Unfortunately, this is a rejection message from the payer has absolutely zero information as to why they returned it to you. You will need to call the payer to find out why they are rejecting your claim. IMPORTANT: Because the payer sent back an EDI rejection, when you call them, you will need to let them know that it was rejected from an electronic submission. Otherwise, they adjudication department will tell you that they have no record of ever receiving the claim.
Articles in this section
- Diagnosis Code Not Billable
- Referring prov first and last name must be in separate fields and both are required
- Element CAS02 (Claim Adjustment Reason Code) is missing. This Elements standard option is Mandatory. Segment CAS is defined in the guideline at position 5450
- A3 143 P406 BILLING NPI REQUIRES RENDERING NPI
- SERVICE LINE COB INFORMATION: INVALID; THE SUM OF ALL SERVICE LINE PAID AMOUNTS PLUS THE SERVICE LINE ADJUSTMENT AMOUNTS FOR EACH PAYER MUST EQUAL LINE ITEM CHARGE AMOUNT
- Invalid Referring Physician NPI Format (Box 17B) - Fails Validation
- Element CRC03 (Condition Indicator) does not contain a valid identification code: YES is not allowed. Segment CRC is defined in the guideline at position 2200. Invalid data: YES
- DATES OF SERVICE NOT IN INSURED POLICY DATES :
- DTP03 NOT IN POLICY DATE RANGE
- Facility Type Code 99 invalid for BCBSNC business.