Your claims cannot be submitted to the secondary insurance because the charge amount does not equal the sum of the paid amount and all line adjustment amounts

Rejection Message

Your claims cannot be submitted to the secondary insurance because the charge amount does not equal the sum of the paid amount and all line adjustment amounts. This would result in a rejection at the clearinghouse. Please open Encounters > Track Claim Status, then find the claim ID above, review the transaction history, locate and open the payment from the primary insurance, and finally, review the amount paid by the primary and all line adjustments amounts and make any necessary corrections. The primary paid amount + all line adjustments must equal the original service line charge.

Rejection Details

Tebra Validation Error

This rejection indicates the sum of the paid amount and all line adjustment amounts do not equal to the charge amount for the primary payment.

Claims billed with an invalid paid and adjustment amount will reject at the clearinghouse; therefore Tebra has held the claim until the error is corrected. Once the error is corrected, resubmit the claims in order for them to be sent to the clearinghouse.

Note: Since claims rejected within Tebra are not forwarded to the clearinghouse, timely filing cannot be generated for the submission until the validation errors have been corrected and the claims are successfully submitted to the clearinghouse.

Resolution

Follow the steps below to correct the posted payment:

1. Click Encounters > Track Claim Status. The Find Claim window opens.
2. Look for and double click the appropriate claim to open. The Edit Claim window opens.
3. Under the Transactions section, locate and double click the primary insurance payment transaction line. The Edit Payment window opens.
4. Select the Apply tab or click Apply Now. The additional payment details display. 
5. Select the appropriate patient, encounter, and/or service line as necessary.
6. Under the Simple (EOB) tab, verify the following for all service lines of the claim and correct the amounts as necessary.
   1. The sum of the Allowed, Contract Adj, and Secondary Adj amounts equals the charge amount.
   2. The sum of the Paid, Deductible, Coinsurance, and Copay amounts equals the Allowed amount.
7. Click Save at the bottom of each relevant window.

Then, rebill and resubmit all affected claims when ready.