgement/Rejected for Missing Information
The Claim/Encounter is missing information specified in the Status
details and has been rejected Status: Claim Adjustment Indicator
Entity: Billing Provider
Category: Acknowledgement/...
REJECTION: Member ID must be valid. (Valid ID is an exact
representation of that on the membership ID card).
WHAT HAPPENED: Based on the patient information the claim, the patient
ID is not correct.
RESOLUTION: Double check the patient's insured ID card...
REJECTION: Member id prefix not valid for DOS.
WHAT HAPPENED: Based on the patient information the claim, the patient
ID prefix is not correct.
RESOLUTION: Double check the patient's insured ID card and then call
payer if needed to verify information.
REJECTION: PROVIDER NUMBER NOT AUTHORIZED
WHAT HAPPENED: According to the payer, pre enrollment has not been
done on their side.
RESOLUTION: Need to contact the payer: 888-333-8594 to verify why the
pre-enrollment is not done on their side if the paperw...
REJECTION: Service Date cannot be greater than current date.
WHAT HAPPENED: The date of service sent was a future date.
RESOLUTION: Usually our system catches this, need to update the date
of service so its not a future date.
REJECTION: Units must be greater than one (1) when a Modifier of 50 is
entered.
WHAT HAPPENED: In box 24d, one of the modifiers sent was 50, but the
units in box 24g were only 1.
RESOLUTION: According to the payer, the modifier of 50 requires a unit
gr...
REJECTION: ACK/REJECT INVAL INFO - SUBSCRIBER AND SUBSCRIBER ID NOT
FOUND.
WHAT HAPPENED: The patient ID does not match the other patient info on
the claim.
RESOLUTION: Verify insured ID, patient name, and date of birth, as
well as verify if they are th...
REJECTION: NO HORIZON BCBSNJ ENROLLMENT FOUND FOR THE PATIENT NAMED ON
THE CLAIM
WHAT HAPPENED: The patient ID does not match the other patient info on
the claim.
RESOLUTION: Verify insured ID, patient name, and date of birth, as
well as verify if they ...
REJECTION: The Billing Provider ID (Loop 2010AA, NM109) is not a valid
NPI number in our database.;The Subscriber/Member ID Number (Loop
2010BA, NM109) is not valid.
WHAT HAPPENED: The NPI in box 33a is not the NPI the payer has on
file. The subscriber...
REJECTION: Invalid Subscriber ID
WHAT HAPPENED: The patient ID does not match the other patient info on
the claim.
RESOLUTION: Verify insured ID, patient name, and date of birth, as
well as verify if they are the primary insured or a dependent (see
att...
REJECTION: The Billing Provider ID (Loop 2010AA, NM109) is not a
valid NPI number in our database.
WHAT HAPPENED: The NPI in box 33a is not the NPI the payer has on file
(see attached picture below).
RESOLUTION: Need to verify the billing provider i...
REJECTION: The Subscriber/Member ID Number (Loop 2010BA, NM109) is
not valid.
WHAT HAPPENED: The subscriber ID in box 1a is not what the payer has
on file.
RESOLUTION: Need to verify the patient info and update as necessary
(see attached picture belo...
REJECTION: Diagnosis code.
WHAT HAPPENED: An "unspecified" diagnosis code was sent.
RESOLUTION: Because the payer did not provide the code that is in
error, need to verify which code has "unspecified" in the description
and replace with more descriptive...
REJECTION: Rejected - Relational Field In Error Claim submitted to
incorrect payer.
WHAT HAPPENED: Claim sent to wrong payer.
RESOLUTION: Need to contact the phone number on the back of the
patients ID card and verify who the claim should be sent to.
REJECTION: ~Acknowledgement/Rejected for Missing Information | Payer
Assigned Claim Control Number
WHAT HAPPENED: The original claim number was not sent in box 22.
RESOLUTION: Need to add the original claim number in box 22 and resend
the claim.
REJECTION: S103 SUB ID INACTIVE/SERV DT
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 the...
REJECTION: X040 PROVSUBM NOT ON TBL FOR
WHAT HAPPENED: Either rendering provider or billing provider is not
linked to our submitter ID.
RESOLUTION: Need to contact the EDI department at (800) 343-5743 to
see which provider NPI is not linked to the Offi...
REJECTION: INVALID PATIENT FIRST NAME (NO SYMBOLS)
WHAT HAPPENED: A symbol was sent in the patient first name field.
RESOLUTION: Needs to only send the name the payer has on file.
REJECTION: BILLING PROVIDER NUMBER NOT ON FILE
WHAT HAPPENED: NPI in box 33a does not match what the payer has on
file.
RESOLUTION: Verify NPI on claim and correct as necessary.
REJECTION: INVALID SUBSCRIBER ID FOR CARRIER CODE
WHAT HAPPENED: The patient ID does not match the other patient info on
the claim.
RESOLUTION: Verify insured ID, patient name, and date of birth, as
well as verify if they are the primary insured or a de...
REJECTION: Rejected - No Additional Details
WHAT HAPPENED: This is an unspecific error message.
RESOLUTION: Please refer to the specific situations below. If the
claim does not fit the scenerio, a ticket needs to be made.
RESOLVED ISSUES INVOLVING...
REJECTION: POSSIBLE REL CODE CONFLICT
WHAT HAPPENED: Relationship Code keyed does not match the relationship
code on file for this patient.
RESOLUTION: Verify relationship code and re-key correct relationship
code and verify if they are the primary or ...
REJECTION: ~Acknowledgement/Rejected for Invalid Information |
Procedure code for services rendered.~Acknowledgement/Returned as
unprocessable claim | Missing or invalid information.
WHAT HAPPENED: A CPT code was sent that the payer does not accept.
RE...
REJECTION: INVALID ACC/ONSET DATE; INVALID CONSULT DATE
WHAT HAPPENED: A date of intial treatment was sent that was after
the DOS.
RESOLUTION: Need to correct the date of intial treamtment so it is not
a date after the date of service.
REJECTION: PAYER, GROUP AND EMPLOYER FIELD DATA IS BLANK OR INVALID.
AT LEAST ONE OF THESE FIELDS IS REQUIRED.
WHAT HAPPENED: One of the above items was not sent.
RESOLUTION: Verify if the insured ID card has a group number or
employer name on it and a...
REJECTION: MISSING/INVALID BILLING PROVIDER ID
WHAT HAPPENED: Please refer to the payer specifc information below.
RESOLUTION: See below.
RESOLVED ISSUES INVOLVING THIS REJECTION MESSAGE.
Date
Payer
Issue and Resolution
All Dates
...
REJECTION: Payer edits require the Billing and PayTo provider to be
the same entity, containing either the same NPI and/or TaxID (FE355)
WHAT HAPPENED: The billing NPI/TIN does not match the Pay-To NPI/TIN.
RESOLUTION: This should be updated in the bill...
REJECTION: Billing NPI (Invalid format / Missing Value) (RC87)
WHAT HAPPENED: The NPI in box 33a (HCFA), box 56 (UB04) is missing
or invalid.
RESOLUTION: Need to add or correct the billing NPI in box 33a (HCFA),
box 56 (UB04) and update the claim.
REJECTION: Billing NPI IS not authorized for Tax ID
WHAT HAPPENED: Billing NPI in box 33a is not linked to the Tax ID sent
in box 25 in the payer's system.
RESOLUTION: Need to contact the payer to verify what they have on file
for the provider. If that ...
REJECTION: ABILLING NPI IS NOT ON FILE
WHAT HAPPENED: Billing NPI in box 33a is not in the payer's system.
RESOLUTION: Verify the provider information set up at the payer and
verify the patient's insured ID card. If that has already been done,
please co...
REJECTION: Billing or Pay-To Provider - Incomplete Address (FE55)
WHAT HAPPENED: Billing provider address in box 1 (UB) or box 33 (HCFA)
does not have all information needed.
RESOLUTION: Double check the information in billing provider box and
update t...
REJECTION: Billing Provider ID Contains Invalid Characters (FV30)
WHAT HAPPENED: The billing provider ID in box 33b has an invalid
character.
RESOLUTION: The billing provider ID in box 33b can only have numbers
or letters, no other characters. Verify th...
REJECTION: Billing Provider Name is missing (FE89)
WHAT HAPPENED: A name was not sent in box 33 (HCFA).
RESOLUTION: Add billing provider name.
REJECTION: Acknowledgement Rejected for relational field in error.
Billing Provider National Provider Identifier (NPI).
WHAT HAPPENED: The billing provider NPI (Box 33a) does not match what
the payer has on file.
RESOLUTION: Call the payer, verify NPI/T...
REJECTION: Billing Provider Required (FE118)
WHAT HAPPENED: Billing provider name in box 33 is missing.
RESOLUTION: Need to add billing provider name in box 33 and update the
claim.
REJECTION: Billing provider requires a Physical Address
(PO,Lockbox,File,Dept Invalid) (FE354)
WHAT HAPPENED: A PO Box was sent in box 33 (HCFA), box 1 (UB04) and
we do not have a physical address registered with the NPI in box 33a
(HCFA only).
RESOLUT...
REJECTION: Segment REF (Billing Provider Secondary Identification) is
used. It is not expected to be used when National Provider ID is
mandated for use and NM109 is used in loop 2010AA. Segment REF is
defined in the guideline at position 0350.
WHAT HAPP...
REJECTION: Acknowledgement Rejected for relational field in error.
Billing Provider Submitter not approved for electronic claim
submissions on behalf of this entity.
WHAT HAPPENED: Claim was sent to payer but pre-enrollment is not set
up on the payer's e...
REJECTION: Billing Provider tax id.
WHAT HAPPENED: The Tax ID (Box 25) submitted does not match what the
payer has on file.
RESOLUTION: Call the payer, verify TIN/Billing NPI, and update the
claim as necessary.
REJECTION: Acknowledgement Rejected for Invalid Information - The
claim encounter has invalid information as specified in the Status
details and has been rejected. Billing Provider specialty taxonomy
code.
WHAT HAPPENED: Billing Provider Taxonomy code i...
REJECTION: Acknowledgement Rejected for Missing Information - The
claim encounter is missing the information specified in the Status
details and has been rejected. Billing Provider specialty taxonomy
code.
WHAT HAPPENED: Taxonomy code was not sent on the...
REJECTION: Payer Specific Edit: Billing Provider Taxonomy Code
Required. (RC190)
WHAT HAPPENED: Billing taxonomy was not sent in box 81 CC (UB04) or
box 33 (HCFA).
RESOLUTION: This is a payer specific requirement. On a HCFA, in box
33, there is a specif...
REJECTION: Billing Provider Zip Code Invalid or Doesnt Match State
Code (FE120)
WHAT HAPPENED: An invalid state and zip code combination was sent in
box 33 (HCFA), Box 1 (UB04).
RESOLUTION: Verify the information in box 33 (HCFA), Box 1 (UB04) and
updat...
REJECTION: Billing Provider/Supplier Missing Address Information
(FE225)
WHAT HAPPENED: Box 33 was sent with incomplete address information.
RESOLUTION: Verify the information in box 33 and update as necessary.
REJECTION: 60091 InvalidData: 55 Location: 2400 - SV104 Svc:
Anesthesia /Oxygen minutes (Loop 2400 SV103) must be present and
greater than zero.
WHAT HAPPENED: Because the CPT code is an anesthesia code, the MJ
qualifier needs to be sent out.
RESOLUTIO...
REJECTION: Svc Anesthesia Oxygen minutes (Loop 2400 SV103) should not
be submitted when procedure code (Loop 2400 SV101) is greater than
01999.
WHAT HAPPENED: CPT code in box 24D is not an Anesthesia code but
the Unit or Basis for Measurement Code qualif...
REJECTION: Clm Professional FEP claims must be filed directly to the
Home Plan.
WHAT HAPPENED: Claim was not sent to the right place.
RESOLUTION: All FEP claims for Blues in CA go to Blue Shield not Blue
Cross. Need to change the payer name to Blue Shie...
REJECTION: Svc When Private Room is indicated (2400 SV201= 011X or
014X) then Value Information (2300 HI0X.2) must equal 01 or 02.
WHAT HAPPENED: When the revenue codes are 011x and 014x series, the
Value Code and Value Code Amounts will be needed in box...
REJECTION: Normal-0x3939612-Value of sub-element SV202-02 is
incorrect. Expected value is from external code list - HCPCS Code
(130) when SV202-01='HC'. Segment SV2 is defined in the guideline at
position 3750.This error was detected at Segment Count 34Co...
REJECTION: Normal-0x393960f-Value of sub-element HI01-02 is incorrect.
Expected value is from external code list - Condition Code (132).
Segment HI is defined in the guideline at position 2310.This error was
detected at Segment Count 28Composite Count 1{
...
REJECTION: Normal-0x3939611-Value of sub-element HI01-02 is incorrect.
Expected value is from external code list - Diagnosis Related Group
(229). Segment HI is defined in the guideline at position 2310.This
error was detected at Segment Count 30Composite
...
REJECTION: Rejected - Unprocessable Claim Normal-0x393944f-Element
SBR05 is missing. It is required when SBR01 is not ''P'' and payer is
Medicare. Segment SBR is defined in the guideline at position
2900.This element was expected in:Segment Count: 29Chara...
REJECTION: Blue Shield of CA is not responsible for Institutional FEP
claims. Please submit to Blue Cross of CA (BC001). (FE331)
WHAT HAPPENED: Claims were sent to the wrong payer.
RESOLUTION: Resubmit to Blue Cross CA with the payer ID of BC001.
REJECTION: Normal-0x3939420-Value of element REF02 (Line Item Control
Number) has been already used in loop 2300. Line Item Control Numbers
are expected to have unique values within loop 2400. Segment REF is
defined in the guideline at position 4700.
WHA...
REJECTION: Normal-0x393961d-Value of sub-element CLM05-01 is
incorrect. Expected value is from external code list - NUBC Bill Type
(236). Segment CLM is defined in the guideline at position 1300.This
error was detected at Segment Count 19Composite Count
...
REJECTION: PLEASE RESUBMIT CLAIM TO ANTHEM BLUE CROSS OF CA
WHAT HAPPENED: The alpha prefix on the claim is for Blue Cross CA.
RESOLUTION: Need to send claims to Blue Cross CA BC001.
REJECTION: Provider ID not on File
WHAT HAPPENED: Provider information on the claim does not match what
they payer has on file.
RESOLUTION: Needs to verify information in box 24j, 33a, and 25 and
update the claim as necessary. Phone number to call is 8...
REJECTION: BSCA Encounter Billing Provider ID Must Begin with IPA0
When NPI is Not Present (FE226)
WHAT HAPPENED: The NPI was not sent, so the blue shield provider ID
was expected in box 33b.
RESOLUTION: Either add NPI in box 33a or provider ID in 33b.
REJECTION: Payer Specific Edit: Primary diagnosis code cannot be an E
code. (RC162)
WHAT HAPPENED: Diagnosis code 1(A) in box 21 cannot be an E (external
cause of injury) code.
RESOLUTION: Need to update the claim so diagnosis code 1(A) is not an
E code...
REJECTION: Billing provider requires a Physical Address starting with
a number (FE376)
WHAT HAPPENED: Address in box 33 did not start with a number.
RESOLUTION: Need to update address to start with a number.
REJECTION: CLAIM IS HEALTH NETWORKS RESPONSIBILITY (FE99)
WHAT HAPPENED: Claim was sent to the wrong payer.
RESOLUTION: Need to verify payer and update the claim as necessary.
REJECTION: Payer Specific Edit: Member ID (1A) must not be length 9
numeric (SSN). (FE328)
WHAT HAPPENED: Box 1a was a 9 digit number.
RESOLUTION: Need to double check the insured ID card and update the
claim.
REJECTION: PROVIDER ID MISSING
WHAT HAPPENED: Generally this has to do with the fact that the claims
were not being sent to the right payer. Claims usually needed to be
sent to IBC instead of Capital.
RESOLUTION: Need to double check the payer the claim...
REJECTION: ACK/RETURNED - MISSING/INVALID DATA PREVENTS PAYER FROM
PROCESSING CLAIM. - PATIENT
OR
ACK/RETURNED - MISSING/INVALID DATA PREVENTS PAYER FROM PROCESSING
CLAIM. (USE CSC CODE 21) - PATIENT
WHAT HAPPENED: Per the payer: Patient first name, ...
REJECTION: Sub-element SV101-07 is missing. It is required when
procedure code is non-specific (SV101-02 is ). Segment SV1 is defined
in the guideline at position 3700.
WHAT HAPPENED: A line item note was not sent for the CPT code listed.
RESOLUTION: A...
REJECTION: Payer Specific Edit: Caremore Member, Please Bill Caremore
(FE332)
WHAT HAPPENED: This was sent to the wrong payer.
RESOLUTION: Based on the insured ID, this claim needs to be sent to
Caremore, payer ID: CARMO.
REJECTION: LABORATORY OR SERVICE LOCATION ADDRESS 1: REQUIRED; MUST BE
ENTERED FOR PAYER
LABORATORY OR SERVICE LOCATION CITY NAME: REQUIRED; MUST BE ENTERED
FOR PAYER
LABORATORY OR SERVICE LOCATION STATE OR PROVINCE CODE: REQUIRED; MUST
BE ENTERED FOR P...
REJECTION: 06 - INVALID PRV
WHAT HAPPENED: Billing provider taxonomy code is missing.
RESOLUTION: Need to add the billing taxonomy in box 33 (see attached
picture below) and resend the claim.
REJECTION: 2320 SBR09 MUST NOT=MB,2320 AMT01 MUST=D
WHAT HAPPENED: Claims were incorrectly sent to Champus.
RESOLUTION: If the patient has Medicare as their primary payer, claims
need to be sent to TriCare for Life. Update the payer name and ID and
res...
REJECTION: PCHARGE MUST BE GREATER THAN ZERO
WHAT HAPPENED: At least 1 line item had a charge of zero.
RESOLUTION: Charges need to be for a least $0.01.
REJECTION: PDUPLICATE OF A CLAIM PREVIOUSLY PAID 1
WHAT HAPPENED: Payer is stating that this is a duplicate claim on
their end.
RESOLUTION: Claim has already been sent to the payer. If this is
supposed to be a corrected claim, need to verify how payer w...
REJECTION: PSTATE IS INVALID B12
WHAT HAPPENED: Claims were not sent to the correct payer based on the
state.
RESOLUTION: Claims from the following states can be sent to payer ID
CH002:
North: CT, DE, IL, IN, KT, MA, MD, ME MI, NH, NJ, NY, NC, OH, PA, ...
REJECTION: PTOTAL CHARGE MUST BE GREATER THAN ZERO FL53
WHAT HAPPENED: Claim had a total charge of zero.
RESOLUTION: Charges need to be for a least $0.01.
REJECTION: RENDERING PHYSICIAN IS REQUIRED
WHAT HAPPENED: Payer was expecting a rendering and billing loop, but
WE DID NOT SEND BOTH LOOPS BECAUSE OF SPECIFIC INSTRUCTIONS WITH THIS
PAYER TO NOT SEND BOTH LOOPS WHEN THE NPI IS THE SAME.
RESOLUTION: Cont...
REJECTION: RENDERING PROV NPI MUST NOT = BILL PROV NPI
WHAT HAPPENED: Neither a billing nor rendering NPI were sent.
RESOLUTION: Need to add either a billing or rendering NPI.
REJECTION: Payer Specific Rejection: Payer no longer accepts CPT code
90791 electronically. Please contact the payer to verify which code to
send or send the claim by paper. (FE459)
WHAT HAPPENED: CPT code 90791 that is no longer a mental health code
and...
REJECTION: Rejected - Invalid Data Patient eligibility not found with
entity.
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 ...
REJECTION: Rejected - Invalid Data Entity not eligible for 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 I...
REJECTION: Rejected - Invalid Data Entitys name, address, phone and id
number.
WHAT HAPPENED: This is an unspecific error.
RESOLUTION: Please contact our customer service department
(360-975-7000 opt 1) so one of our reps can pull the report and find
o...
REJECTION: HCPCS Procedure Code is invalid in Professional Service.
Value of sub-element SV101-02 is incorrect. Expected value is from
external code list - HCPCS Code (130) when SV101-01='HC'. Segment SV1
is defined in the guideline
WHAT HAPPENED: The C...
REJECTION: Rejected - Unprocessable Claim Entitys tax id.
Invalid Tax ID
WHAT HAPPENED: Correct info was not sent in box 25.
RESOLUTION: Need to verify the number in box 25 (see attached picture
below) and update the claim as necessary.
REJECTION: A data element is too short. The length of Element NM109
(Identification Code) is 1. The minimum allowed length is 2. Segment
NM1 is defined in the guideline at position 3250
WHAT HAPPENED: In one of the NM109 segments, only 1 character was
s...
REJECTION: PAYER RESPONSE: Present on Admission Indicator Missing
WHAT HAPPENED: The 'Present on Admission' indicator was not sent with
the diagnosis codes.
RESOLUTION: In the dropdown box next to the diagnosis code, need to
select 'Y' and resubmit.
REJECTION: Present on Admission Indicator is required for Principal
Diagnosis Sub-element HI01-09 is missing. Present on Admission
Indicator is required for claims involving inpatient admissions to
general acute
WHAT HAPPENED: The 'Present on Admission' ...
REJECTION: Service Date is invalid : it is after Transaction Creation
Date. Value of element DTP03 (Service Date) is incorrect. Value for
date or start period date is expected to be a date earlier than the
Trans
WHAT HAPPENED: The date of service sent wa...
REJECTION: Claim DOS Beyond one year timely filing period (FE94)
WHAT HAPPENED: The dates of service in box 24a are beyond the one year
timely filing period.
RESOLUTION: Verify the dates of service in box 24a, if they are
correct, claim needs to be sent...
REJECTION: Claim DOS Beyond two year timely filing period (FE97)
WHAT HAPPENED: A claim was sent that has dates of service from over
2 years ago.
RESOLUTION: Cannot submit claims that old through us. Would need to go
by paper.
REJECTION: Acknowledgement Rejected for Invalid Information - The
claim encounter has invalid information as specified in the Status
details and has been rejected. Claim Frequency Code
WHAT HAPPENED: Payer does not accept the number being sent as the
Res...
REJECTION: Claim Frequency Type Code is invalid. Invalid data: 6
Payer Claim Control Number is not used for first time submitted claim.
Invalid data: REF*F8
WHAT HAPPENED: An invalid Resubmission Code was sent in box 22. The
second error message ties int...
REJECTION: Acknowledgement Returned as unprocessable claim-The claim
encounter has been rejected and has not been entered into the
adjudication system. Subscriber Claim submitted to incorrect payer.
WHAT HAPPENED: Claim was sent to wrong payer.
RESOLUTI...
REJECTION: CLIA Number is required for all lab services. (FE302)
WHAT HAPPENED: CLIA number was not sent in.
RESOLUTION: Based on the place of service (e.g. 81) a CLIA number is
required. Add CLIA number to claim and resend.
REJECTION: Clinical Resource Group: Insured ID must be all 8 digit
numeric OR begin with G followed by 8 numeric and 01 suffix. (FE336)
WHAT HAPPENED: Incorrect insured ID was sent in box 1a.
RESOLUTION: Insured ID need needs to fit the criteria of bein...
REJECTION: Missing Plan Name: AMM03 Requires EMSF, CMS, CAR, TPB, or
CTU indicator in Box 11c (SBR04) (RC124)
WHAT HAPPENED: Box 11c is missing one of the above indicators.
RESOLUTION: Add one of the indicators in box 11c and update the claim.
REJECTION: 21.(1.) DIAGNOSIS OR NATURE OF ILLNESS OR INJURY CODE
(Invalid Type / Missing Value) (RC22)
WHAT HAPPENED: No diagnosis code was sent in box 21.
RESOLUTION: Need to add diagnosis code in box 21 and update the claim.
REJECTION: CCIH: Patient address invalid, address should be from
Institutional Abbreviations list. (FE359)
WHAT HAPPENED: Patient address is not valid as per what the payer has
on file.
RESOLUTION: This payer has specific abbreviations for each
correcti...
REJECTION: CCIH: Insured ID must be 6 characters in length, starting
with a letter and ending in 4 numbers. (FE337)
WHAT HAPPENED: The insured ID in box 1a is invalid.
RESOLUTION: The insured ID needs to fit the criteria of starting with
a letter and en...
REJECTION: CCIH: Patient Account Number must be 13 characters or less
per CorrectCare. (FE360)
WHAT HAPPENED: Patient account number in box 26 does not fit the
criteria of being 13 characters or less.
RESOLUTION: Update box 26 to 13 characters or less.
REJECTION: CPLAN ROUTE CODE (PREFIX) ENDED PRIOR TODAY
WHAT HAPPENED: Alpha prefix in box 1a is invald.
RESOLUTION: Needs to verify the claim was sent to the correct payer.
Also needs to verify the insured ID is still active in the payer's
system.
REJECTION: CPT 99213 thru 99215 and 99203 thru 99205 cannot be used
with modifier 50 (FE403)
WHAT HAPPENED: One of the above CPT codes were used in box 24d with
the modifier of 50.
RESOLUTION: Verify the codes in box 24d and update the claims as
necess...
REJECTION: CPT code on line __ not in Payers allowed code list
(LC201)
WHAT HAPPENED: The CPT code on specified line is not accepted by
this payer.
RESOLUTION: Verify the CPT code on specified line and update the
claim as necessary.
Here are the payers...
REJECTION: CPT code, on line __ is invalid. (LC1245)
WHAT HAPPENED: The CPT code on the indicated line number is invalid.
RESOLUTION: Verify the CPT code on the indicated line number and
update the claim as necessary. Also verify the date of service be...
REJECTION: CPT Invalid Code (RC06)
WHAT HAPPENED: One of the codes on the claim is not valid.
RESOLUTION: Verify the CPT codes on the claim. Since this is an Office
Ally rejection, our customer service department can run them on our
end to advise which ...
REJECTION: (Specified Date) cannot be in the future. (FP04)
WHAT HAPPENED: The date specified is in the future.
RESOLUTION: Change the date to a date that is not in the future.
REJECTION: Date of Accident Required (DE180)
WHAT HAPPENED: Box 10 had a box marked 'Yes' but an accident date was
not sent in Box 15 (with qualifier 439) or the Additional Fields
section.
RESOLUTION: Need to add accident date in Box 15 or the Additiona...
REJECTION: Date(s) of service.
WHAT HAPPENED: There is an error with a date(s) of service on the
claim. There should be another message specifying what is wrong with
the date.
RESOLUTION: See the other message for the full error description and
update a...
REJECTION: Acknowledgement Returned as unprocessable claim-The claim
encounter has been rejected and has not been entered into the
adjudication system. Dependent not eligible for benefits for submitted
dates of service.
WHAT HAPPENED: Based on the patien...
REJECTION: Rejected
WHAT HAPPENED: Please refer to the payer specifc information below.
RESOLUTION: See below.
RESOLVED ISSUES INVOLVING THIS REJECTION MESSAGE.
Date
Payer
Issue and Resolution
All Dates
Desert Medical (DESRT)...
REJECTION: Diagnosis code specified not valid for patient age.
WHAT HAPPENED: Diagnosis code in box 21 is not valid for the patient
date of birth in box 3.
RESOLUTION: Verify specified diagnosis code in box 21 and update the
claim as necessary. If you...
REJECTION: Diagnosis code (letter/number will be specified) not valid
for patient gender
WHAT HAPPENED: Diagnosis code specified in box 21 is not valid for
the patient gender selected in box 3.
RESOLUTION: Verify diagnosis code specified in box 21 and ...
REJECTION: Diagnosis code (letter/number will be specified) is
invalid. (LC1270)
WHAT HAPPENED: Diagnosis code in specified position in box 21 is
invalid.
RESOLUTION: Verify diagnosis code in box 21 and update the claim as
necessary.
REJECTION: Diagnosis code (number/letter will be specified) is not
billable (further specification required). (FE141)
WHAT HAPPENED: Diagnosis code in the position specified in Box 21 is
no longer billable.
RESOLUTION: If you do not already know how to ...
REJECTION: Diagnosis code (number/letter will be specified) not
effective for this DOS (FE137)
WHAT HAPPENED: Diagnosis code is not valid for the date of service.
RESOLUTION: If you do not already know how to use the code search,
please click HERE
[http...
REJECTION: Diagnosis code __ not effective for this DOS
WHAT HAPPENED: The diagnosis code specified in box 21 cannot be
billed for the date of service in box 24.
RESOLUTION: Verify the specified diagnosis code in box 21 and update
the claim as necessar...
REJECTION: DIAGNOSIS Code 1(A) Required (FE73)
WHAT HAPPENED: No diagnosis code was sent in box 21.
RESOLUTION: Add dignosis code in box 21 and update the claim.
REJECTION: SUBSCRIBER PRIMARY IDENTIFIER- INVALID; MUST BE 9 NUMERIC
CHARACTERS FOR PAYER
WHAT HAPPENED: Claims were more than likely supposed to go to Medicare
IL.
RESOLUTION: The Office Ally payer ID for Medicare IL is: MCRIL. Payer
IDs can vary from...
REJECTION: ~Acknowledgement/Rejected for Missing Information |
Duplicate of a previously processed claim/line.
WHAT HAPPENED: The payer as already received this claim previously.
RESOLUTION: If this is a corrected claim, the EDI department needs to
be ...
REJECTION: Medicare Claim contains Missing/Invalid Referring Provider
Information (FV26)
WHAT HAPPENED: No information was sent in box 17.
RESOLUTION: For this payer, they require a referring physician. Please
add rendering physician in box 17.
REJECTION: Drug Quantity Required (RC139)
Drug Measure Required (RC140)
WHAT HAPPENED: The quantity (NDC Qty) or the quantity qualifier (NDC
QtyQual) was not in the grey section above the line items in box 24j.
RESOLUTION: Put in the qu...
REJECTION: Drug Quantity Qualifier (ME) is only valid for ANSI 5010
Payers. Current Payer is not 5010. (FE373)
WHAT HAPPENED: The NDC measurement code ME cannot be used on 4010
claims.
RESOLUTION: Need to submit by paper until this payer transitions to
...
REJECTION: Duplicate claim (within 90 days) (RC07)
WHAT HAPPENED: A duplicate claim was sent.
RESOLUTION: If the claim is a corrected claim, turn off the Duplicate
Filter and contact the payer to verify how to submit a corrected claim
electronically. He...
REJECTION: Duplicate Diagnosis Code. (LC1718)
WHAT HAPPENED: One of the diagnosis codes in box 21 is being sent more
than once.
RESOLUTION: Verify the diagnosis codes in box 21 and remove the
duplicate code.
REJECTION: Rejected - Unprocessable Claim Duplicate of a previously
processed claim/line.
WHAT HAPPENED: Payer is stating that this is a duplicate claim on
their end.
RESOLUTION: Claim has already been sent to the payer. If this is
supposed to be a corr...
REJECTION: Duplicate Procedure Modifier (LC1717)
WHAT HAPPENED: One of the line items has a modifier in box 24d that's
being sent twice.
RESOLUTION: Verify the modifiers in box 24d on all of the line items
and remove the duplicate modifier.
REJECTION: Element SV111 is used. It may be used on Medicaid claims
only. Segment SV1 is defined in the guideline at position 3700.
WHAT HAPPENED: Information was sent in box 24h.
RESOLUTION: Box 24h needs to be blank unless it's a Medicaid claim and
Me...
REJECTION: 40790 InvalidData: 1417504587 Location: 2010AA - REF02
Prov: Billing Provider Reference ID Code (Loop 2010AA, REF02) must
match the pattern 123456789 with no specia characters when the
Reference ID Qualifier (Loop 2010AA, REF01) is equal to EI ...
REJECTION: Entity not eligible for 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...
REJECTION: ~Acknowledgement/Returned as unprocessable claim | Entity
not found.
WHAT HAPPENED: An entity on the claim (provider, patient, etc.) is
incorrect.
RESOLUTION: Unless the payer sent to is specified below, please
contact our customer service d...
REJECTION: ACK/RETURNED - ENTITY NOT FOUND. - PATIENT
WHAT HAPPENED: Based on the patient information the claim, the patient
was not found in the payer's system.
RESOLUTION: Need to verify the claim was sent to the correct payer.
If so, verify the insu...
REJECTION: ACK/RETURNED - ENTITY NOT FOUND. - PROVIDER
WHAT HAPPENED: Some or all of the provider information on the claim
(NPI in box 24j or 33a, TIN in box 25, provider name in box 33) (see
attached pictures below) is not what the payer has in their s...
REJECTION: Category: Acknowledgement/Rejected for Missing Information
The Claim/Encounter is missing information specified in the Status
details and has been rejected Status: Entity's health insurance claim
number (HICN) Entity: Payer
WHAT HAPPENED: An ...
REJECTION: ~Acknowledgement/Rejected for Invalid Information |
Entity's specialty/taxonomy code. | Submitter not approved for
electronic claim submissions on behalf of this entity.
WHAT HAPPENED: The taxonomy code was not correct.
RESOLUTION: Verify th...
REJECTION: A8:158 Acknowledgement / Rejected for relational field in
error.:Entitys date of birth. Note: This code requires use of an
Entity Code.: Entity Patient (A8:158:QC) (A8:158:QC)
WHAT HAPPENED: Patient date of birth in box 3 is not what the paye...
REJECTION: Lineitem Service Id Qualifier ER Not Supported (RC143)
WHAT HAPPENED: In loop 2400, SV101-1 the qualifier 'ER' was sent.
RESOLUTION: At this time, 'ER' is not a valid qualifier. Need to make
an update in the billing software to a valid qualif...
REJECTION: Error in Processing-Please Resubmit (FE230)
WHAT HAPPENED: This an Office Ally rejection for an error in our
processing to the payer.
RESOLUTION: Just need to resubmit the claims. Nothing needs to be
changed.
REJECTION: Per Payer: Exceeds 120 day timely filing limit. Please drop
to paper and include proof of timely submission for reconsideration.
(FE310)
WHAT HAPPENED: Date of service is outside of the timely filing period.
RESOLUTION: Claim needs to be subm...
REJECTION: Payer Specific Edit: Facility Name Required when Place of
Service is 21,22,23,24,31 (RC47)
WHAT HAPPENED: One of the above place of service codes was sent in box
24b, but the facility information in box 32 was left blank.
RESOLUTION: Need to ...
REJECTION: Facility NPI (Box 32A) Is Required (RC136)
WHAT HAPPENED: The facility NPI in box 32a was not sent.
RESOLUTION: When the facility loop is sent, the NPI is required as
well. Add the NPI in box 32a and update the claim.
REJECTION: Facility NPI (Invalid Format / Missing Value), required by
payer when place of service is (1,2,21,22,23) (RC90)
WHAT HAPPENED: Facility NPI was not sent in box 32a.
RESOLUTION: Need to add facility NPI in box 32a and resend the claim.
REJECTION: FEDERAL TAX ID # has Invalid Length on Claim (RC63)
WHAT HAPPENED: Tax ID in box 25(HCFA) does not fit the criteria of
being 9 digits long.
RESOLUTION: Verify the tax ID in box 25(HCFA) (see attached picture
below) and update the claim as nec...
REJECTION: Insured ID Contains Invalid Characters FV36
WHAT HAPPENED: The insured ID in box 1a contains characters other than
letters and numbers.
RESOLUTION: Per the payer, insured ID numbers can only contain letters
and/or numbers. Need to verify the ...
REJECTION: Policy number not on file
WHAT HAPPENED: Based on the patient information the claim, the patient
ID is not correct.
RESOLUTION: Double check the patient's insured ID card and then call
payer if needed to verify information.If this has alread...
REJECTION: Future Dates are not allowed (FP01)
WHAT HAPPENED: One of the various date boxes on the claim has a future
date.
RESOLUTION: Verify all dates on the claim and update as necessary.
REJECTION: CLAIM REJECTED BY GEHA Duplicate Claim Received
WHAT HAPPENED: Payer is stating that this is a duplicate claim on
their end.
RESOLUTION: Claim has already been sent to the payer. If this is
supposed to be a corrected claim, verify how payer w...
REJECTION: CLAIM REJECTED BY GEHA, 2010BA - Insured ID Must be Valid
WHAT HAPPENED: An invalid insured ID was sent.
RESOLUTION: Need to verify insured ID card and contact the payer if
needed. If this has already been done, please obtain proof of the
pa...
REJECTION: Payer Specific Edit: Diagnosis codes which start with 303,
304 or 305 are not accepted. Resubmit on paper. (LC1735)
WHAT HAPPENED: This payer does not accept 303, 304 or 305
electronically.
RESOLUTION: Will need to send by paper or use differ...
REJECTION: Secondary Claim: Group Code (Invalid Type / Missing Value).
(FE375)
WHAT HAPPENED: One of the group codes in the secondary section
(bottom) of the claim is invalid.
RESOLUTION: There is a browse window next to the group code box (see
attached...
REJECTION: Insured Group Policy Number Cannot Equal Insured ID (FE224)
WHAT HAPPENED: Information in box 1a and 11 was the same.
RESOLUTION: The boxes cannot be the same. Double check the insured ID
card and update claim as necessary.
REJECTION: The submitted Group/Practice ID does not match Payor
Contract ID on file (RC56)
WHAT HAPPENED: The ID above the NPI in box 24j is not valid.
RESOLUTION: Need to verify the ID above the NPI in 24j and update the
claim.
REJECTION: H10005 Value is too short for N401
WHAT HAPPENED: N401 refers to an address in the ANSI format. Only 1
letter was sent.
RESOLUTION: Review all address fields on the claim and update as
necessary. If you cannot see any incorrect addresses, ...
REJECTION: H10005 Value is too short for N402
WHAT HAPPENED: N402 refers to the state in an address in the ANSI
format. Only 1 letter was sent.
RESOLUTION: Review all address fields on the claim and update the
state abbreviations as necessary. If you ...
REJECTION: Rejected - Unprocessable Claim H20203 Element HI02 is
present, though marked Not Used
WHAT HAPPENED: Too many diagnosis codes were sent in.
RESOLUTION: Can only send up to 12 diagnosis codes. Update software
and resubmit.
REJECTION: PRV04 - FROM DATE BEFORE PROV EFFECTIVE DATE
WHAT HAPPENED: The provider listed on the claim was not set up on the
payer's end to send claims for the date of service on the claim.
RESOLUTION: Need to contact the payer to verify the provider'...
REJECTION: MISCELLANEOUS ERROR. PLEASE CALL CUSTOMER SERVICE AT
1-800-851 -3379
WHAT HAPPENED: Payer has further details on the rejection.
RESOLUTION: Need to call the above phone number and select options 3,
5, then 1 to reach the department that hand...
REJECTION: PAYER RESPONSE: Mandatory segment missing (HI:32:2300)
WHAT HAPPENED: The admitting diagnosis code (HI*BJ) was not sent.
RESOLUTION: Add admitting diagnosis to box 69 and resend.
REJECTION: Cannot resolve claim location for payee and provider
WHAT HAPPENED: The billing provider address does not match what the
payer has on file.
RESOLUTION: Call provider services and verify what the payer has on
file.
REJECTION: (043) Cannot resolve service facility location for payee
WHAT HAPPENED: Information in box 32 does not match what the payer
has on file.
RESOLUTION: Double check the facility address. Call provider services
and verify what the payer has on...
REJECTION: Entity 000OD is not a valid contract entity for claim!
WHAT HAPPENED: Provider was not set up with the payer on the date of
service for the claim.
RESOLUTION: Contact provider services to verify if set up and resubmit
the claims as necessary...
REJECTION: DENIED - INC./MISSING/INVALID CLAIM
WHAT HAPPENED: This is a denial from the claims department, not the
EDI department.
RESOLUTION: Please call the claims department for further information
on this rejection, 800.839.2177
REJECTION: DENIED - USUAL & CUSTOMARY
WHAT HAPPENED: This is a denial from the claims department, not the
EDI department.
RESOLUTION: Please call the claims department for further information
on this rejection, 800.839.2177
REJECTION: The member ID (Loop 2010BA, Segment NM109) must be eight
numeric digits.
WHAT HAPPENED: The insured ID in box 1a did not fit the format of
being 8 numbers long.
RESOLUTION: Need to verify the insured ID from the patient's insured
ID card and...
REJECTION: All line items must have the same place of service
WHAT HAPPENED: The place of service in box in box 24b is not the same
for all line items.
RESOLUTION: This payer requires all line items to have the same place
of service in box 24b. Need to...
REJECTION: Payer Specific Edit: Member ID must begin with letter M
followed by 9 numeric. (FE356)
WHAT HAPPENED: Insured ID in box 1a did not fit the criteria of
starting with an M and then 9 numbers.
RESOLUTION: There is more than one payer that goes b...
REJECTION: Category- Acknowledgement/Returned as unprocessable claim
The Claim/Encounter has been rejected and has not been entered into
the adjudication system Status- Duplicate of a previously processed
claim/line
WHAT HAPPENED: Payer is stating that ...
REJECTION: Category- Acknowledgement/Returned as unprocessable claim
The Claim/Encounter has been rejected and has not been entered into
the adjudication system Status- Entity not found Entity- Patient
WHAT HAPPENED: The patient ID does not match the ot...
REJECTION: ICD9 NOTE: At least one other status code is required to
identify the related procedure code or diagnosis code.
WHAT HAPPENED: ICD-9 code(s) were sent, but the date of service was
after 10/1/15.
RESOLUTION: Update the diagnosis code(s) and IC...
REJECTION: Incomplete Facility Information (FE222)
WHAT HAPPENED: Box 32 was sent with incomplete information
RESOLUTION: Verify the information in box 32 and update the claim.
REJECTION: IEHP Requires box 1A to be length 9 or 14 (FE147)
WHAT HAPPENED: An incorrect insured ID was sent in box 1a. The ID
could be a 12-digit ID with a 2-digit person number 00 or 01 in total
the ID would be 14 digits.
RESOLUTION: Verify insured ID...
REJECTION: Insufficient Bad Address
WHAT HAPPENED: This claim was sent by paper. A valid address was not
sent.
RESOLUTION: Need to put a valid address.
REJECTION: Payer Specific Edit: Insured Date of Birth Required when
Patient Relationship to Insured is not Self (RC170)
WHAT HAPPENED: Box 6 was not marked self, but no patient date of birth
was sent in box 11a.
RESOLUTION: Need to add patient date of b...
REJECTION: Payer Specific Edit: Insured Gender Required when Patient
Relationship to Insured is not Self (RC171)
WHAT HAPPENED: Box 6 was not marked self, but no patient gender was
sent in box 11a.
RESOLUTION: Need to add patient gender in box 11a or up...
REJECTION: INSURED I.D. Number (Invalid Type / Missing Value) (RC20)
WHAT HAPPENED: The insured ID was not sent in box 1a.
RESOLUTION: Add insured ID in box 1a and resend the claim.
REJECTION: Payer Specific Edit: Insured Last Name Required when
Patient Relationship to Insured is not Self (RC169)
WHAT HAPPENED: Box 6 was not marked self, but no patient last name was
sent in box 4.
RESOLUTION: Need to add patient last name in box 4 ...
REJECTION: Invalid Billing Provider NPI Format (Box 33A) (RC82)
WHAT HAPPENED: The information in box 33a does not meet the criteria
of being 10 digits in length.
RESOLUTION: Verify the information in box 33a and update the claim as
necessary.
REJECTION: Invalid Claim Frequency Code (FE318)
WHAT HAPPENED: The resubmission code in box 22 is not a valid code.
RESOLUTION: Need to verify the information in box 22 and update the
claim.
REJECTION: Payer Specific Edit: Invalid Claim Frequency Code 6 -
Receiver Does Not Accept Corrections. (RC159)
WHAT HAPPENED: The code '6' cannot be sent in box 22.
RESOLUTION: If this is a corrected claim, need to contact the payer to
verify how they w...
REJECTION: Payer Specific Edit: Invalid Claim Frequency Code 7 -
Receiver Does Not Accept Replacements. (RC137)
WHAT HAPPENED: The code '7' cannot be sent in box 22.
RESOLUTION: If this is a corrected claim, need to contact the payer to
verify how they ...
REJECTION: Invalid Clia Number (FE405)
WHAT HAPPENED: The CLIA number in the Additional Fields section does
not fit the correct format CLIA numbers.
RESOLUTION: CLIA numbers must start with 2 numbers, the letter D, then
7 numbers. Need to verify the CLI...
REJECTION: Rejected - Invalid Data Diagnosis code.
WHAT HAPPENED: One of the diagnosis codes in box 21 is not valid or
one of the diagnosis codes was sent more than once. Error message will
specify the code in question.
RESOLUTION: Verify the diagnosis ...
REJECTION: Rejected - Invalid Data H51112 The last position of the
Bill Type Code is not a valid NUBC Frequency code for this
transaction.
WHAT HAPPENED: An invalid code was sent in box 22. Generally, this
box is used to show it's a corrected claim.
RES...
REJECTION: Invalid Date of Service (DE110)
WHAT HAPPENED: One of the dates of service in box 24A is not valid.
RESOLUTION: Verify all line items in box 24A and update the claim as
necessary.
REJECTION: Invalid Dental Procedure Code Line __
WHAT HAPPENED: The code in box 29 on the indicated line item is not
valid.
RESOLUTION: Verify the code in box 29 and update the claim as
necessary.
REJECTION: Claim Contains Invalid Diagnosis Code References in Line
Items (RC66)
WHAT HAPPENED: One of the line items does not a valid letter for the
diagnosis code pointer in box 24e on the inbound file.
RESOLUTION: Verify all of the diagnosis code val...
REJECTION: Invalid Drug Qualifier (LIN02) (RC125)
WHAT HAPPENED: The NDC qualifier in box 24 above the line item is
incorrect.
RESOLUTION: Verify the NDC qualifier in box 24 and update the claim as
necessary.
REJECTION: Invalid Drug Quantity Code Qualifier (CTP05-01). (FE374)
WHAT HAPPENED: The NDC measurement code listed is not a valid code.
RESOLUTION: Verify the measurement unit code in box 24 and update the
claim.
REJECTION: Invalid Facility City ST Zip (FE216)
WHAT HAPPENED: Box 32 was sent with incorrect information for the
city/state/zip code.
RESOLUTION: Verify the information in box 32 and update the claim.
REJECTION: Invalid Facility Zip (FE114)
WHAT HAPPENED: An incorrect zip code was sent in box 32.
RESOLUTION: Verify information in box 32 and resubmit the claim. Zip
code can be verified HERE [https://www.usps.com/].
REJECTION: Invalid Modifier, modifiers must be 2 characters (FV27)
WHAT HAPPENED: One of the modifiers in box 24D is less than 2
characters.
RESOLUTION: Verify the modifiers on the claim and update to a valid
modifier (see attached picture).
REJECTION: Invalid NDC Code (FE115)
WHAT HAPPENED: An invalid NDC code was sent in box 24 (HCFA), box 49
(UB04).
RESOLUTION: Needs to verify the NDC code in box 24 (HCFA) / box 49
(UB04) and update the claim as necessary. Make sure there are only
number...
REJECTION: Invalid Ordering Physician NPI Format (RC84)
WHAT HAPPENED: The NPI format in box 17b or the additional fields
section for the ordering physician does not fit the format of 10
digits in length.
RESOLUTION: Need to verify the NPI for the order...
REJECTION: Invalid Patient Name (DE200)
WHAT HAPPENED: Name in box 2 does not have correct characters.
RESOLUTION: Verify the name in box 2 and update the claim as
necessary.
REJECTION: Invalid Provider Accept Assignment Code (RC105)
WHAT HAPPENED: Box 27 was sent blank.
RESOLUTION: Need to mark one of the boxes in box 27 and update the
claim.
REJECTION: Invalid Referring Name Format (HCFA Box 17, ANSI 2310A NM1)
(RC113)
WHAT HAPPENED: Box 17 can only have a first and last name.
RESOLUTION: Verify box 17 only has provider's first and last name,
remove any credentials, and update the claim.
REJECTION: Invalid Referring Physician NPI Format (Box 17B) - Fails
Validation (RC80)
WHAT HAPPENED: An NPI was sent that did not fit the format of 10
digits in box 17b.
RESOLUTION: The number of digits may look correct on the claim image,
so check the ...
REJECTION: Invalid Rendering Physician NPI Format (Box 24J) (RC86)
WHAT HAPPENED: An NPI was sent that did not fit the format of 10
digits or is an invalid NPI.
RESOLUTION: Verify the NPI in box 24j. The number of digits may
look correct on the claim i...
REJECTION: Invalid Secondary Insured Address: SAME (RC150)
WHAT HAPPENED: The word 'Same' was sent in loop 2330A for the other
subscriber address.
RESOLUTION: Need to update the other subscriber address in the billing
software and resend the claim.
REJECTION: Invalid Secondary Insured City: SAME (RC151)
WHAT HAPPENED: The word 'Same' was sent in loop 2330A for the other
subscriber city.
RESOLUTION: Need to update the other subscriber city in the billing
software and resend the claim.
REJECTION: Invalid Subscriber Id (DC307) (2049) (DE307)
WHAT HAPPENED: The patient ID (box 15 Dental, 8a and box 60 UB, 1a
HCFA) does not match the other patient info on the claim.
RESOLUTION: Verify insured ID, patient name, and date of birth, as
wel...
REJECTION: Invalid Subscriber Name (DE210)
WHAT HAPPENED: Name in box 4 does not have correct characters.
RESOLUTION: Verify the name in box 4 and update the claim as
necessary.
REJECTION: Invalid Tooth Surface Code (1968, 1969, 1970, 1977)
WHAT HAPPENED: In box 28, one of the tooth surface codes is incorrect.
RESOLUTION: When in claimfix, once you click inside box 28, a drop
down menu appears. Choose one of the valid codes fro...
REJECTION: Claim contains invalid UNIT value(s) (RC64)
WHAT HAPPENED: One of the line items does not have a positive/valid
number for the units in box 24g.
RESOLUTION: Verify all of the unit values in box 24g and update the
claim as necessary.
REJECTION: Invalid/Missing Patient Gender Code (FE68)
WHAT HAPPENED: Gender code in box 3 (HCFA), box 11 (UB04) is missing.
RESOLUTION: Need to add gender code in box 3 (HCFA), box 11
(UB04) and update the claim.
REJECTION: 2320 SBR05 cannot be used when SBR01 = P or 2330B NM108
does not equal XV (Centers for Medicare and Medicaid Services PlanID)
WHAT HAPPENED: Our system defaults loop 2320 SBR05 to 47 when Medicare
is the secondary. This payer does not want an...
REJECTION: Rejected - Unprocessable Claim Claim submitted to incorrect
payer.
WHAT HAPPENED: Claim was sent to the wrong payer ID.
RESOLUTION: Kaiser has many payer ID numbers. Need to verify the payer
ID the claim needs to be sent to and update the cl...
REJECTION: Rejected - Invalid Data Missing or invalid information.
Note: Changed as of 6/01
WHAT HAPPENED: This is an unspecific error message.
RESOLUTION: Please contact our customer service department
(360-975-7000 opt 1) so a ticket can be opened fo...
REJECTION: Acknowledgement Rejected for Invalid Information - The
claim encounter has invalid information as specified in the Status
details and has been rejected. Missing or invalid information.
WHAT HAPPENED: This is an unspecific error message. An a...
REJECTION: INSURED NAME, SSN/EMPLOYEE ID NUMBER, ACCOUNT/GROUP NUMBER,
GROUP NAME NOT FOUND ON CARRIER
WHAT HAPPENED: Based on the patient information the claim, the patient
could not be found in the payer's system.
RESOLUTION: Verify insured ID, patien...
REJECTION: Payer Specific Edit: Member ID must be all numeric, length
8 through 12 (FE341)
WHAT HAPPENED: The insured ID in box 1a (HCFA), boxes 8a and 60 (UB04)
does not fit the criteria of being 8-12 numerical characters in
length.
RESOLUTION: Double ...
REJECTION: Acknowledgement Rejected for Invalid Information - The
claim encounter has invalid information as specified in the Status
details and has been rejected. Referral authorization.
WHAT HAPPENED: The information in box 23 is not valid.
RESOLUTION...
REJECTION: Payer Specific Edit: Member ID must be length 9, 12, 13, or
14. (FE342)
WHAT HAPPENED: The insured ID in box 1a (HCFA), boxes 8a and 60 (UB04)
does not fit the criteria of being 9, 12, 13, or 14 characters in
length.
RESOLUTION: Double check ...
REJECTION: Payer Specific Edit: Member ID must begin with 954. (FE330)
WHAT HAPPENED: The insured ID in box 1a does not fit the criteria of
beginning with the digits 954.
RESOLUTION: Double check the insured ID, verify the payer, and the
information in ...
REJECTION: Billing NPI required when legacy Billing ID does not exist.
(RC133)
WHAT HAPPENED: Neither the NPI or the Billing ID were sent in box 33a
or 33b.
RESOLUTION: Need to add the NPI or the Billing ID in box 33a or 33b
and update the claim as nece...
REJECTION: Coordination of Benefits: Line Adjudication Date (Missing
or Invalid). (FE312)
WHAT HAPPENED: The adjudication date (date of the EOB) at the bottom
of the claim form was not sent.
RESOLUTION: Need to add adjudication date and update the claim...
REJECTION: Secondary Claim Information Missing or Invalid - Line Item
Charge Amount must Equal Sum Of Adjustment Amounts plus Primary Payer
Paid Amount (FE212)
WHAT HAPPENED: The amount in the primary payer payment amount plus the
amounts in the reasons ...
REJECTION: LINE ITEM CHARGES DO NOT MATCH TOTAL CHARGE (RC73)
WHAT HAPPENED: The line item charges in boxes 24f do not add up to the
charges that are in box 28.
RESOLUTION: This is the information that came over from the inbound
file. If this is auto-ca...
REJECTION: Line Item Control Number
WHAT HAPPENED: The same line item control number was sent in Loop
2400 REF*6R for multiple line itmes.
RESOLUTION: Need to update software so that it is different for each
line item.
REJECTION: LineItem CAS Invalid (FE384)
WHAT HAPPENED: On the inbound file, one of the CAS segments in loop
2430 is invalid.
RESOLUTION: Please contact our customer service department
(360-975-7000 opt 1) so one of our reps can advise which line item
ha...
REJECTION: LineItem Must Have a dollar amount greater than 0 to be
billed (FE64)
WHAT HAPPENED: A zero dollar charge was sent in box 24.
RESOLUTION: Charges need to be at least $0.01.
REJECTION: Lineitem Service Id Qualifier IV Not Supported (RC144)
WHAT HAPPENED: In loop 2400, SV101-1 the qualifier 'IV' was sent.
RESOLUTION: At this time, 'IV' is not a valid qualifier. Need to make
an update in the billing software to a valid qualif...
REJECTION: Lineitem Service Id Qualifier Unknown (RC146)
WHAT HAPPENED: One of the line items has an invalid qualifier in the
SV101-1 segment.
RESOLUTION: Need to update the invalid qualifier in the billing
software and resubmit the claim.
REJECTION: Lineitem Service Id ZZ Not Supported (RC147)
WHAT HAPPENED: In loop 2400, SV101-1 the qualifier 'ZZ' was sent.
RESOLUTION: At this time, 'ZZ' is not a valid qualifier. Need to make
an update in the billing software to a valid qualifier and re...
REJECTION: Claim not covered by this payor contractor. Please submit
to correct payor.
WHAT HAPPENED: Claim to wrong payer.
RESOLUTION: Contact the phone number on the back of the patients ID
card and verify where the claim should be sent.
REJECTION: Member Not Found.
WHAT HAPPENED: Patient ID in box 1a (HCFA) or box 60 (UB) is invalid.
RESOLUTION: Most of the prefixes will either be BSCJ or BSLJ. If
there are any questions on eligibility, please visit this website:
www.magellanprovider....
REJECTION: Complete Payer Address Information Required (RC142)
WHAT HAPPENED: PO Box was not sent in the payer information.
RESOLUTION: This payer requires the PO Box to be sent in the payer
loop. Need to update the payer PO Box and resend.
REJECTION: TIN NOT FOUND, CHECK FOR TYPOS. IF TIN CORRECT, CONTACT
YOUR PROVIDER REP
WHAT HAPPENED: Box 25 does not match what the payer has on file.
RESOLUTION: Verify number in box 25 and call the payer to update info
if needed.
REJECTION: SUBSCRIBER GROUP OR POLICY NUMBER: REQUIRED; MUST BE
ENTERED FOR PAYER
WHAT HAPPENED: Box 11 was left blank.
RESOLUTION: Need to verify insured ID card and update claim as
necessary.
REJECTION: Mammography Certification Number is required for mammogram
services. (FE390)
WHAT HAPPENED: Mammography services were billed, but no Mammography
Certificate number was sent on the claim.
RESOLUTION: This can be added in the additional fields ...
REJECTION: 1053721431 Rendering Provider NPI is not registered.Trading
Partner enrollment needs to be completed.
WHAT HAPPENED: Sent claims to payer, but pre enrollment is not set up
on the payers end.
RESOLUTION: Verify who the claim was sent to and wh...
REJECTION: 01Invalid Provider ID - Billing Physician (EDS Table)
WHAT HAPPENED: The billing provider NPI in box 33a is not what the
payer has on file.
RESOLUTION: Verify the NPI in box 33a and update the claim as
necessary (see attached picture below).
REJECTION: Maximum allowed value for line item charge is 99,999.99.
(FE319)
WHAT HAPPENED: One of the line item charges in box 24F was more than
the allowable amount.
RESOLUTION: Verify the charges in box 24 and update the claim.
REJECTION: Maximum number of lineitems exceeded (50 per claim) (FE136)
WHAT HAPPENED: More than 50 line items were sent.
RESOLUTION: Split claim into more than one (1) claim.
REJECTION: REJ-Prior Authorization Number (INVALID CHARACTER(S).)
WHAT HAPPENED: Invalid information was sent in box 23.
RESOLUTION: Verify information in box 23 and update as necessary. If
there is no authorization, leave box 23 blank.
REJECTION: Payer Specific Edit: Medi-cal should not be billed first
when patient has Medicare. Bill Medicare first. If Medicare paid $0,
then bill a Primary claim with Medi-cal as Primary, do not list
Medicare. (FE418)
WHAT HAPPENED: Medicare was listed ...
REJECTION: Payer Specific Edit: Payer Amount Due cannot be less than
zero. (RC174)
WHAT HAPPENED: Box 55 was sent blank.
RESOLUTION: Payer requires amount due to be sent in box 55. Add the
information and update the claim.
REJECTION: Claim/submission format is invalid.
WHAT HAPPENED: Medicaid is not the primary payer.
RESOLUTION: Verify the primary payer and file Medicaid as the
secondary.
REJECTION: Acknowledgement/Returned as unprocessable claim | Entity
not found. | Entitys authorization/certification number.
WHAT HAPPENED: The prior authorization number in box 23 was not sent.
RESOLUTION: Based on the CPT codemodifier being billed, ...
REJECTION: TPO rejected claim/line because payer name is missing. (Use
status code 21 and status code 125 with entity code )
WHAT HAPPENED: The primary payer carrier code needs to be sent in the
'Secondary Claim Info' section where the payer ID usually ...
REJECTION: SENDER NOT AUTHORIZED TO SUBMIT FOR THIS PROVIDER - HL 2
WHAT HAPPENED: The correct transactions were not selected when
filling out the pre enrollment form, or not pre enrolled yet.
RESOLUTION: Contact the payer and verify what EDI transact...
REJECTION: 00 Multiple Service Location error| Multiple Service
Locatio Multiple Service Location error| Multiple Service Locations
Exist - the Service Location Must be Provided.
WHAT HAPPENED: The facility ID was not sent in box 32b.
RESOLUTION: Need t...
REJECTION: Payer Specific Edit: Rendering ID must be length 7. (FE344)
WHAT HAPPENED: The provider pin above the NPI in 24j needs to be 7
characters long.
RESOLUTION: Verify the information for the provider pin above the NPI
in box 24j and update the cl...
REJECTION: Referring Provider Information Missing
WHAT HAPPENED: A referral number was sent but a referring provider
was not.
RESOLUTION: Either remove referral number or send a referring
provider.
REJECTION: Entity not eligible for benefits for submitted dates of
service. Note: This code requires use of an Entity Code
WHAT HAPPENED: Based on the patient information the claim, the patient
was not eligible for benefits on the date of service.
RESOL...
REJECTION: E1018 - Other Payer Primary Identifier must be 4 Chars. or
less
WHAT HAPPENED: The carrier code for the primary payer was not sent
RESOLUTION: Need to send the carrier code for the primary payer in the
'Secondary Claim Info' section at the b...
REJECTION: E1018 - Other Payer Primary Identifier must be 3 Chars. or
less
WHAT HAPPENED: The primary payer carrier code needs to be sent in the
'Secondary Claim Info' section where the payer ID usually goes.
RESOLUTION: Need to add the primary payer c...
REJECTION: Acknowledgement/Returned as unprocessable claim | CLAIM
INDICATES CLIENT HAS OTHER INSURANCE. ALL OR PART OF THE REQUIRED
INFORMATION IS MISSING. SEE PROVIDER MANUAL FOR REQUIRED OTHER
INSURANCE INFORMATION. | PERFORMING PROVIDER NUMBER NOT IDE...
REJECTION: Other Payer Primary Identifier must be 3 Chars. or less
WHAT HAPPENED: The primary payer carrier code needs to be sent in the
'Secondary Claim Info' section where the payer ID usually goes.
RESOLUTION: If the payer ID is there, please refer...
REJECTION: Subscriber ID must be less than 9 Chars
WHAT HAPPENED: The insured ID in box 1a does not fit the criteria of
being less than 9 characters.
RESOLUTION: Verify the insured ID card and update the claim as
necessary.
REJECTION: Payer Specific Edit: Invalid Insured ID format. Must be 11
characters. 9 numeric followed WA. (RC130)
WHAT HAPPENED: The insured ID in box 1a does not fit the above
criteria.
RESOLUTION: Verify the patient's insured ID and update box 1a as
ne...
REJECTION: Acute Manifestation Date Required when CPT code is 98940,
98941, 98942, 98943 and CR2-08 (HCFA Box 10d) is "A" or "M" (RC183)
WHAT HAPPENED: Box 10d (Additional Fields) was sent with the letter
'A' or 'M' but the Acute Manifestation Date was n...
REJECTION: ~Acknowledgement/Rejected for Invalid Information |
Entity's authorization/certification number.
WHAT HAPPENED: The Mammography Certificate number in the Additional
Fields is not correct.
RESOLUTION: Need to correct/remove the Mammography Cer...
REJECTION: Acknowledgement Rejected for Invalid Information - The
claim encounter has invalid information as specified in the Status
details and has been rejected. claim filing indicator.
WHAT HAPPENED: The original uploaded ANSI file had "MB" in the SBR...
REJECTION: ~Acknowledgement / Rejected for relational field in error.
| Detailed description of service.
WHAT HAPPENED: One of the CPT codes needs a line item note.
RESOLUTION: If it is a drug that is being billed, need to put the
name of that drug in ...
REJECTION: Acknowledgement / Rejected for relational field in error. |
Entity's National Provider Identifier (NPI). | Entity's tax id.
WHAT HAPPENED: NPI/TIN combination is not what the payer has on file.
RESOLUTION: Verify the NPI/TIN (see attached pi...
REJECTION: ~Acknowledgement/Rejected for Invalid Information | Entitys
Middle Name
WHAT HAPPENED: A character other than a letter was sent for the middle
initial. NOTE: The rejection is not specific to which name is in
error.
RESOLUTION: Verify what is...
REJECTION: ~Acknowledgement/Rejected for Invalid Information | Entitys
Postal/Zip Code.
WHAT HAPPENED: There is a zip code on the claim that is not valid.
RESOLUTION: If all of the zip codes do match the city/state
combination on the claim form, you wi...
REJECTION: ~Acknowledgement/Rejected for Invalid Information |
External Cause of Injury Code (E-code). | Principal diagnosis code.
WHAT HAPPENED: The first diagnosis code in box 21 is an E-code.
RESOLUTION: 'E' codes cannot be the first code in box 21....
REJECTION: Acknowledgement/Rejected for Invalid Information | HCPCS |
Line Adjudication Information. Note: At least one other status code is
required to identify the data element in error.
WHAT HAPPENED: One of the CPT codes was not valid on the date of...
REJECTION: Hospice Employee Indicator
WHAT HAPPENED: CLM05 (place of service) was sent with the code 34,
which stands for hospice, but the CRC segment (Hospice Employee
Indicator) was not sent.
RESOLUTION: When CLM05 (place of service) is 34, must send ...
REJECTION: ~Acknowledgement / Rejected for relational field in error.
| Entity's name, address, phone and id number. | Missing or invalid
information.
WHAT HAPPENED: This claim rejection is unspecific.
RESOLUTION: You will need to call our customer ser...
REJECTION: Rejected - Invalid Data National Provider Identifier (NPI)
WHAT HAPPENED: An invalid NPI was sent on the claim.
RESOLUTION: Will want to verify what NPIs are set up at the payer.
A customer service rep can verify if this is the rendering or ...
REJECTION: Payer Responsibility Sequence Number can occur only once in
a claim
WHAT HAPPENED: One of the SBR loops were sent twice. This means that
there are two payers indicated as primary or two payers indicated as
secondary on the same claim.
RESOLU...
REJECTION: ~Acknowledgement/Rejected for Invalid Information | Length
invalid for receiver's application system. Note: At least one other
status code is required to identify the data element in error. |
Submitted charges.
WHAT HAPPENED: Either total char...
REJECTION: ~Acknowledgement/Rejected for Invalid Information |
Information submitted inconsistent with billing guidelines. Note: At
least one other status code is required to identify the inconsistent
information. | Unit or Basis for Measurement Code
WH...
REJECTION: ~Acknowledgement/Rejected for Invalid Information |
Entity's Postal/Zip Code. | Other payer's Explanation of
Benefits/payment information.
WHAT HAPPENED: The 'other payer's' zip code is invalid.
RESOLUTION: There is not a place to fix this ...
REJECTION: INS TYPE CD (2320/SBR05 = MB ) INVALID AS SECONDARY
WHAT HAPPENED: The word 'Medicare' was sent in box 9d.
RESOLUTION: Remove the word medicare from box 9d and resend.
REJECTION: Payer Specific Edit: Member ID (1A) must be 9 or 10 digit
number. (FE368)
WHAT HAPPENED: The insured ID in box 1a does not fit the format of
being a 9 or 10 digit number (no letters).
RESOLUTION: Verify the claim was sent to the correct payer...
REJECTION: Payer Specific Edit: Member ID (1A) must not be less than
length 9. (FE329)
WHAT HAPPENED: Insured ID is not long enough.
RESOLUTION: Verify the patient ID from the insured ID card.
REJECTION: Payer Specific Edit: Member ID (1A) must be 9 thru 11 digit
number. (FE210)
WHAT HAPPENED: An incorrect insured ID was sent.
RESOLUTION: As per the payer, the insured ID can only 9-11 numbers
long, no letters or special characters.
REJECTION: Billing Provider Phone Number Required as Secondary
Provider Id (1898)
WHAT HAPPENED: Phone number was not sent in box 52.
RESOLUTION: This is a payer specific requirement needed to be sent.
Add phone number to box 52 and update the claim.
REJECTION: Acknowledgement Returned as unprocessable claim-The claim
encounter has been rejected and has not been entered into the
adjudication system. Missing or invalid information.
WHAT HAPPENED: This is an unspecific error message. An additional
mes...
REJECTION: Missing Primary Insureds First Name (FE61)
WHAT HAPPENED: Insured's first name in box 4 is missing.
RESOLUTION: Verify the information in box 4 and update the claim as
necessary.
REJECTION: Missing Primary Insureds Last Name (FE60)
WHAT HAPPENED: Insured's last name in box 4 (HCFA), box 8b and 38
(UB04) is missing.
RESOLUTION: Verify the information in box 4 (HCFA), box 8b and 38
(UB04) and update the claim as necessary.
REJECTION: Missing/Invalid Ambulance Miles (FE325)
WHAT HAPPENED: Ambulance miles were not sent in the Additional Fields
section.
RESOLUTION: Need to add ambulance miles and resend.
REJECTION: Missing/Invalid Other Insured Name (HCFA box 9, UB box 58)
(FE338)
WHAT HAPPENED: Box 9 (HCFA), box 58 (UB04) does not have the other
insured's name.
RESOLUTION: When box 11d is marked 'Yes' a name is required in box 9
(HCFA), box 58 (UB04). ...
REJECTION: A7:54 Acknowledgement/Rejected for Invalid Information -
The claim/encounter has invalid information as specified in the Status
details and has been rejected.:Duplicate of a previously processed
claim/line. (A7:54) (A7:54)
WHAT HAPPENED: Paye...
REJECTION: Payer does not accept claims with more than 22 line items
(FE119)
WHAT HAPPENED: More than 22 line items were sent on one claim.
RESOLUTION: Need to split the claim into more than one claim so there
is no more than 22 line items on each claim...
REJECTION: Payer Specific Edit: Recipient Does Not Accept Out of State
Claims (FE315)
WHAT HAPPENED: Claim was sent from outside of CA.
RESOLUTION: Claims can only be sent from within CA. Needs to verify
insured ID card and update as necessary.
REJECTION: REJ- 187 (Date(s) of service.Claim Level Status - )
WHAT HAPPENED: The claim rejected due to the patient not being covered
on those dates of service. More than likely the claim was sent to the
wrong payer.
RESOLUTION: Need to verify the insur...
REJECTION: REJ- 32(Subscriber and policy number/contract number not
found.Claim Level Status - )
WHAT HAPPENED: The patient ID in box 1a does not match the other
patient info on the claim.
RESOLUTION: Verify insured ID, patient name, and date of birth, ...
REJECTION: DETAILED EXPLANATION MISSING OR INVALID INFORMATION
(21);COORDINATION OF BENEFITS CODE (550)
WHAT HAPPENED: This indicates the patient has another Primary
Insurance other than MVP.
RESOLUTION: Need to verify the patient's primary insurance an...
REJECTION: DETAILED EXPLANATION : PATIENT NOT ELIGIBLE NOT APPROVED
FOR DATES OF SERVICE (88);
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, pa...
REJECTION: BILLING AND SERVICE FACILITY NPI CANNOT BE THE SAME
WHAT HAPPENED: The facility loop and billing loop contained the same
NPI.
RESOLUTION: Remove the information from box 32 if it is the same as
box 33, or update the NPI in box 32a or 33a as n...
REJECTION: CARRIER ACKNOWLEDGES RECEIPT OF CLAIM
PLEASE SEND THE PRIMARY SURGEONS NAME
PLEASE SEND THE PRIMARY SURGEONS NAME
MISSING/INVALID PROVIDER ID PREVENTS CARRIER FROM PROCESSING CLAIM
WHAT HAPPENED: Did not send the rendering provider pin in bo...
REJECTION: NATIONAL DRUG CODE- REQUIRED; MUST BE ENTERED WHEN SERVICE
LINE PROCEDURE CODE BEGINS WITH J FOR PAYER
WHAT HAPPENED: A CPT code starting with the letter 'J' was sent, but
an NDC code was not sent for that code.
RESOLUTION: Need to send the ...
REJECTION: Payor requires 9 digit, billing provider, zip code. (FE233)
WHAT HAPPENED: 9 digit zip code was not sent in box 33.
RESOLUTION: Need to add the 4 digit extention in box 33.
REJECTION: Payor requires 9 digit, facility address, zip code. (FE235)
WHAT HAPPENED: 9 digit zip code was not sent in box 32.
RESOLUTION: Need to add the 4 digit extention in box 32.
REJECTION: Newborn - patient not found (RC50)
WHAT HAPPENED: Based on the eligibility file we received from this
payer, the insured's name, date of birth, and insured ID combination
does not match what the payer has on file.
RESOLUTION: Verify the insur...
REJECTION: Some Diagnosis Codes exist on this Claim with no Line Item
Pointers (LC1715)
WHAT HAPPENED: There are diagnosis codes in box 21 that are not being
referenced in box 24e in any of the line items.
RESOLUTION: Either update box 24e or remove the...
REJECTION: No line items are billed for this claim (RC74)
WHAT HAPPENED: No line items came in on the inbound file.
RESOLUTION: The billing software created a file that had no line
items. Need to verify the information in the billing software and
contac...
REJECTION: Description required when submitting a non-specific
procedure code. (FE395)
WHAT HAPPENED: One of the codes in box 44 requires a description to be
sent in box 43 (UB04) or the description can be sent as a line item
note in box 24 (HCFA).
RESO...
REJECTION: Payer Requirement: Submit separate submitters in separate
files. (FV29)
WHAT HAPPENED: For Noridian, only 1 NPI and 1 TIN can be sent per
file.
RESOLUTION: Verify the TIN and NPI on the claims. If they need to be
different, they need to be se...
REJECTION: NPI IS MISSING FOR PROVIDER . NPI IS REQUIRED.
WHAT HAPPENED: One of the NPIs on the claim is missing.
RESOLUTION: Review the claim and add NPI as needed.
REJECTION: Payer Specific Edit: Onset Date of Current Illness/Symptom
is Invalid. Must not occur after Date of Service (RC160)
WHAT HAPPENED: The date in box 14 is after the date of service in box
24a.
RESOLUTION: Need to update either date in box 14 or...
REJECTION: Onset of Current Illness or Symptom cannot be in the
future. (FP03)
WHAT HAPPENED: The date in box 14 is in the future.
RESOLUTION: Update the date in box 14 so it is no longer in the
future.
REJECTION: ORD PROV ADDR LIN NOT ALLOWED
WHAT HAPPENED: Ordering physician address info was sent but was not
expected.
RESOLUTION: In 5010, the only reason an address is sent in that loop
is if the claim is for DME or if Oxygen Therapy Certification is
...
REJECTION: 2420E N402 Ordering Provider State Code must be 2 bytes
(RC161)
WHAT HAPPENED: State code for the Ordering Provider in loop 2420E is
not valid.
RESOLUTION: Need to verify the address information in loop 2420E in
the billing software and resen...
REJECTION: Original Ref No (REF-F8 or Box 22) Missing/Invalid.
Required When Claim Frequency Code Indicates a Resubmission (RC135)
WHAT HAPPENED: A reference number was not sent in box 22.
RESOLUTION: If a resubmission code is sent in box 22, the origin...
REJECTION: OSNA Specific Edit: New Patient Filter (RC164)
WHAT HAPPENED: CPT code that was billed is for new patients only. The
patient being billed has had claims previously submitted, therefore
they are not a new patient.
RESOLUTION: Need to double ch...
REJECTION: Other Insured Info (Field 9,a-d) is Missing on Claim (RC65)
WHAT HAPPENED: Box 11d was marked 'Y' but not all of the boxes in
9,a-d were filled out.
RESOLUTION: Need to fill out all boxes in 9,a-d or mark box 11d as 'N'
and update the claim.
REJECTION: Other Payer Information Required (DE304) (2024)
WHAT HAPPENED: (HCFA) The 'Other Payer Loop' (2330B, NM1*PR) was not
sent in. (Dental) This payer requires to have the other payer
information filled out in boxes 5-11.
RESOLUTION: (HCFA)When l...
REJECTION: Other PayerId Missing (DE322)
WHAT HAPPENED: The payer ID is missing from the 'Other Payer Loop'
(2330B, NM109), box 50b (UB04).
RESOLUTION: This is something that needs to be updated in the
software. Contact software vendor if there is any q...
REJECTION: Other Subscriber zip or State invalid (FE362)
WHAT HAPPENED: There is an incorrect city/state/zip combination on the
inbound file in Loop 2330A.
RESOLUTION: Need to update the software to send the correct
information for the other subscriber ...
REJECTION: Rejected - Invalid Data Date(s) of Service.
WHAT HAPPENED: A date of service was sent that was not valid.
RESOLUTION: Verify the dates in box 24a (HCFA) or box 45 (UB) and
update the claim as necessary.
REJECTION: Rejected - Invalid Data Procedure code for services
rendered.
WHAT HAPPENED: An invalid CPT code was sent in.
RESOLUTION: Needs to verify code and speak to provider services if
necessary.
REJECTION: Patient / Subscriber DOB Invalid - Future Dates Not
Accepted (FE348)
WHAT HAPPENED: The date of birth in box 3 or 11a is a future date.
RESOLUTION: Verify the date of birth and update the claim.
REJECTION: Patient / subscriber dob invalid (FE361)
WHAT HAPPENED: The date of birth is box 3 (HCFA), box 10 (UB04) not a
valid date.
RESOLUTION: Verify the information in box 3 (HCFA), box 10 (UB04) and
update the claim as necessary.
REJECTION: Patient City Missing/Invalid Length (FE70)
WHAT HAPPENED: Patient's city in box 5 (HCFA), box 9b and box 38
(UB04) is missing.
RESOLUTION: Add patient city in box 5 (HCFA), box 9b and box 38 (UB04)
and update the claim.
REJECTION: Patient Date Of Birth Required (FE67)
WHAT HAPPENED: The patient's date of birth in box 3 (HCFA), box 10
(UB04) is missing.
RESOLUTION: Add the date of birth in box 3 (HCFA), box 10 (UB04) and
update the claim.
REJECTION: Acknowledgement Returned as unprocessable claim-The claim
encounter has been rejected and has not been entered into the
adjudication system. Patient eligibility not found with entity.
WHAT HAPPENED: Based on the patient information the claim, ...
REJECTION: Patient First Name Required (FE66)
WHAT HAPPENED: The patient's first name was not listed in box 2.
RESOLUTION: Need to add patient's first name in box 2 and update the
claim.
REJECTION: Incomplete insured information was provided for a patient
who is not the insured (FE87)
WHAT HAPPENED: Box 6 was marked as something other than 'Self' and
information in either box 4 or 7 is incomplete.
RESOLUTION: Verify that box 6 was marke...
REJECTION: Patient Last Name required (FE65)
WHAT HAPPENED: Patient last name in box 2 (HCFA), box 8b, box 38
(UB04) is missing.
RESOLUTION: Verify the information in box 2 (HCFA), box 8b, box 38
(UB04) and update the claim as necessary.
REJECTION: Patient Not Covered (at time of service) (RC03)
WHAT HAPPENED: Patient did not have coverage at the time of service as
per the eligibility file we received from the payer.
RESOLUTION: Need to contact the payer to verify coverage.
REJECTION: Patient Not Found (RC02)
WHAT HAPPENED: Patient did not match eligibility records that we
received from the payer. For a list of payers we check, you can
contact our customer service department.
RESOLUTION: If you do not know how to use the p...
REJECTION: PATIENT NOT ON CARRIER FILES OR PATIENT BIRTH DATE INVALID
WHAT HAPPENED: The patient ID does not match the other patient info on
the claim.
RESOLUTION: Verify insured ID, patient name, and date of birth, as
well as verify if they are the pri...
REJECTION: Payer Specific Edit: Insured First Name Required when
Patient Relationship to Insured is not Self (RC168)
WHAT HAPPENED: Box 6 was not marked self, but no patient first name
was sent in box 4.
RESOLUTION: Need to add patient first name in box...
REJECTION: Per Payer - Patient Relationship To Insured Must Be Self,
Patient should be listed as both Patient and Insured. (RC120)
WHAT HAPPENED: Box 6 was not marked as 'Self'.
RESOLUTION: As per the payer, box 6 always needs to be marked as
'Self'.
REJECTION: Patient Street Address Required (FE69)
WHAT HAPPENED: Patient address in box 5 (HCFA), box 9, a-d and box 38
(UB04) is missing.
RESOLUTION: Need to add patient address in box 5 (HCFA), box 9, a-d
and box 38 (UB04) and update the claim.
REJECTION: Patient Zip Code Invalid or Doesnt Match State Code (FE121)
WHAT HAPPENED: A valid state and zip code combination was not sent in
box 5.
RESOLUTION: Verify the information in box 5 and update as necessary.
REJECTION: Patient Zip code required (FE72)
WHAT HAPPENED: Patient zip code in box 5 (HCFA), box 9d and box 38
(UB04) is missing or invalid.
RESOLUTION: Verify the zip code in box 5 (HCFA), box 9d and box 38
(UB04) and update the claim.
REJECTION: Patient Zip Invalid For State (FE358)
WHAT HAPPENED: Zip code listed on the claim does not match the
city/state combination.
RESOLUTION: Check the address on the USPS website
[https://www.usps.com/] and update the claim as necessary.
REJECTION: Patient/Subscriber State Code is Missing or Invalid (FE71)
WHAT HAPPENED: The state code in box 5 (HCFA), box 9c and box 38
(UB04) is either missing or not correct.
RESOLUTION: Verify the state code in box 5 (HCFA), box 9c and box 38
(UB04) a...
REJECTION: Payer Specific Edit: Payer Address is Required (RC75)
WHAT HAPPENED: The payer's address was not sent on the claim.
RESOLUTION: Need to add payer's address on the top of the claim form
and resubmit the claim.
REJECTION: Payer Assigned Claim Control Number
WHAT HAPPENED: The Orig. Ref. No. in the second box of box 22 (HCFA),
box 64 (UB04) is invalid or was not expected.
RESOLUTION: Verify the number being sent with the payer and update or
remove as necessary...
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: ...
REJECTION: Payer does not accept claims with more than 6 line items
(FE132)
WHAT HAPPENED: This is a payer specific edit. They do not allow more
than 6 line items per claim.
RESOLUTION: Need to split claim into more than one (1) claim.
REJECTION: Payer does not Accept ICD-10 Diagnosis Codes for this DOS
WHAT HAPPENED: The ICD Indicator selected is not valid for the date of
service being billed.
RESOLUTION: If you create you create your claims via one of the Office
Ally applications (O...
REJECTION: Payer no longer accepts paper claims from clearinghouses.
Please print and mail claim directly to payer. (RC123)
WHAT HAPPENED: This claim was sent by paper and payer can only accept
paper claims from the provider directly.
RESOLUTION: Either...
REJECTION: Payer not accepting this claim type
WHAT HAPPENED: Claim is either an auto claim billed to a workcomp only
payer, or vice versa.
RESOLUTION: Verify the payer ID claim should be sent to. Some payers
will have JXXXX for their workcomp payer ID ...
REJECTION: Payer Paid Amount (AMT*D) or any CAS segments are not
allowed when the COB Total Non-Covered Amount (AMT*A8) is submitted.
WHAT HAPPENED: The AMT*A8 cannot be sent when the AMT*D and CAS
segments are sent.
RESOLUTION: The AMT*A8 segment repr...
REJECTION: Payer Requires Pre-Enrollment for Electronic Claims
Submission. Provider is not yet approved to submit claims
electronically to this payer (RC55)
Printing Services Not requested, to enable contact (866)-575-4120
option 1 (RC68)
WHAT HAPPENED...
REJECTION: Payer zip or State invalid (FE363)
WHAT HAPPENED: The city, state, zip combination for the payer at the
top of the claim is not valid.
RESOLUTION: Verify the the payer address information and update the
claim as necessary.
REJECTION: PayTo Address is Incomplete. When Street Address or City or
State or Zip is Present then ALL are Required. (FE381)
WHAT HAPPENED: Part of the pay-to address was sent, but not the entire
segment.
RESOLUTION: Need to add the rest of the pay-to ...
REJECTION: Missing Invalid Billed Charge
WHAT HAPPENED: A zero dollar charge was sent.
RESOLUTION: Charges need to be for a least $0.01.
REJECTION: CO PROVIDER NOT FOUND.
WHAT HAPPENED: The rendering provider is either missing or not linked
to the billing provider.
RESOLUTION: Need to add the rendering provider NPI or need to call the
payer to get the rendering provider linked to the bi...
REJECTION: VENDOR ID NOT FOUND / EMPTY
WHAT HAPPENED: The submitted tax ID not set up in PUP's system.
RESOLUTION: The provider will need to call PUP's provider Relations
Department at 1.866.427.9152 and verify that their identifiers are set
up correctl...
REJECTION: Place of service code, on claim level is invalid. (LC1736)
WHAT HAPPENED: This was sent in ANSI. An invalid Place of Service in
loop 2300 segment CLM05
RESOLUTION: Make an update in the billing software to send the
correct place of service in...
REJECTION: Place of service code, on line (number will be indicated)
is invalid.
WHAT HAPPENED: The place of service code in box 24b on the indicated
line item is invalid.
RESOLUTION: Verify the place of service code in box 24 on the
indicated line ite...
REJECTION: Policy number not on file
WHAT HAPPENED: Based on the patient information the claim, the patient
ID is not correct.
RESOLUTION: Double check the patient's insured ID card and then call
payer if needed to verify information. If this has been ...
REJECTION: Payer No Longer Accepting Paper Claims - Pre-Enrollment
Needed (RC77)
WHAT HAPPENED: We do not have pre enrollment logged for this payer for
the NPI in box 33a.
RESOLUTION: Verify the claim was sent to the correct payer. Verify if
have receiv...
REJECTION: Rejected - Unprocessable Claim Should be handled by entity.
WHAT HAPPENED: Claim was sent to the wrong payer.
RESOLUTION: If the claim is for a chiropractor, need to submit to HSM,
not Preferred One.
REJECTION: Amisys member id submitted
WHAT HAPPENED: Insured ID is not correct.
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 already been done, please obtai...
REJECTION: DOB-Nomtch
WHAT HAPPENED: Date of birth on the claim does not match the other
patient info on the claim.
RESOLUTION: Need to double check the patient's insured ID card and
then call payer if needed to verify information.
REJECTION: Primary Payer Required on Secondary Claim (DE301)
WHAT HAPPENED: Payer name and payer ID is required in the secondary
section (bottom) of the claim.
RESOLUTION: Verify the information at the bottom of the claim for the
payer name and payer ID...
REJECTION: Printing Services Not Requested by User (RC62)
WHAT HAPPENED: There are two possible reasons for this rejection:
1) We do not have pre-enrollment logged for this payer for the NPI in
box 33a
2) The payer does not accept this type of claim el...
REJECTION: Prov-Unknown
WHAT HAPPENED: This is an unspecific error message.
RESOLUTION: Need to verify that all provider info on the claim is
EXACTLY what the payer has in their system including name, address,
NPI, and taxonomy if needed.
REJECTION: Payer Specific Edit: Invalid Insured ID Format. Must be 11
characters starting with 100, OR 10 characters starting with 2
letters, OR 9 characters starting with R. Last 2 characters must be
numeric. (RC129)
WHAT HAPPENED: The insured ID in box...
REJECTION: Provider City/State/Zip Missing (FE98)
WHAT HAPPENED: The billing provider city/state/zip code is missing in
box 33.
RESOLUTION: Add the billing provider city/state/zip code in box 33 and
update the claim.
REJECTION: Provider ID Cannot Be Same Value as Tax ID (FE215)
WHAT HAPPENED: The Tax ID was sent in box 24j above the NPI.
RESOLUTION: The Tax ID and provider ID cannot be the same. Need to
update either box 25 or the provider ID above the NPI in box 24...
REJECTION: Provider Last Name Missing (FE50)
WHAT HAPPENED: The rendering provider's name in box 33 was left blank.
RESOLUTION: Add rendering provider's last name and update the claim.
REJECTION: Provider Not Found (RC01)
WHAT HAPPENED: Provider is not loaded into our system.
RESOLUTION: Please contact Customer Service via live chat, email
(info@officeally.com) or phone (360-975-7000 option 1) for assistance.
REJECTION: Provider Tax ID Missing/Invalid (FE53)
WHAT HAPPENED: The information box 25 (HCFA) or box 5 (UB04) is
missing or invalid.
RESOLUTION: Verify the information in box 25 (HCFA) or box 5 (UB04)
and update the claim as necessary.
REJECTION: Provider Taxonomy Code Is Missing or Invalid (RC108)
WHAT HAPPENED: A taxonomy code is required to be sent and payer will
not accept a claim without it being sent originally.
RESOLUTION: Add taxonomy code to the claim (Box 33 for HCFA / Box 8...
REJECTION: Providers have 180 days from DOS to submit (FE155)
WHAT HAPPENED: Date of service is outside of the timely filing period.
RESOLUTION: Claim needs to be submitted by paper, we cannot send this
claim to the payer electronically.
REJECTION: 2420B NM108 Purchase Service ID Qualifier must be XX
(RC153)
WHAT HAPPENED: The wrong qualifier was sent for the Purchase Service
Provider in NM108.
RESOLUTION: The qualifier in NM108 of loop 2420B must be 'XX'. Need to
update in the billing ...
REJECTION: Purchase Service Provider name, address, phone and id
number.
WHAT HAPPENED: The Purchased Service provider name was sent but the
Purchased Service information was not sent.
RESOLUTION: This cannot be fixed in ClaimFix. Must be updated in
bil...
REJECTION: Acknowledgement Rejected for relational field in error.
Purchase Service Provider Missing or invalid information.
WHAT HAPPENED: The Purchased Service provider name was sent but the
Purchased Service information was not sent.
RESOLUTION: This...
REJECTION: Ambulance transport information is incomplete: Purpose
Description Required When Transport Code is X (Round Trip) (FE335)
WHAT HAPPENED: A line item note was missing in box 24.
RESOLUTION: When the transport code is X, a line item note is
req...
REJECTION: Secondary Claim: Reason Code (Invalid Type / Missing
Value). (FE323)
WHAT HAPPENED: One of the line items at the bottom of the claim form
does not have a reason code.
RESOLUTION: Need to add reason code in the primary EOB section and
update t...
REJECTION: Payer Specific Edit: Referring Provider required when
Referral Number present. (RC154)
WHAT HAPPENED: The referral number was sent in the Additional Fields
section, but the referring provider information was not sent sent in
box 17.
RESOLUTIO...
REJECTION: Referring fields required when Original Ref No (Box 22) is
Present (RC131)
WHAT HAPPENED: Box 17 was sent blank as was the referral number in
the Additional Fields section.
RESOLUTION: When box 22 is sent, box 17 is required as is the referra...
REJECTION: Referring Physician NPI (Invalid Format / Missing Value),
required when Referring Physician Name present (RC88)
WHAT HAPPENED: A name was sent in box 17 but no NPI was sent in box
17b.
RESOLUTION: Add the NPI in box 17b and resend the claim.
REJECTION: Referring prov first and last name must be in separate
fields and both are required (RC158)
WHAT HAPPENED: Either the first or last name for the referring
provider in box 17 was missing.
RESOLUTION: Need to verify the information in box 17 an...
REJECTION: Referring Provider ID Contains Invalid Characters (FV32)
WHAT HAPPENED: The referring provider ID in box 17a has an invalid
character.
RESOLUTION: The referring provider ID in box 17a can only have numbers
or letters, no other characters. Ver...
REJECTION: Referring Provider NPI (or UPIN if NPI unavailable) Missing
/ Invalid (FV28)
WHAT HAPPENED: A valid NPI was not sent in box 17b.
RESOLUTION: If a name is going to be sent box 17, then an NPI is
required in 17b.
REJECTION: Acknowledgement/Returned as unprocessable claim | Other
Entity's Adjudication or Payment/Remittance Date. Note: An Entity code
is required to identify the Other Payer Entity, i.e. primary,
secondary.
WHAT HAPPENED: Medicare was the primary an...
REJECTION: REJ- 19(Entity acknowledges receipt of
claim/encounter.Claim Level Status - )
WHAT HAPPENED: Generally, this is an issue with the group number in
box 11.
RESOLUTION: Verify that the group number on the claim is exactly as it
is on the insure...
REJECTION: Coordination of Benefits: Remittance Date (Missing or
Invalid). (FE398)
WHAT HAPPENED: The claim was sent as a secondary claim, but no
remittance date was sent.
RESOLUTION: Need to verifiy the information in the billing software
and resend th...
REJECTION: Rendering NPI required when legacy Rendering ID does not
exist (RC126)
WHAT HAPPENED: Neither the NPI or the Rendering ID were sent in box
24j.
RESOLUTION: Need to add either the NPI or Rendering ID in box 24j and
update the claim as necessar...
REJECTION: TRENDERING NPI IS NOT ON FILE
WHAT HAPPENED: NPI in box 24j is incorrect.
RESOLUTION: User needs to verify the claim was sent to the correct
payer and also verify the provider information set up in the payer's
system.
REJECTION: Rendering Physician NPI (Invalid Format / Missing Value),
required when Legacy Number present (RC89)
WHAT HAPPENED: NPI was not sent in box 24j under the legacy ID number.
RESOLUTION: Need to add NPI to box 24j and resend the claim.
REJECTION: Rendering Physician NPI (Box 24J) Is Required (RC106)
WHAT HAPPENED: The NPI was not sent in the correct box in 24j.
RESOLUTION: Verify box 24j, add the NPI to the correct box, and update
the claim.
REJECTION: MISSING/INVALID RENDERING PROVIDER ADDRESS
WHAT HAPPENED: The rendering provider NPI does not match what the
payer has on their end.
RESOLUTION: Need to contact the payer to update their rendering
provider information. If this has already bee...
REJECTION: Rendering Provider ID Contains Invalid Characters (FV31)
WHAT HAPPENED: The rendering provider ID above the NPI in 24j has an
invalid character.
RESOLUTION: The rendering provider ID above the NPI can only have
numbers or letters, no other ch...
REJECTION: Rendering Provider Name Required (FE218)
WHAT HAPPENED: The provider's name was not sent in the rendering loop.
RESOLUTION: For these payers, 'signature on file' cannot be sent.
Update the rendering provider name field and resubmit.
REJECTION: Acknowledgement Rejected for Invalid Information - The
claim encounter has invalid information as specified in the Status
details and has been rejected. Rendering Provider National Provider
Identifier (NPI).
WHAT HAPPENED: The NPI in box 24j d...
REJECTION: Payer does not accept more than one unique Rendering
Provider NPI per claim (RC114)
WHAT HAPPENED: Multiple NPIs were sent in different line items in box
24j.
RESOLUTION: Only one rendering NPI can be sent per claim. Need to
update the NPIs i...
REJECTION: Payer edit - repeated CPT code on the same day on different
lines must be coded with a procedure modifer (FE392)
WHAT HAPPENED: The same CPT code was billed for the same date of
service on different line items without different modifiers.
RES...
REJECTION: Requests for additional Information Documentation-Requests
for additional supporting documentation. Examples: certification,
x-ray, notes.Supporting documentation.
WHAT HAPPENED: Additional documentation is required for the processing
of the c...
REJECTION: REQUIRED: Insured Group Name (HCFA 11C, UB04 61, 837 2000B
SBR04) (FE126)
WHAT HAPPENED: Group name was not sent in box 11C (HCFA), box 61
(UB04).
RESOLUTION: Add group name in box 11C (HCFA), box 61 (UB04). If unsure
of what to put there, ca...
REJECTION: REQUIRED: Insured Group Number (HCFA 11, UB04 62, 837 2000B
SBR03) (FE214)
WHAT HAPPENED: Group number was not sent in box 11 (HCFA), box 62
(UB04).
RESOLUTION: Add group number in box 11 (HCFA), box 62 (UB04). If
unsure of what to put there,...
REJECTION: Acknowledgement Returned as unprocessable claim-The claim
encounter has been rejected and has not been entered into the
adjudication system. Returned to Entity.
WHAT HAPPENED: This is an unspecific error message. An additional
message is gene...
REJECTION: CLAIM REJECTED, ENS ECT #20130917E861066D000001
Loop/Segment: 2310/NM1 - Implementation Dependent “Not Used”
Segment Present
WHAT HAPPENED: Payer recently updated their system to not accept box
32 when the information is the same as box 33 (s...
REJECTION: PAYER NAME- INVALID; MUST BE A VALID PAYER NAME FOR PAYER
WHAT HAPPENED: The specific payer name for the patient's group was not
correct.
RESOLUTION: Claims for the following Payer/Plan Names should be
submitted to Samaritan Health Services u...
REJECTION: ABATCH ACCEPTED\RINVALID MEMBER NUMBER
WHAT HAPPENED: The patient ID does not match the other patient info on
the claim.
RESOLUTION: Verify insured ID, patient name, and date of birth, as
well as verify if they are the primary insured or a d...
REJECTION: WHEN THE SECONDARY PAYER RELATIONSHIP TO INSURED = SELF,
THE SECONDARY INSURED A ND PATIENT NAMES MUST BE THE SAME
WHAT HAPPENED: The individual relationship for both the primary and
other insured were both sent as "self", but the names were ...
REJECTION: CptCode Term Date Less Then Service Date/Todays Date
Predetermination (1983, 1984, 1985, 1986, 1987, 1988, 1989, 1990)
WHAT HAPPENED: One of the CPT codes used is no longer valid.
RESOLUTION: Verify the CPT codes and update the claims as nec...
REJECTION: Service Facility Information Required. (RC117)
WHAT HAPPENED: Based on the place of service in box 24b, box 32 is
required.
RESOLUTION: Add the address in box 32 and update the claim.
REJECTION: Identification Code should not be used in Service Facility
Location Name. Element NM109 is used. It is not expected to be used
when it has the same value as element NM109 in loop 2010AA. Segment
NM1 is defined in the guideline at position 2500....
REJECTION: Service Facility Zip Code Invalid or Doesnt Match State
Code (FE122)
WHAT HAPPENED: An invalid state and zip code combination was sent in
box 32.
RESOLUTION: Verify the information in box 32 and update as necessary.
REJECTION: Missing/incomplete/invalid billing provider secondary
identifier
WHAT HAPPENED: The Tax ID + Billing NPI combination is not valid for
Sharp
RESOLUTION: Need to confirm with Sharp that the claim is being billed
with the correct Tax ID + Billin...
REJECTION: National Correct Coding Initiative, CPT cannot be rendered
on the same day as similar CPT without a modifier (FE396)
WHAT HAPPENED: 2 of the CPT codes are similar, but were not sent with
a modifier.
RESOLUTION: A modifier needs to be sent wit...
REJECTION: SOCIAL SECURITY/EMPLOYEE NUMBER NOT FOUND ON CARRIER FILES
WHAT HAPPENED: The patient ID does not match the other patient info on
the claim.
RESOLUTION: Verify insured ID, patient name, and date of birth, as
well as verify if they are the pri...
REJECTION: Payment adjusted because treatment was deemed by the payer
to have been rendered in an inappropriate
WHAT HAPPENED: This is a denial from the claims department.
RESOLUTION: Need to call the claims department for further details.
REJECTION: Start/Stop Time required for CPT code (RC12)
WHAT HAPPENED: One of the CPT codes in box 24d needs a start and stop
time.
RESOLUTION: Verify what codes are being billed in box 24d and add the
start and stop times to the applicable codes. Thes...
REJECTION: Statement dates spanning different years must be sent on
separate claims. (FE400)
WHAT HAPPENED: The dates in box 6 span from one year to another.
RESOLUTION: Need to change the dates in box 6 so they do not span one
year to another. Need to ...
REJECTION: Acknowledgement Rejected for Invalid Information - The
claim encounter has invalid information as specified in the Status
details and has been rejected. Statement from-through dates.
WHAT HAPPENED: Invalid/future date(s) of service were sent ...
REJECTION: STC Tooth number or letter.-Field Tooth - cannot be blank
WHAT HAPPENED: One of the CPT codes requires a tooth number to be
submitted.
RESOLUTION: Needs to add tooth number. Can speak to payer's provider
services if there are questions on whi...
REJECTION: Acknowledgement Rejected for relational field in error.
Submitter Submitter not approved for electronic claim submissions on
behalf of this entity.
WHAT HAPPENED: Sent claims to payer, but pre-enrollment is not set up
on the payers end.
RESOL...
REJECTION: Acknowledgement Returned as unprocessable claim-The claim
encounter has been rejected and has not been entered into the
adjudication system. Subscriber and subscriber id mismatched.
WHAT HAPPENED: Based upon the patient information listed on t...
REJECTION: ~Acknowledgement/Returned as unprocessable claim |
Subscriber and subscriber id not found.
WHAT HAPPENED: The patient ID does not match the other patient info on
the claim.
RESOLUTION: Verify claim was sent to the correct payer. If so,
verif...
REJECTION: Acknowledgement Returned as unprocessable claim-The claim
encounter has been rejected and has not been entered into the
adjudication system. Subscriber and subscriber id not found.
WHAT HAPPENED: The patient ID does not match the other patient...
REJECTION: Subscriber City Missing/Invalid Length (FE377)
WHAT HAPPENED: The city in box 7 (HCFA) or box 38 (UB04) is not a
valid city.
RESOLUTION: Verify the information in box 7 (HCFA) or box 38
(UB04) and update the claims as necessary.
REJECTION: Acknowledgement Rejected for Invalid Information - The
claim encounter has invalid information as specified in the Status
details and has been rejected. Subscriber contract member number.
WHAT HAPPENED: The patient ID does not match the other ...
REJECTION: Acknowledgement Rejected for Invalid Information - The
claim encounter has invalid information as specified in the Status
details and has been rejected. Subscriber contract member number.
WHAT HAPPENED: The patient ID does not match the other ...
REJECTION: Subscriber date of birth.
WHAT HAPPENED: The patient date of birth in box 3 does not match what
the payer has on file.
RESOLUTION: Verify the patient's insured ID card and call the payer as
necessary.
REJECTION: Acknowledgement Rejected for Invalid Information - The
claim encounter has invalid information as specified in the Status
details and has been rejected. Subscriber name.
WHAT HAPPENED: The patient name in box 2 does not match what the payer
ha...
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 patie...
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 t...
REJECTION: Subscriber Not Found (RC165)
WHAT HAPPENED: The patient info on the claim does not match the
eligibility file we received from the payer.
RESOLUTION: Needs to verify insured ID, patient name, and date of
birth, as well as verify if they are t...
REJECTION: Subscriber Zip Invalid For State (FE357)
WHAT HAPPENED: Zip code listed on the claim in box 7 (HCFA) or box 38
(UB04) does not match the city/state combination. NOTE: Generally
the state box is blank.
RESOLUTION: Verify there is a state sele...
REJECTION: Supervising NPI (Invalid Format / Missing Value), required
when supervising physician name present (RC92)
WHAT HAPPENED: Supervising physician name was sent in box 17 or the
additonal fields section, but the NPI was not.
RESOLUTION: Need to a...
REJECTION: BTax ID is not on file for the Billing NPI
WHAT HAPPENED: NPI/TIN combination is not correct.
RESOLUTION: User needs to verify the provider information set up at
the payer's end and verify the patient's insured ID card. If this has
already be...
REJECTION: HCFA Box 25 / UB Box 5: TaxID is Missing or Invalid (RC29)
WHAT HAPPENED: No Tax ID/SSN was sent in box 25(HCFA) or box 5 (UB04).
RESOLUTION: Need to add Tax ID/SSN in HCFA Box 25 / UB Box 5 (see
attached picture below) and update the claim.
REJECTION: Payer Specific Edit: Rendering(837P) / Attending(837I)
Provider Taxonomy Code Required. (FE369)
WHAT HAPPENED: Attending taxonomy was not sent in box 81 CC (UB04) or
box 33 (HCFA).
RESOLUTION: This is a payer specific requirement. On a HCFA, ...
REJECTION: The Line Item Control Number must be unique within a claim.
(FE402)
WHAT HAPPENED: On the inbound file, the 6R segment in loop 2400 was
sent with the same reference identity (REF02) in more than one line
item.
RESOLUTION: Need to update so e...
REJECTION: The payer ID is not valid. Please correct and resubmit the
failed transactions.
WHAT HAPPENED: We can no longer send to this payer electronically.
RESOLUTION: We are no longer able to send this claim electronically.
Will need to send the cla...
REJECTION: Ambulance transport information is incomplete: Transport
Code and Transport Reason Code Required (FE127)
Ambulance transport information is incomplete: Condition Indicator is
Missing or Invalid (FE241)
WHAT HAPPENED: Transport code or transpo...
REJECTION: Ambulance transport information is incomplete: Transport
Reason Code Is Invalid (FE349)
WHAT HAPPENED: The ambulance transport reason code in the Additional
Fields section is missing or an invalid code.
RESOLUTION: Need to verify the place of...
REJECTION: Payer Specific Edit: Admission Date must match Statement
Date when Bill Type Code Ends in 1 or 2. (FE327)
WHAT HAPPENED: The date in box 12 does not match the date in box 6.
RESOLUTION: When box 4 ends with 1 or 2, this payer requires admit
d...
REJECTION: Admission Type Code (2300 CL101) is Required for Inpatient
Services. (FE372)
WHAT HAPPENED: The admission type code is missing in box 14.
RESOLUTION: Need to add the admission type code in box 14 and resend
the claim.
REJECTION: Claim should not have both Admitting Diagnosis and Reason
for Visit Diagnosis (FE382)
WHAT HAPPENED: Diagnosis codes were sent in both boxes 69 and 70.
RESOLUTION: Only need one or the other. Update as necessary and
resubmit.
REJECTION: Attending Phys Taxid Invalid (FE351)
WHAT HAPPENED: On the inbound file, the attending physician's tax
ID was incorrect.
RESOLUTION: As per 5010, this segement actually does not need to be
sent, so it should be removed from software. Update i...
REJECTION: Attending Physician Is Required (FE80)
WHAT HAPPENED: Attending physician was not sent in box 76.
RESOLUTION: Add attending provider in box 76 and resend the claim.
REJECTION: Attending provider must be a person, firstname is required
(FE404)
WHAT HAPPENED: Attending provider first name in box 76 is missing.
RESOLUTION: Need to add attending provider first name in box 76 and
resend the claim.
REJECTION: Billtype, Facility code or Claim Frequency missing (FE389)
WHAT HAPPENED: Information in box 4 is not valid.
RESOLUTION: Need to complete the information in box 4 and resubmit.
REJECTION: Claim Frequency missing or incorrect value (FE393)
WHAT HAPPENED: The last digit from box 4 is either missing or not
correct.
RESOLUTION: Verify the information in box 4 and update the claim as
necessary.
REJECTION: Date of Service is invalid. Must be Between Statement Date
Range (FE317)
WHAT HAPPENED: There's a date in box 45 that does not fall between the
date range in box 6.
RESOLUTION: Need to update box 45 or box 6 and resubmit.
REJECTION: Line Service Dates cannot be in the future (FE385)
Statement Dates cannot be in the Future (FE388)
WHAT HAPPENED: Dates in box 6 or dates in box 45 are in the future.
RESOLUTION: Need to update boxes 6 or 45 so the dates are not in the
futur...
REJECTION: There must be a discharge date for bill types ending in 1
or 4 (FE83)
WHAT HAPPENED: Discharge hour was not sent in box 16.
RESOLUTION: Based on the last digit of the type of bill in box 4, the
discharge hour is required in box 16. Add the di...
REJECTION: Discharge Hour is missing. It is required on all final
inpatient claims. (FE316)
WHAT HAPPENED: Discharge hour was not sent in box 16.
RESOLUTION: Based on the type of bill, the discharge hour is required
in box 16. Add the information and up...
REJECTION: HCPCS / Procedure code invalid (FE148)
WHAT HAPPENED: The procedure code sent in box 44 is invalid.
RESOLUTION: Verify the code in box 44 and update the claim as
necessary.
REJECTION: Inpatient Services, without admitting diagnosis code
(FE116)
WHAT HAPPENED: The type of bill in box 4 is for inpatient services,
but no admit diagnosis code was sent in box 69.
RESOLUTION: Need to add admit diagnosis code in box 69.
REJECTION: Invalid Patient ID: Must be at least two characters (FE347)
WHAT HAPPENED: Box 8a does not have a valid insured ID.
RESOLUTION: Double check the insured ID card and update the claim.
REJECTION: Invalid PayTo TaxId (DE306)
WHAT HAPPENED: The Tax ID in box 2 does not fit the criteria of being
9 digits in length.
RESOLUTION: Verify the Tax ID in box 2 (see attached picture below)
and update the claim as necessary.
REJECTION: Invalid Revenue Code (FE380)
WHAT HAPPENED: One of the revenue codes in box 42 is not valid.
RESOLUTION: Verify the codes in box 42 and update the claim as
necessary.
REJECTION: Invalid type of bill (FE78)
WHAT HAPPENED: The type of bill in box 4 is not valid.
RESOLUTION: Verify the info in box 4 and update the claim as
necessary. If the bill type is valid or has been used before, please
contact Customer Service at 3...
REJECTION: Line Item Sequence Number Is Invalid - Must Begin With 1
and Increment By 1 For Each New LX (FE367)
WHAT HAPPENED: There was a space between the line items on the inbound
file.
RESOLUTION: Though the claim image looks correct, on the inbound ...
REJECTION: Missing Insureds ID Number (FE59)
WHAT HAPPENED: Insured ID is missing in box 60.
RESOLUTION: Add the insured ID to box 60 and resend the claim.
REJECTION: NUBC Value Code(s) and/or Amount(s)
WHAT HAPPENED: One of the value codes in boxes 39-41 is invalid.
RESOLUTION: Need to verify all codes in boxes 39-41 and update the
claim as necessary.
REJECTION: Occurrence codes (HI) date is missing (FE391)
WHAT HAPPENED: In one of the Occurenece boxes, 31-36, there is a code
but no date.
RESOLUTION: Verify boxes 31-36 and add date to the box that only has
the code.
REJECTION: Operating Phys Taxid Invalid (FE352)
WHAT HAPPENED: On the inbound file, the operating physician's tax ID
was incorrect.
RESOLUTION: As per 5010, this segement actually does not need to be
sent, so it should be removed from software. Update i...
REJECTION: Other Subscriber Id Missing/Invalid (DE325)
WHAT HAPPENED: The other subscriber ID in box 60b is missing or
invalid.
RESOLUTION: Verify the information in box 60b and update the claim as
necessary.
REJECTION: Outpatient claims require Service Date on lineitems (FE153)
WHAT HAPPENED: A service date was not sent on one of the line items.
RESOLUTION: Need to review all line items and be sure that box 45 has
a date for each line item.
REJECTION: Patient City,State,Zip Invalid (DE250)
WHAT HAPPENED: The patient city, state, zip code combination in boxes
8b-d and box 38 is not valid.
RESOLUTION: Verify the information in boxes 8b-d and 38 and update the
claim as necessary.
REJECTION: Payer Claim Control Number (REF-F8) is missing/invalid.
Required when Claim Frequency Code (CLM05-3) indicates a Resubmission.
(RC191)
WHAT HAPPENED: The last digit of the type of bill (box 4) is 7 or 8,
but the payer's original claim number (...
REJECTION: POA Indicator Is Required When Bill Type Matches 011X
(FE346)
WHAT HAPPENED: The 'Present on Admission' indicator was not sent with
the diagnosis codes. It is required when the last 2 characters in box
4 are 11
RESOLUTION: In the dropdown box...
REJECTION: Rate is required for Room and Board Codes (FE117)
WHAT HAPPENED: Based on the rev code in box 42, the rate is required
in box 44.
RESOLUTION: Add the rate in box 44 and resend the claim.
REJECTION: Release of Information Code Is Required and Must be Y
(FE217)
WHAT HAPPENED: Box 52 was not sent with a 'Y'.
RESOLUTION: Update box 52 with a 'Y'.
REJECTION: H24391 Missing HIPAA Required 'Product Service ID' in
'2430'.
WHAT HAPPENED: The revenue code was not sent in loop 2430, segment
SVD04.
RESOLUTION: This cannot be fixed in Claim Fix. Must be updated in
billing software and resent.
REJECTION: Revenue code does not exist and is required (FE129)
WHAT HAPPENED: A rev code was not sent in box 42.
RESOLUTION: Need to add rev code in box 42 and resend the claim.
REJECTION: THE TO DATE OF SERVICE CANNOT BE BEFORE THE FROM DATE OF
SERVICE (FE90)
WHAT HAPPENED: The 'from' date in box 6 is after the 'to' date in box
6.
RESOLUTION: Update the dates in box 6 so the 'from' date is before the
'to' date and resend the c...
REJECTION: Value Code Associated Amount ( Missing / Invalid ). (FE305)
WHAT HAPPENED: There was a value code sent in box 39, but no amount
was sent.
RESOLUTION: Need to add amount for the value code in box 39 that was
sent blank.
REJECTION: Facility Code not accepted by this payer (DE171)
WHAT HAPPENED: This payer does not accept the facility code (first 2
digits of type of bill) being sent in box 4.
RESOLUTION: Verify the type of bill in box 4 and contact the payer as
necessary...
REJECTION: Invalid Line Item Charge (FE79)
WHAT HAPPENED: One of the line items has an invalid charge in box 47.
RESOLUTION: Verify the line items charges in box 47 for all of the
line items and update the claim as necessary.
REJECTION: ~Acknowledgement/Returned as unprocessable claim |
Missing/invalid data prevents payer from processing claim.
WHAT HAPPENED: This is an unspecific error message.
RESOLUTION: Please refer to the specific situations below. If the
claim does not...
REJECTION: DATES OF SERVICE SPAN BENEFIT PERIOD
WHAT HAPPENED: The dates of service are spanning between September and
October.
RESOLUTION: Medicare's fiscal year begins on 10/1. Claims cannot span
from one fiscal year to another. Claim needs to be spli...
REJECTION: PDATES OF SERVICE SPAN BENEFIT PERIOD
WHAT HAPPENED: The dates of service are spanning between September and
October.
RESOLUTION: Medicare's fiscal year begins on 10/1. Claims cannot span
from one fiscal year to another. Claim needs to be spl...
REJECTION: PDUT'S MUST EQUAL 1
WHAT HAPPENED: Any revenue codes such as 360 or 490 are considered
surgeries and cannot have more than one DUT or Unit (Box 46)
RESOLUTION: Need to update box 46 and resubmit claim.
REJECTION: REJECT- UNABLE TO IDENTIFY AS MEMBER
WHAT HAPPENED: Based on the patient information the claim, the patient
ID is not correct.
RESOLUTION: Verify the claim was sent to the correct payer. Double
check the patient's insured ID card and then ca...
REJECTION: Undefined Other PayerID. This pointer must point to an
existing Other PayerID Number in Loop 2330B. (RC156)
WHAT HAPPENED: A valid payer ID was not sent in NM109 2330B (secondary
section at the bottom of the claim).
RESOLUTION: Need to update...
REJECTION: ~Acknowledgement/Returned as unprocessable claim | Entity
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 se...
REJECTION: Rejected - Missing Data Entitys name, address, phone and id
number.
WHAT HAPPENED: Unspecific error from United Healthcare.
RESOLUTION: Please conctact our customer service department to verify
the error rejection since there are many possibi...
REJECTION: No Vendor Match for NPI:
WHAT HAPPENED: The NPI indicated in the rejection message is not what
the payer has on file.
RESOLUTION: Verify the NPI on the claim and update the claim as
necessary (see attached picture below).
REJECTION: Payer Specific Edit: 11 Digit Primary Patient ID Required
(FE240)
WHAT HAPPENED: Box 1a did not fit the criteria of being 11 digits
long.
RESOLUTION: Need to double check insured ID card and update the claim
as necessary.
REJECTION: Unknown/Invalid Payer (RC51)
WHAT HAPPENED: Based on the payer name, payer ID, and address, we
could either not determine who should be receiving the claim or the
payer is not on our Payer List:
https://cms.officeally.com/Pages/ResourceCenter/...
REJECTION: Acknowledgement/Returned as unprocessable claim | CASE
NUMBER NOT VALID~MSG: CASE NUMBER NOT VALID
WHAT HAPPENED: The case number in box 11 is not what the payer has on
file (see attached picture below).
RESOLUTION: Need to contact the payer ...
REJECTION: Missing Archive Legacy Provider ID 2010BB REF01 should be
G2 and REF02 should be the 9-digit Provider Number Assigned by DOL.
(RC155)
WHAT HAPPENED: This payer requires the legacy ID number assigned by
the payer. Was not sent in 33b.
RESOLUTI...
REJECTION: User not approved to submit claims to this payer (FE549)
WHAT HAPPENED: These payers provide Office Ally a list of approved
providers who can send them claims. The payer IDs for these payers are
not published on our external payer list and are...
REJECTION: User Requested claim to be rejected (FE131)
WHAT HAPPENED: Someone contacted Office Ally and requested the claim
to be failed back to claimfix.
RESOLUTION: Claim simply needs to be corrected as the user sees fit.
REJECTION: SUBSCRIBER PRIMARY IDENTIFIER- INVALID; MUST BE IN A VALID
FORMAT FOR PAYER
WHAT HAPPENED: The insured ID in box 1a is not valid.
RESOLUTION: Verify the patient's insured ID and update box 1a as
necessary (see attached picture below). If thi...
REJECTION: Value of sub-element HI05-02 cannot be verified because
there were no pointers to this code
WHAT HAPPENED: Payer is not recognizing Diagnosis code 5(e) because
it's not being pointed in box 24E.
RESOLUTION: Need to remove code that is not be...
REJECTION: Payer Specific Edit: Decimal Values for Units Field is Not
Allowed. (FE86)
WHAT HAPPENED: One of line items has a a unit with a decimal in box
24g.
RESOLUTION: Units must be a whole number for this payer. Verify the
information in box 24g and...
REJECTION: Last Name inconsistent with WBA demographic records
WHAT HAPPENED: Based upon the patient information on the claim, the
correct last name of the patient was not sent.
RESOLUTION: Double check the patient's insured ID card and then call
payer...
REJECTION: Missing or invalid information. (Receiver)
WHAT HAPPENED: This is an unspecified error message.
RESOLUTION: Please see the specific identified known issues below. If
your claim does not fit that scenario, please contact our customer
service d...
REJECTION: Rejected - Unprocessable Claim
A3:275-Acknowledgement/Returned as unprocessable claim-Claim.
WHAT HAPPENED: Billing provider taxonomy was not sent.
RESOLUTION: Need to add taxonomy code and resend the claim.
REJECTION: Prior Authorization (Payer Claim Control Number/Case
Number) or Referral Number is required. (RC127)
WHAT HAPPENED: ReferralPrior Authorization number in box 23 was not
sent.
RESOLUTION: ReferralPrior Authorization numbers are required for
Wo...
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