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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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