Submitter not approved for electronic claim submissions on behalf of this entity

Rejection Message

Submitter not approved for electronic claim submissions on behalf of this entity.

Rejection Details

This rejection has three possible causes:

• The practice is not credentialed or enrolled with this payer.
• The claims were submitted with the incorrect billing information.
• The claims were submitted to the wrong payer ID.

Resolution

Resolution steps will vary depending on the cause:

• If the practice is not credentialed or enrolled with the payer, contact the payer directly for further assistance.
  1. Verify what provider IDs the payer has on file to determine the information claims should be submitted with.
     1. Is the provider enrolled with their Group NPI or Individual NPI?
     2. Is the provider enrolled with their Tax ID or SSN?
  2. Verify if there are any additional payer-assigned provider IDs that also need to be submitted on the claims. If so, what loop and segment should the information populate?
  3. Verify the Payer ID used is correct/valid for the policy information submitted.
• If the claims were submitted with different billing information than what is on file with the payer, verify and edit the billing information.
• If the claims were submitted to the wrong payer ID, verify and edit the payer ID.

When all corrective actions are completed, verify enrollment is completed (or not required) before submitting e-claims. Then, rebill and resubmit all affected claims.