Claim failed Pre-Membership Validation

Rejection Message

Claim failed Pre-Membership Validation

Rejection Details

This rejection has three possible causes:

1. The claim was submitted to the wrong payer ID.
2. The patient’s demographics or insurance policy included on the claim was not eligible for the date of service billed.
3. The patient is a newborn or recently added to the guarantor’s insurance policy.

Resolution

Resolution steps will vary depending on the cause:

1. If the claim is submitted to the wrong payer ID, verify and edit the payer ID.
2. If the patient demographics or policy is incorrect, verify the patient's eligibility.
3. If the patient is a newborn or recently added to the guarantor’s insurance policy, please contact the payer to verify the patient is active under the insured’s policy.

When all corrective actions are completed, rebill and resubmit all affected claims.