Rejections Examples

Rejections Examples

Rejection: Invalid Subscriber ID Format for ___

Resolution:
  1. From the Patient Dashboard, verify Eligibility​, view the Eligibility Report, view the Patient's Scanned Insurance Card, and/or call the Patient.
  2. Correct the Policy Number.
  3. On the Encounter Dashboard, change the Claim Status to Ready for Submission/Resubmission.
Resolution:
  1. On the Encounter Dashboard, select the Modify button.
  2. in the Claims panel, select Accident.
  3. On the Accident popup:
    1. Enter the Accident Date.
    2. Choose the Related Cause.
    3. Choose a second Related Cause if applicable. For Example, An Auto Accident was Employment Related.
    4. Enter or Lookup the two letter State abbreviation where the Accident occurred.
    5. Click Save [F2].
  4. Resubmit the Claim.
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Rejection: Global Edit Other Subscriber Relationship Missing

This usually occurs when the Policy Holder Relationship is missing in your Clinic Documentation.

Resolution:
  1. In the Policy Breakdown panel on the Encounter Dashboard, select the affected Insurance Policy name.
  2. Use the Lookup icon to select the Relationship code.
  3. If the Relationship field is NOT Self, complete the Policy Holder name and Address.
  4. Select Save [F2].

  1. On the Encounter Dashboard, change the Claim Status to Ready for Submission/Resubmission.


Rejection: Ordering Provider Information is Required

The Encounter requires a referring provider (often Medicare or DME claims).

Resolution:
  1. On the Encounter Dashboard, select Modify.
  2. On the Modify Charge screen in the Claim panel, choose a Referring Provider.
  3. Click Save [F2].
  4. Resubmit the Claim.


Rejection: Subscriber Group or Policy Number (2320*SBR03) Must be Alphanumeric.

There is a character or space that is not recognized in the Policy or Group Number, such as &, *, #, @.
  1. On the Encounter Dashboard in the Policy Breakdown panel, select the Policy name with the invalid character.
  2. Correct the Policy or Group.
  3. Click Save [F2].
  4. Resubmit the Claim.


Rejection: Medicare only allows for a Claim Frequency Code 1, Original Claim

Medicare does not accept Replacement for the Frequency Code (7) on a Corrected Claim. The System will automatically change this and add Corrected Claim in the ANSI CLAIM LEVEL NOTE Field. If anything is entered in the CLMNOTE field, it will override the automatic setting. If manually setting this:
  1. On the Encounter Dashboard, select Modify.
  2. On the Modify Charge screen, change Claim to Original (1).
  3. Click Save[F2].
  4. Resubmit the Claim.