Electronic Claim Errors
A knowledge base of common electronic claim errors and possible solutions.
- 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.
- ACK/RETURNED - ENTITYS ID NUMBER. - SUBSCRIBER
- The Subscriber Member ID Number (Loop 2010BA, NM109) is not valid.
- Element NM104 is missing. It is recommended to be used when Referring Provider is a person (NM102=1). Segment NM1 is defined in the guideline at position 2500.
- A3 125 P147 REFERRING PROVIDER FIRST NAME IS MISSING OR INVALID - CLAIM
- BILLING PROVIDER TAXONOMY CODE: INVALID; MUST BE A VALID TAXONOMY CODE
- Member NOT Found. Cannot load claim
- ACK RETURNED - ENTITYS POSTAL ZIP CODE. - PATIENT
- Value of element CAS02 is incorrect. Expected value is from external code list - Claim Adjustment Reason Code (139). Segment CAS is defined in the guideline at position 5450. Invalid data: 127
- Sub-Element SV101-02 (Product/Service ID) is missing. This Sub-Elements standard option is Mandatory. Segment SV1 is defined in the guideline at position 3700.
- 40659 InvalidData F802 Location 2300 - HI03-02 Clm The Diagnosis Code XXX has been used more than once
- MEM - MEMBERSHIP FOR PATIENT NAME IS INACTIVE OR UNABLE TO LOCATE MEMBER. AN INCORRECT BIRTHDATE OR GENDER MAY HAVE BEEN SUPPLIED, CONTACT CUSTOMER SERVICE
- Description required when submitting a non-specific procedure code. FE39
- Patients name doees not match the name in the payers system.
- Payer Specific Edit: Original Ref No (Box 22, REF*F8) not a Martins Point Claim Number. Must be 11 or 13 digits.
- Secondary Claims Submission Unsupported for this Payer
- Invalid Facility Zip
- A3 562 P531 BILLING NPI NOT PRESENT ON CORPORATE CROSSWALK
- PROV - PERFORMING / RENDERING PROVIDER NUMBER IS REQUIRED NPI
- Svc BCBSNE Rule 837P - HME procedure requires RR or NU :
- Missing Primary Insureds Last Name