Clearinghouse Rejection: Service Line 1 COB Claim adjudication date

Clearinghouse Rejection: Service Line 1 COB Claim adjudication date

CE: Service Line 1 COB Claim, adjudication date is required for payer id 'MCRTX'  Service Line 1 COB not balanced; Line Payments + Line Adjustments do not equal Line Billed Amount for Payer id MCRTX (Loop 2430)

***MCRTX is being used in the example. Your Medicare would be MCR plus your 2 letter state abbreviation.
  1. The first segment of the rejection (adjudication date is required for payer ID MCRTX), indicates that the System is not seeing any Charges/Transactions for this Payer ID.
  2. This means the Payer that the Charges/Transactions were posted under is not the same as the Payer in the current Insurance Profile.
  3. Therefore, the System is not able to "balance" to the current balance owed.
Resolution: Make sure the Insurance that paid is the same Insurance that you are sending the Secondary to.

CE: Adjudication Date cannot be greater than today for Service Line.

  1. The Claim is being sent to the Secondary Payer. The Adjudication Date on the Primary Claim cannot be greater than today's date.
Resolution: Change the Payment Posted Date for the Primary Payer to a date of today or before.

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