Payer Rejections

• Payer Rejections Overview

Acknowledgement/Receipt

• Payer Rejection: A6 -A1-;Acknowledgment/Receipt

Adjudication Date

• Payer Rejected: INVALID ADJ PAYMENT DATE

Claim Filing Indicator (CFI)

• Payer Rejection: INVALID FILING INDICATOR CODE 'CI'

Claim Frequency Code

• Payer Rejection: A6 Rejected for Invalid Information; Claim Frequency Code

CLIA Number

• Payer Rejection: CLIA

COB (Other Insurance Coverage)

• Payer Rejection: Other Insurance Coverage

• Payer Rejection: Invalid Information - May be another Insurance

Date of Birth

• Payer Rejection: Member ID mismatch with date of birth

Dates of Service

Detailed Description

• Payer Rejection: Rejected; Detailed description
• Payer Rejection-A8: Rejected for Detailed Description of Service

Entity not Found

• Payer Rejection: Entity Not Found Patient/Insured/Subscriber/Dependent

Etactics Note

• Etactics Note: Previously Rejected on Earlier Report

Facility NPI

• Payer Rejection: A6 -A3-;Rejected; Missing or invalid information. Facility NPI should not be in Loop 2310D

ICN (Claim Control Number)

• Payer Rejection: Readjudication Payer Claim Control Number (ICN)

Invalid Payer Responsibility Sequence Number Code

• Rejection: Invalid Payer Resp Seq Num Code

Length Invalid

• Rejection: Invalid Information - Length Invalid for Receiver's Application System

Missing or Invalid Information

• Payer Rejection: Rejected for Invalid Information - Cannot Provide further status electronically; File with Medicare as Primary

NDC

1. Missing or Invalid Information: PROCEDURE XXXXX MUST BE BILLED WITH VALID NDC DATA
   

Not Eligible

• Payer Rejection: Rejected Entity not Eligible/not approved for Dates of Service
• Payer Rejected: Not Eligible

NPI

• Payer Rejection: Invalid Info - Entity's NPI Usage

Occurrence Code and Revenue Code

• Payer Rejected: NUBC OCCURRENCE CODE - check the Revenue code - an occurrence code is required

Purchase Service - Missing 2420B

• Payer Rejection: Purchase Service Missing 2420B

Reason not Clear

• Payer Rejection: Reason Not Clear

Sequestion CO253

• Missing Sequestration Adjustment CO253.

Service Date

• Payer Rejected: A6 SERVICE FROM DATE - INVALID; SERVICE FROM DATE MUST BE VALID FOR PAYER

Smart Edit

• Payer Rejection: Smart Edit

Sub-Element SV101-07 Missing

• Payer Rejection: SUB-ELEMENT SV101-07 IS MISSING
  

Subscriber ID

Zero Charge

• Payer Rejection: CHARGE MUST BE GREATER THAN ZERO [PE]