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Understanding Rejected Claim Messages

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Why did I receive a rejected claim message?

A claim is typically rejected because of errors. For example, an insurance company might reject a claim because of common errors like incorrectly inputting a client's insurance member ID.

This list is continually updated. Please check back to see additional rejection message definitions.

 

Rejection Message What Does it Mean? What Action Should I Take?
Payer Assigned Claim Control Number Required Typically, this rejection reason occurs on a resubmitted claim. When a resubmitted claim does not have the reference number of the previously submitted claim this rejection may occur depending on the payer. Not all payers require resubmitted claims to reference the previous claim, but some do.

When resubmitting a claim that was rejected for this reason make sure the Resubmission option is selected in Box 22. This typically happens by default anytime you are resubmitting a rejected claim. This will also populate the previous claim's reference number. Be careful not to delete this reference number. 

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For Claim Re-Submissions or Cancellations, You Need to Provide The Original Claim Reference ID In Field 22

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The Claim's Payer Control Number Should Be Present If Claim Frequency Is 7 or 8

These messages can occur when Box 22 indicates this is a Resubmission, but the original claim's reference ID number is not entered in the adjacent field.

When resubmitting a claim, SimplePractice will auto-fill these fields in Box 22. To avoid issues it's important not adjust or delete these fields.

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Add the Reference ID from the original claim to the Original Ref. No. field.

Show me how to find the original claim number 

If you are not able to find the original claim's reference ID number, it's best to mark the claim as Original in Box 22 and leave the Original Ref. No. field blank.

Subscriber and Subscriber Id Not Found The member ID does not match the member name on file with the payer.

1. Check to make sure the client's member ID is entered correctly.

2. If it has special characters (& - # @ | \) it is recommended you remove these. Some payers will not recognize the member ID's when they include special characters.

3. Check the spelling of the client's name everywhere it exists on the form. All instances of the client's name must match the name on file with the insurance company. Be sure not to include a nickname or abbreviation.

Issue still not resolved? Check out this detailed troubleshooting guide to help get the required information from the payer.

Invalid Subscriber Contract/Member Number (164) The payer didn't recognize the client's member number. Many payers (especially Medicare) will reject a member number submitted with dashes or other special characters (& - # @ | \).

Be sure to remove any dash or other special characters.

No Agreement With Entity The payer indicates that they do not recognize you as one of their registered providers and you do not have permission to submit claims based on the info you've submitted

If you have multiple NPI numbers be sure to enroll using your Billing NPI number.

Enrolling with an NPI number the payer doesn't recognize could cause the rejection reason.

Note: This error message is most commonly recieved when enrolling with Medicare and Medicaid

 

The Claim/Encounter Is Missing the Information Specified in The Status Details and Has Been Rejected (A6). Missing or Invalid Information. Note: At Least One Other Status Code Is Required to Identify the Missing or Invalid Information (21) The payer was not able to identify you based on the NPI number(s) and address(es) entered in Box 32 and/or Box 33.

This rejected claim message typically occurs when a billing NPI is required for Box 33a, or when the billing NPI in Box 33a does not match the address in Box 33. Check to ensure the information in these fields is correct.

Dependent Level Information Is Not Allowed for This Payer The payer does not accept claims filed with "dependent" information. In this case, the dependent needs to be filed as the subscriber his or herself.

Change the CMS claim form to indicate that the client is the primary insured. This will be done in Box 4, 6, 7, and 11.

Payer Claim Office Number Is Missing or Incorrect. Verify with Authorization of Care Letter or Your Authorizing Service Center. If the Number Was Entered Correctly Magellan Isn't the Payerimg_06.gif

The claim was filed with the incorrect Magellan payer

Check out this detailed article on filing online claims with Magellan.

Parameter Service_Facility[Address][State] Is Too Long

Typically, this message indicates that the state name has been spelled out instead of using the state's abbreviation (e.g. "New York" instead "NY").

Replace full state name values anywhere address information to their common two-letter abbreviation. Payers will almost always reject claims if the state is spelled out on any address in the claim form.

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