Electronic Claim Errors
A knowledge base of common electronic claim errors and possible solutions.
- CLAIM FREQUENCY CODE: INVALID; MUST BE A VALID FREQUENCY CODE [6]
- Category: Acknowledgement/Returned as unprocessable claim The Claim/Encounter has been rejected and has not been entered into the adjudication system Status: Returned to Entity Entity: Payer^^^\\\\R^^R SUBMIT WITH SSN, EDI PI(10) OR MVI ICN (17)^^^
- SERVICE LINE ADJUDICATION OR PAYMENT DATE: INVALID; MUST BE GREATER THAN OR EQUAL TO ADJUSTMENT REASON CODE EFFECTIVE DATE AND MUST BE LESS THAN OR EQUAL TO ADJUSTMENT REASON CODE TERM DATE [YYYYMMDD]
- PAYER RESPONSIBILITY SEQUENCE NUMBER: INVALID; WITHIN A GIVEN CLAIM, VALUES CANNOT OCCUR MORE THAN ONCE
- Element NM104 (Name First) is present. This Element is marked as \'Excluded\' and therefore must not be present in the data. Segment NM1 is defined in the guideline at position 2500. Invalid data: xxxx
- Element NM102 (Entity Type Qualifier) does not contain a valid identification code: \'1\' is not allowed. Segment NM1 is defined in the guideline at position 2500. Invalid data: 1
- Element NM103 (Name Last or Organization Name) is missing. This Element\'s user option is \'Must Use\'. Segment NM1 is defined in the guideline at position 0150
- Value of element SBR01 has been already used in loops 2000B/2300. Elements SBR01 are expected to be different from SBR01 specified in loop 2000B and to have unique values within loop 2300 excluding \'U\' value. Segment SBR is defined in the guideline at p
- Category: Acknowledgement/Rejected for relational field in error. Status: Missing or invalid information
- Requests for additional Information/Documentation-Requests for additional supporting documentation. Examples: certification, x-ray, notes.
- Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected.
- SUBSCRIBER PRIMARY IDENTIFIER: INVALID; MUST BE 12 CHARACTERS WITH POSITION 1 EQUAL TO H OR C, POSITION 2 MUST CONTAIN AN ALPHA-NUMERIC CHARACTER AND POSITIONS 3-12 MUST BE NUMERIC FOR PAYER [xxxxxxxxxx]^^^
- NM1-09 PATIENT NAME, MEMBER ID NUMBER NOT VALID FOR DOS. [1225541568 -NM1-09 YPYW1253399805]^^^
- Category: Acknowledgement/Rejected for Invalid Information The Claim/Encounter has invalid information as specified in the Status details and has been rejected Status: Subscriber and Subscriber id not found Entity: Payer
- Category: Acknowledgement/Rejected for Invalid Information The Claim/Encounter has invalid information as specified in the Status details and has been rejected Status: Entity not affiliated Entity: Billing Provider
- [ERROR MESSAGE]Payer requires BL as the filing indicator
- SUBSCRIBER PRIMARY IDENTIFIER: INVALID; MUST NOT EQUAL SUBSCRIBER GROUP OR POLICY NUMBER [##########]^^^\\\\R^^SERVICE LINE ADJUDICATION OR PAYMENT DATE: INVALID; MUST BE GREATER THAN OR EQUAL TO ADJUSTMENT REASON CODE EFFECTIVE DATE AND MUST BE LESS THAN
- Value of sub-element HI01-02 is incorrect. External cause code cannot be used as Principal Diagnosis code. Segment HI is defined in the guideline at position 2310. Invalid data:
- COB REPORTING INCONSISTENT/INVALID
- H46474 THE OTHER SUBSCRIBER INFORMATION WAS NOT FOUND BUT WAS EXPECTED BECAUSE THE DESTINATION PAYER IS NOT THE PRIMARY PAYER
- PAYER RESPONSIBILITY SEQUENCE NUMBER: INVALID, MUST NOT HAVE A SECONDARY PAYER WITHOUT A PRIMARY PAYER, MUST NOT HAVE A TERTIARY PAYER WITHOUT A PRIMARY AND SECONDARY PAYER [02]^^^\\\\R^^PAYER RESPONSIBILITY SEQUENCE NUMBER: INVALID; MUST BE A VALID SEQUE
- Loop 2320 is missing. It is expected to be used when Medicare is the secondary payer (SBR05 is used)
- P4999CCIUN SMARTEDIT (CCIUN) PROCEDURE ----- IS INCLUDED WITH PROCEDURE ----- ON THE CURRENT OR PREVIOUSLY SUBMITTED CLAIM. UNDER APPROPRIATE CIRCUMSTANCES, A DESIGNATED MODIFIER MAY BE ALLOWED TO IDENTIFY DISTINCT SERVICES
- Acknowledgement/Rejected for Invalid Information The Claim/Encounter has invalid information as specified in the Status details and has been rejected Status: Reject Reason Code
- Missing Archive Legacy Provider ID 2010BB REF01 Should Be G2 and REF02 Should Be the 9-Digit Provider Number Assigned By DOL
- 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