Claim-Rejections

Claim Rejections

01 - INVALID MBR DOB

24.(A) DATE(S) OF SERVICE (RC23)

24.(B)(1) Place of Service (RC24)

24J - Rendering ID (RC30)

Accident Date cannot be in the future

ACCIDENT DATE MUST ALSO BE PROVIDED

Accident Date Required on Accidents and Workers Comp Claims (FE134)

ADA - Invalid Billing Provider TaxId (1877) (DE105)

Admission Date required for this Type of Bill (FE124

Aetna 60054 - Entity not eligible

Aetna 60054 - Subscriber not eligible for benefits

Aetna 60054 - Subscriber Policy Canceled

Amerigroup (All states)

BCBS - 2010AA - NM109 Subscr

BCBS (ALL) - 41253 InvalidData: 33 Location

BCBS (ALL) - Entity's health industry id number

BCBS (ALL) - GY modifier

BCBS (ALL) - SUB-ELEMENT SV101-04

BCBS (ALL) - Subscriber and policy number

BCBS (ALL) - Value of element NM109

BCBS FL 00590 - Billing Provider Number

BCBS FL 00590 - Medicare adjudication

BCBS IL 00621 - element NM108

BCBS LA 53120 - CLAIM IS LEGACY

BCBS MN 00720 - (NPI) Entity: Billing Provider

BCBS NC SB810 - Units must be greater than

BCBS NJ 22099 - BCBSNJ ENROLLMENT

BCBS of Hawaii (HMSA) HMSA1

BCBS of Hawaii (HMSA) HMSA1

BCBS of Hawaii (HMSA) HMSA1

BCBS of Hawaii (HMSA) HMSA1

BCBS SC BCSSC - BILLING PROVIDER NUMBER NOT ON FILE

Billing and PayTo provider same entity (FE355)

BILLING NPI IS NOT ON FILE

Billing NPI (RC87)

Billing Provider Submitter not approved for electronic claim submissions

Billing Provider Taxonomy Code Required. (RC190)

BMC HealthNet Plan 13337 - Provider ID not on File

BSCA Encounters BS003 - Billing Provider ID IPA0 (FE226)

Cenpatico Behavioral Health 68068 - 06 - INVALID PRV

Cigna 62308 - Entity not eligible

Cigna 62308 - HCPCS Procedure Code

Cigna 62308 - Invalid Tax ID

CPLAN ROUTE CODE (PREFIX) ENDED PRIOR TODAY

CPT Invalid Code (RC06)

Date of Accident Required (DE180)

DESRT - Rejected

Diversified Grp Brokerage 06102

Drug Quantity / Drug Measure (RC139)

Empire BCBS 00803

Entity not eligible for benefits

Entity not found

ENTITY NOT FOUND. - PROVIDER

Entity's specialty/taxonomy code

Facility Name Required (RC47)

FEDERAL TAX ID # (RC63)

First Choice Health Network 91131 - Insured ID FV36

Group Code (Invalid Type / Missing Value). (FE375)

Group/Practice ID not matching Payor Contract ID on file (RC56)

Harvard Pilgrim Health Plan 04271 - FROM DATE BEFORE PROV EFFECTIVE DATE

Healthy Palm Beaches, Inc. 95827 - member ID

Hill Physicians Medical Group HIL01 - same place of service

HMA Administrators 39044 - Member ID

Humana 61101 - Entity not found Entity- Patient

Invalid Billing Provider NPI (RC82)

Invalid Modifier (FV27)

Invalid Rendering Physician NPI (RC86)

Invalid Subscriber Id (DC307) (2049) (DE307

Kaiser (ALL) - incorrect payer

Kaiser CSI 94320 - NOT FOUND ON CARRIER

KPS Healthplans KPS01 - Member ID must begin with 954. (FE330)

legacy Billing ID does not exist. (RC133)

Managed Health Services (Medicaid HMO) 39186 - 01Invalid Provider ID

Medicaid AR MCDAR - authorization/certification number

Medicaid MT MCDMT - Rendering ID (FE344)

Medicaid TX TMHP1 - CLIENT HAS OTHER INSURANCE

Medicaid WA MC006 - Invalid Insured ID format (RC130)

Medi-Cal MC051 - Bill Medicare first (FE418)

Medicare (ALL) - Acute Manifestation Date

Medicare (ALL) - authorization/certification number

Medicare (ALL) - Entity's tax id

Medicare (ALL) - External Cause of Injury Code

Medicare (ALL) - HCPCS

Medicare (ALL) - Unit or Basis for Measurement Code

Member ID (1A) must be 9 or 10 digit number. (FE368)

Multiplan Wisconsin PPN 34080 - Subscriber and policy number

MVP Health Plan (Mohawk Valley) 14165 - COORDINATION OF BENEFITS CODE (550)

N-A-M-M So Cal IP079 - PROVIDER ID

Newborn - patient not found (RC50)

Onset Date of Current Illness/Symptom is Invalid. (RC160)

Oxford Health Plans 06111

PATIENT NOT ON CARRIER FILES

Payer does not Accept ICD-10

Providence Health Plan PHP01 - Invalid Insured ID Format (RC129)

Provider ID Cannot Be Same Value as Tax ID

Provider Tax ID Missing/Invalid (FE53)

Provider Taxonomy Code (RC108)

REJ- 19 Entity acknowledges receipt

Rendering ID does not exist (RC126)

Alameda Alliance for Health 95327 - Provider not enrolled for EDI

Aloha Care 99030 - Billing Provider FedID

Ambulance dropoff address state code invalid (FE446)

Ambulance dropoff address ZipCode (FE448)

BCBS NC SB810 - PROVIDER NUMBER NOT AUTHORIZED

BCBS of Kansas 47163 - Diagnosis code

Common ICD-9/ICD-10 Rejections

CPT code not in Payers allowed code list

Diagnosis code ___ is not billable (further specification required)

Diagnosis code ___ not effective for this DOS

Diagnosis code __ not valid for patient age.

Diagnosis code __ not valid for patient gender

Duplicate claim (within 90 days) (RC07)

Invalid Facility Zip (FE114)

Line Item Charge Amount (FE212)

Magellan 01260 - Member Not Found

Managed HC Admin Blue Choice MHCA2 - Rendering Provider NPI

Medicaid NH MCDNH - E1018 Other Payer Primary Identifier

Medicaid RI SX106 - E1018 - Other Payer Primary

Medicaid VT MCDVT - Other Payer Primary Identifier

Patient Zip Invalid For State (FE358)

Payer not accepting this claim type

Requests for additional Information

Subscriber Zip Invalid For State (FE357)

Unknown/Invalid Payer (RC51)

Billing provider requires a Physical Address (FE354)

Billing Provider taxonomy code invalid

Diagnosis code ___ not effective for this DOS

Payer Requires Pre-Enrollment (RC68)

Pre-Enrollment Needed (RC77)

Printing Services Not Requested by User (RC62)

24.(D)(1) CPT/HCPCS (RC25)

24.(F)(1) $ CHARGES (RC27)

24.(G)(1) DAYS OR UNITS (RC28)

3. PATIENT BIRTH DATE (RC21)

4010 payers -Error Code FE213

8 diagnosis codes (RC149)

Accommodation rate FE75

ACCOMMODATIONS SERVICE LINE- REQUIRED

ADA - Billing Provider City,State,Zip Invalid (1896)

ADA - Invalid Billing Provider NPI (1872)

ADA - Invalid Billing Provider State License (1891)

ADA - Invalid PayTo Provider NPI (1876) (DE104)

ADA - Invalid Referring Provider NPI (1874)

ADA - Leave Date Of Service Blank for PreDetermination Claims (2068)

ADA - Rendering Provider City,State,Zip Invalid (1897)

ADA - Subscriber City,State,Zip Invalid (1899)

ADA - SubscriberId and Plan-Group Can Not be The Same (2075)

ADA - Tooth Number Letter Invalid (2079)

Adjustment Amount - Cannot be zero dollars. (FE366)

Aetna 60054 - Billing Provider National Provider Identifier (NPI)

Aetna 60054 - Contract Provisions

Aetna 60054 - Dependent not eligible

Alameda Alliance for Health 95327 - PROCEDURE CODE INVALID UNKNOWN

Allowable/paid from other entities coverage HB0117

All Payers - Future date

All Payers - Submitted charges

Ambulance Dropoff Invalid (FE370)

Ambulance Drop-off Location (FE379)

Ambulance Pick-up Location (FE378)

Ambulance PickUp Location Invalid (FE371)

American Specialty Health ASHP1

American Specialty Health ASHP1 - Incorrect Address

Amount Paid should not exceed Amount Approved FE350

Anesthesia CPT (RC172)

Assurant Health 39065

Attachment Control Number (AT003)

Attachment Report Type Code (AT001)

Attachment Transmission Code (AT002)

ATTENDING PROVIDER NAME

Auto Accident State (Invalid Type / Missing Value) (FE334)

Axminster Medical Group AXM01

(AZBlue) Pre-Membership Validation

Banner Health Company - IDENTIFICATION CODE

BCBS (ALL) - EPSDT Indicator

BCBS (ALL) - Member ID (Loop 2010BA, NM109)

BCBS (ALL) - Submit to local plan

BCBS AR 00520 - NM104 Subscriber First Name

BCBS AZ 53589 - Future dates

BCBS AZ 53589 - Resubmit with description

BCBS AZ 53589 - The Initial Treatment Date

BCBS Central NY 00805 - CONTRACT NOT EFFECTIVE

BCBS Central NY 00805 - NO COVERAGE LOCATED

BCBS FL 00590 - Medicare Report Number

BCBS FL 00590 - member number

BCBS FL 00590 - member number and DOB

BCBS GA 00601 - Date of Service future

BCBS IA BCSIA - Initial Treatment Date (FE397)

BCBS IL 00621 - Value of element DTP03

BCBS Kansas City 47171 - Date of the last x-ray

BCBS MA BS059 - Member Identification Number

BCBS MA BS059 - Submitter is not authorized

BCBS MI 00710 - CONTRACT ALPHA PREFIX

BCBS MI 00710 - CONTRACT IS MEDICARE

BCBS MN 00720 - Billing Provider (HICN)

BCBS NC SB810 - Member ID must be valid

BCBS NC SB810 - Member id prefix

BCBS NC SB810 - Service Date

BCBS PA 54771 - incorrect payer

BCBS Payer Assigned Claim Control Number

BCBS RI 00870 - S103 SUB ID INACTIVE/SERV DT

BCBS RI 00870 - X040 PROV\SUBM NOT ON TBL

BCBS SC BCSSC - INVALID SUBSCRIBER ID FOR CARRIER CODE

BCBS SC BCSSC - PATIENT FIRST NAME

BCBS - Segment PER

BCBS VA 00923 -ACC/ONSET DATE

BCBS VA 00923 - No Additional Details

BCBS VA 00923 - POSSIBLE REL CODE CONFLICT

BCBS VA 00923 - Procedure code

Beacon 43324 - PAYER, GROUP AND EMPLOYER

Beacon Strategies 43324 - MISSING/INVALID BILLING PROVIDER ID

Billing NPI is not authorized for Tax ID

Billing or Pay-To Provider - Incomplete Address (FE55)

Billing Provider ID (FV30)

Billing Provider Name is missing (FE89)

Billing Provider National Provider Identifier (NPI)

Billing Provider Required

Billing Provider Secondary Identification

Billing Provider/Supplier Missing Address Information (FE225)

Billing Provider tax id

Billing Provider taxonomy code missing

Billing Provider Zip Code Invalid or Doesnt Match State Code (FE120)

Blue Cross CA BC001 - Anesthesia /Oxygen minutes

Blue Cross CA BC001 - Anesthesia Oxygen minutes

Blue Cross CA BC001 - FEP claims

Blue Cross CA BC001 - Private Room

Blue Shield CA BS001

Blue Shield CA BS001 - Condition Code (132)

Blue Shield CA BS001 - Diagnosis Related Group (229)