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  2. Electronic Claim Errors
  3. Electronic Claim Errors

Electronic Claim Errors

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A knowledge base of common electronic claim errors and possible solutions.

  • Federal Sequestrations Adjustment Rejections - AARP Medicare Supplement Plans
  • 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 :
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