Payer Rejections (PE)
Payer Rejection Articles
Payer Rejections Overview Payer Rejection: SUB-ELEMENT SV101-07 IS MISSING Payer Rejected: A6 SERVICE FROM DATE - INVALID; SERVICE FROM DATE MUST BE VALID FOR PAYER Payer Rejection: A6 -A3-;Rejected; Missing or invalid information. Facility NPI ...
Payer Rejection: SUB-ELEMENT SV101-07 IS MISSING
PE SUB-ELEMENT SV101-07 IS MISSING. IT IS REQUIRED WHEN PROCEDURE CODE IS NON-SPECIFIC (SV101-02 IS J3301). SEGMENT SV1 IS DEFINED IN THE GUIDELINE AT POSITION 3. The non-specific Procedure Code needs a more detailed description. Resolution: Add a ...
Payer Rejected: A6 SERVICE FROM DATE- INVALID; SERVICE FROM DATE MUST BE VALID FOR PAYER
A6 SERVICE FROM DATE- INVALID; SERVICE FROM DATE MUST BE VALID FOR PAYER [PE This Rejection is for DOS and may be due to: An incorrect Payer ID. Patient was not eligible on the DOS. Patient no longer has this Insurance.
Payer Rejected: A6 -A3-;Rejected;Missing or invalid information. Facility NPI should not be in Loop 2310D
PE: A6 -A3-;Rejected;Missing or invalid information. Note- At least one other status code is required to identify the missing or invalid information.;-ELEMENT NM109 IS USED. IT IS NOT EXPECTED TO BE USED WHEN IT HAS THE SAME VALUE AS ELEMENT NM109 IN ...
Payer Rejected: NUBC OCCURRENCE CODE- check the Revenue code - an occurrence code is required
PE: NUBC OCCURRENCE CODE- check the Revenue code - an occurrence code is required An Occurrence Code is required for ER Revenue Code. An ER revenue code must have an occurrence code of '01' OR '02' OR '03' OR '04' OR '05' OR '06' OR '11' Example: ...
Payer Rejected: INVALID ADJ PAYMENT DATE
PE A6 GB; PDT0303 INVALID ADJ PAYMENT DATE Rejected; Other Entity's Adjudication or Payment/Remittance Date. Note- An Entity code is required to identify the Other Payer Entity i.e. primary secondary.;Payer If the Claim has been crossed by Medicare, ...
Payer Rejection: A6 Rejected for Invalid Information; Claim Frequency Code
PE: A6 Rejected for Invalid Information; Claim Frequency Code The Payer does not accept "Replacement" as the Frequency Code (usually Medicare). Resolution: Change the Frequency from Replacement to Original on the Modify Charge screen. (Encounter ...
Payer Rejection: Invalid Information - May be another Insurance
PE A7-104- Rejected for Invalid Information. Processed according to plan provisions (Plan refers to provisions that exist between the Health Plan and the Consumer or Patient) If this is from Medicaid, it usually means the Payer thinks there is ...
Payer Rejection: CLIA
PE: A6 A7-0- Rejected for Invalid Information - Cannot provide further status electronically A7-544- Rejected for Invalid Information - Clinical Laboratory Improvement Amendment Rejected for CLIA number. Resolution: Enter the CLIA number on the ...
Payer Rejection: Rejected for Invalid Information - Cannot provide further status electronically
PE: A6 A7-0- Rejected for Invalid Information - Cannot provide further status electronically: File with Medicare as Primary A7-284- Rejected for Invalid Information - Copy of Medicare ID card. -Resolution: Needs to be filed to Medicare as primary.
Payer Rejection: Rejected;Detailed description
PE: A6 -A1-;Acknowledgement/Receipt-The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication.;Entity acknowledges receipt of claim/encounter.;Payer-A8-;Rejected;Detailed description of service. ...
Payer Rejection: A6 -A1-;Acknowledgement/Receipt
PE: A6 -A1-;Acknowledgement/Receipt-The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication.;Entity acknowledges receipt of claim/encounter.;Payer-A7-;Rejected for Invalid ...
Payer Rejection: INVALID FILING INDICATOR CODE 'CI'
PE: A6 PSBR0905-INVALID FILING INDICATOR CODE 'CI' PSBR0906-INVALID FILING INDICATOR CODE 'CI' The Claims Filing Indicator (CFI) is not correct. Resolution: Check the Claims Filing Indicator on the Insurance. Example: The CFI is CI (Commercial) in ...
Payer Rejection: Rejected Entity not Eligible/not approved for Dates of Service
PE: A6 -A3-;Rejected;Entity not eligible/not approved for dates of service ERROR NO MEMBER ID MATCH FOR 'TEST,BOBBY H12345678' BY SERVICE DATE NOT ELIGIBLE The Subscriber was not found or was not eligible on the DOS. Resolution: Compare the Insurance ...
Payer Rejection: CHARGE MUST BE GREATER THAN ZERO [PE]
PE: A6 - CHARGE MUST BE GREATER THAN ZERO [PE] The Charge was sent with a $0.00 Fee. The Payer does not accept $0.00. Resolution: Three options for Resubmission Enter a Fee for the Line Item/Charge. Exclude the $0.00 Charge from the Claim. If the ...
Payer Rejections Overview
Payer Rejections When a Claim is submitted electronically, the information on the individual Claim is matched with the information the Payer has on file. If the information is not in alignment with the Payer Information, the Claim is rejected and not ...
Payer Rejection: Reason Not Clear
Payer Rejection: Reason Not Clear Payer Rejection prefixes: EP: Third-Party Clearinghouse AP: Payer Contact the Payer Payer Rejections can be more difficult to read as they often do not comply with standard responses. For Payer rejections that you ...
Payer Rejection: Readjudication Payer Claim Control Number (ICN)
A6 ACK/RETURNED - REQUESTS FOR RE-ADJUDICATION MUST REFERENCE THE NEWLY ASSIGNED PAYER CLAIM CONTROL NUMBER FOR THIS PREVIOUSLY ADJUSTED CLAIM. CORRECT THE PAYER CLAIM CONTROL NUMBER AND RE-SUBMIT. The ICN Number is missing for a previously adjusted ...
Payer Rejection: Member ID mismatch with date of birth
A6 -A3-;Rejected;Entity not found.;Patient-A3-;Rejected;Claim Note Text;-MEMBER ID CAME IN ON THE CLAIM IS NOT PRESENT IN THE FACETS SYSTEM DUE TO MISMATCH IN DATE OF BIRTH, NAME AND GRGR_CK. RESUBMIT WITH CORRECT DETAILS.-; The member ID and Date of ...
Payer Rejection: Other Insurance Coverage
A6 ACK/REJECT MISS INFO - OTHER INSURANCE COVERAGE INFORMATION (HEALTH, LIABILITY, AUTO, ETC.). The Patient has other Insurance that may be Primary. This often occurs when a Patient has a Medicare Advantage Plan, and the Patient presented the red, ...
Payer Rejection: Entity Not Found Patient/Insured/Subscriber/Dependent
A6 ACK/RETURNED - ENTITY NOT FOUND. USAGE- THIS CODE REQUIRES USE OF AN ENTITY CODE. - PATIENT A6 ACK/RETURNED - ENTITY NOT FOUND. USAGE- THIS CODE REQUIRES USE OF AN ENTITY CODE. - INSURED A6 ACK/RETURNED - ENTITY NOT ELIGIBLE. USAGE- THIS CODE ...
Payer Rejection: Subscriber and subscriber ID Not Found
A6 ACK/RETURNED - SUBSCRIBER AND SUBSCRIBER ID NOT FOUND. | Payer Control Number- FLN 946230653766200 ICN DU35148878 | MEMBER PICK REJECT | Payer Control Number- FLN 946230653766200 ICN DU35148878 The claim was submitted to the incorrect Payer ID. ...
Payer Rejection: Invalid Info - Entity's NPI Usage
A6 ACK/REJECT INVAL INFO - ENTITYS NATIONAL PROVIDER IDENTIFIER (NPI). USAGE- THIS CODE REQUIRES USE OF AN ENTITY CODE This is a common error from Medicare, but other Payers may use it as well. The payer is indicating that either the NPI that you ...
Payer Rejection-A8: Rejected for Detailed Description of Service
Rejection: PE - A6 -A1-;Acknowledgement/Receipt-The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication.;Entity acknowledges receipt of claim/encounter.;Payer-A8-;Rejected;Detailed description of ...
Rejection: Invalid Payer Resp Seq Num Code
Reason for rejection This Payer does not accept Secondary Claims. Resolution: Libraries > Insurances Select the Insurance ID for the Payer. Click Edit. From the Secondary Form Type dropdown list, select HCFA. Enter the Payer's Address if not already ...
Payer Rejected: Not Eligible
The Claims with this Payer Rejection did not make it into the Payer adjudication system. If you call the Payer, they will not have a record of this claim. Options Call the Patient for updated Insurance information or Go to the Encounter Dashboard and ...
Payer Rejection: Smart Edit
Medicare started the concept of SmartEdits. The Claim rejects at the Clearinghouse level with an alert explaining that the Claim may be denied when processed. Some claims are rejected by a Smart Edit and do not enter the claims processing system. ...
Rejection: Missing or Invalid Information
Missing or Invalid Information Rejections Because these Rejection messages are from the Payer, Support may be are unable to discern the reason for a rejection. It is recommended that you reach out to the Payer for more information. Rejection for NDC ...
Rejection: Invalid Information - Length Invalid for Receiver's Application System
Note: At least one other status code is required to identify the data element in error.;-A7-;Rejected for Invalid Information;Submitted charges Reason for rejection: The payer cannot process the claim amount over $100,000,000. To fix this this ...
Etactics Note: Previously Rejected on Earlier Report
Reason for rejection The payer responded more than once to the Clearinghouse. To fix this rejection: Go to the Encounter Dashboard. From the Policy Breakdown panel, click Claim History. Use the Filter Criteria, select Payer Rejected from ...