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'"
    1. The System is not seeing the Primary Payment details, like the date the primary insurer processed it when it tries to send the Claim to MCRTX (secondary).
  2. The second segment of the rejection: "Service Line 1 COB not balanced; Line Payments + Line Adjustments do not equal Line Billed Amount for Payer id MCRTX (Loop 2430)
    1. The Paid amounts and Adjustments from the Primary Payer do not add up to the original billed amount for that service line.
      1. The Paid amounts and/or Adjustments were posted incorrectly or were not posted at all.
      2. Or, the Payer where the the Charges and Transactions were posted is not the same as the Payer in the current Insurance Profile.
    2. The System is not able to "balance" to the current balance owed.
Resolution:
  1. Make sure the Primary Payments and Adjustments are posted and posted correctly.
  2. Make sure the Insurance that paid is the same Insurance that is on the Insurance Profile.

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

  1. The Claim is being sent to the Secondary Payer.
  2. 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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