Claim Rejections
A guide to troubleshooting claim rejections, including a list of the top rejections received by Tebra customers, a description of possible causes, and suggestions for correcting in the Desktop Application (PM). To quickly find a specific claim rejection, press Ctrl+F on your keyboard and search for key words from the rejection message. If you do not have access to a specific task or function described within the topics of these resources, please contact the person in your office who is a System Administrator for Tebra.
- General
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- At Tebra, we understand that getting paid faster is essential to the health of your business. One of the most significant areas that can delay getting paid is claim rejections. Watch the quick 10-minute video on some of the best practices we recommend, avoiding any setbacks that are within your reach to correct. Use Help Articles to get started, follow a checklist, etc.
- Common Claim Rejections
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- Common Claim Rejections Resolutions
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- Validation Errors
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- Claim Rejection Codes
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- 2010BB VALUE OF ELEMENT N403 IS INCORRECT
- 2310C Element NM109 is Used. It is not expected to be used when it has the same value as element NM109 in loop 2010AA
- 2400 Loop 2420E (Ordering Provider Name) is Used
- 2400 SUB-ELEMENT SV101-07 IS MISSING
- 2430 SVD02 Claim or Line Level Prior Payment Information Required for this Patient
- Accident Date is required when the diagnosis code is between 800 - 999, or the diagnosis code is V015 or 53511
- ACKNOWLEDGEMENT/RETURNED AS UNPROCESSABLE CLAIM THE CLAIM/ENCOUNTER HAS BEEN REJECTED AND H CATEGORY - BCBS
- ACKNOWLEDGEMENT/RETURNED AS UNPROCESSABLE CLAIM THE CLAIM/ENCOUNTER HAS BEEN REJECTED AND H - Humana
- Acknowledgement/Rejected for Invalid Information Entity's Health Industry ID Number
- Acknowledgement/Rejected for Invalid Information Procedure Code-XXXXX Modifier(s)-XX SVC Line Response - Procedure Code Modifier(s) for Service(s) Rendered Procedure Code-XXXXX Modifier(s)-XX SVC
- Acknowledgement/Rejected for Missing Information Entity's Tax ID. Rendering Provider
- Acknowledgement/Returned as unprocessable (BCBS/UHC/Aetna)
- Adjudication or Payment Date is Required When Sending Line Adjudication Information. 2430.DTP*573
- A data element is too short. The length of Element NM109 (Identification Code) is '1'. The minimum allowed length is '2'. Loop 2330A NM109 Other subscriber name
- A data element is too short. The length of Sub-Element SV101-03 (Procedure Modifier) is '1'. The minimum allowed length is '2'
- BCBSNE Rule: 837P Accident Related Injury Indicator (I00)
- Billing Provider Address1 cannot be a PO Box or Lockbox Address. 2010AA.N3*01
- Billing Provider NPI/API to TPI Combination or NPI/API Information is Invalid
- Billing Provider Taxonomy Code Required
- Billing Provider Tax ID/EIN Submitted Does Not Match BCBSF Files
- BILLING TAXONOMY MISSING/INVALID
- BWC Pay to Provider Number Invalid
- CHARGE MUST BE GREATER THAN ZERO
- Claims Submitted with an Accident Diagnosis Must Indicate if the Accident was due to a Work Injury, an Auto Accident or Other Accident
- CLAIMS WITH MEDICARE OTHER PAYER CANNOT BE SENT TO THIS PAYER, PLEASE USE TRICARE FOR LIFE
- Claim failed Pre-Membership Validation
- Claim Frequency Code Acknowledgement/Rejected for Invalid Information
- Claim Frequency Code is invalid
- Claim Frequency Type Code is Invalid
- Claim Level Date is Missing or Invalid. Date Must be in the CCYYMMDD Format - CMS-1500
- CLAIM LEVEL SERVICE FACILITY INFORMATION- INVALID; CLAIM LEVEL SERVICE FACILITY INFORMATION INVALID FO R PAYER
- Claim must be billed direct to Blue Shield CA
- CLAIM SERVICE LOCATION NPI REQUIRED; PAYER HAS MANDATED USE OF NPI
- Claim/Line Check or Remittance Date is Required on Adjudicated Claims. 2320/2430.DTP*573
- COB AMOUNT IS MISSING OR INVALID; OTHER PAYER RESPONSIBILITY SEQUENCE CODE IS MISSING OR INVALID (Bad Data: T )
- Contract Number Not Found
- Crosswalk did not give 1 to 1 match for NPI XXXXXXXXXX. Number of rows returned was 0
- CURR-SOURCE OF PAYMENT IS REQUIRED
- Destination Payer's Sequence Code must be "P" Primary
- Detailed description of service Acknowledgement / Rejected for relational field in error
- Discharge Date (DTP-01=096) was not expected because this claim is not for Inpatient Services
- Drug Unit Count Code Qualifier is required and must be valid
- Duplicate Claim; Submitted Previously
- EDI PROFESSIONAL CLAIMS ARE NOT AVAILABLE FOR THIS PAYER ID
- Entity's ID Number – Subscriber
- ENTITYS SPECIALTY TAXONOMY CODE. - BILLING PROVIDER
- Entity not eligible for benefits for submitted dates of service
- Entity Not Found Entity: Patient
- EPSDT Indicator
- ERROR- Wrong Tax ID Used | ERROR- Dr Not On File/Not in System
- ERROR 026: PROVIDER IS NOT VALID FOR THIS SUBMITTER
- Facility admission date. Admission Date is required on inpatient medical visits. 2300.DTP*435
- FINAL/DENIAL - FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE
- First Symptom Date Required
- ICD 10 Diagnosis Code 2 must be valid. 2300.HI*02-2
- ICD 10 Diagnosis Code 3 must be valid. 2300.HI*03-2
- ICD 10 Diagnosis Code 4 must be valid. 2300.HI*04-2
- ICD 10 Principal Diagnosis Code must be valid. 2300.HI*01-2
- Insurance Type Code is required for non-Primary Medicare payer. Element SBR05 is missing. It is required when SBR01 is not 'P' and payer is Medicare
- Insured or Subscriber: Entity's Postal/Zip Code
- Internal Review/Audit Pending/Requested Information
- INVALID DIAGNOSIS CODE TYPE - EXPECTED VALUE IS ICD-9
- INVALID OTH
- Investigating existence of other insurance coverage Pending/Provider Requested Information
- LINE COUNTER IS MISSING, INVALID, OR OUT OF SEQUENCE
- LINE LEVEL PROCEDURE CODE IS MISSING OR INVALID
- MEDICAID ALLOWANCE INCLUDES FULL MEDICARE DEDUCTIBLE AND MAY INCLUDE FULL OR PARTIAL COINSURANCE
- Missing No Vendor Match for NPI
- Modifier 2 cannot be the same as Modifier 3 or 4
- No Trading Partner Associated with this Claim
- ORDERING PROVIDER NAME / PRIMARY IDENTIFIER IS MISSING OR INVALID
- Ordering provider required for DMERC claims
- Other Entity's Adjudication or Payment/Remittance Date Entity- Payer
- Other Insurance Coverage Information: Health, Liability, Auto, Etc
- Other Insured Claim Filing Indicator Code Must be Valid. 2320.SBR*09
- Other Payer Claim Filing Indicator Code is Invalid. Cannot = Medicare
- OTHER PAYER CLAIM LEVEL ADJUSTMENT IS MISSING OR INVALID
- Other Payer Insurance Type is required when Payer is Medicare - Not Primary
- Other Subscriber Identification Code Qualifier is required and must be II or MI. 2330A.NM1*08
- Patient : Entity not eligible for benefits for submitted dates of service
- Patient Not Covered
- Patient Not Found
- Patient/Subscriber is not Eligible Please Verify Member ID/Insurance/Coverage
- Pay-To Provider Country Code should be Blank, CA, or MX. 2010AB.N4*04
- Payer ID Number is required and must be valid
- Payer Responsibility Sequence Number Code cannot occur more than once within a claim
- Pay To Affiliation Error - No Pay To Provider Found
- Pay to Provider Number is Authorized for Rendering Only
- Performing Provider Number Not Identified as Part of the Group Billing Number
- Per CCI Guidelines Procedures Code XXXXX has an Unbundle Relationship With Procedure Code XXXXX Billed for the Same Date of Service. Review Documentation to Determine if a Modifier Override is Appropriate
- PLEASE SUBMIT SECONDARY/COB CLAIMS ON PAPER WHEN PRIMARY IS NOT MEDICARE
- Prefix for Entity's Contract/Member Number
- PRINCIPAL DIAGNOSIS CODE IS MISSING OR INVALID FOR DIAGNOSIS TYPE GIVEN (ICD-9, ICD-10) OR CANNOT BE EXTERNAL CAUSE CODE
- PROCEDURE CODE DESCRIPTION IS MISSING OR INVALID
- Procedure Code Modifier(s) for Service(s) Rendered Acknowledgement/Rejected for Invalid Information
- PROCEDURE CODE MODIFIER IS MISSING OR INVALID
- Provider ID Not on File
- Provider Not Auto-matched - awaiting manual review
- Receiver Reject Reason Cod
- Reference Number is Missing, Contains Invalid Characters, or Greater than 30 Bytes
- Referring Physician Provider Number Missing
- Rejected at clearinghouse 2 alpha/5 numeric noridian issued submitter ID is requred. The submitter ID was submitted or bridged incorrectly. Please contact Capario EDI services for assistance
- Rejected at Clearinghouse Billing / Pay-To Provider Taxonomy Code - Provider Type Qualifier is Missing or Invalid
- Rejected at Clearinghouse Billling and Rendering Provider NPI Cannot be the Same Value
- Rejected at Clearinghouse Claim Level Date is Missing or Invalid
- Rejected at Clearinghouse Claim Secondary Identifier Description is Not to be Used
- REJECTED AT CLEARINGHOUSE CLM REJECTED AT CLEARINGHOUSE FOR HIPAA COMPLIANCE
- Rejected at Clearinghouse Diagnosis Code Pointer (X) is Missing or Invalid. Must Point to a Valid Diagnosis Code
- Rejected at Clearinghouse This Payer Is Not Active (xxxxx)
- Rejected for Invalid Information NDC Number
- Related Causes Code 1 must be AA, EM, or OA. 2300.CLM*11-1
- Related Cause Information is Missing or Invalid (Error Code: 2300~CLM~11)
- Relationship to Insured must be 18 - Self for Medicare. 2000B.SBR*02
- RENDERING NPI IS NOT ON FILE
- Rendering Physician is Required
- Rendering Provider Specialty Code is Missing or Invalid
- Requests for readjudication must reference the newly assigned payer claim control number
- REQUIRED REFERRAL CODE FOR CHILD HEALTH CHECK-UP IS MISSING
- Same Day Duplicate
- Segment has data element errors Loop:2300 Segment:HI Invalid Character in Data Element
- Service Facility NPI Must Not Match Billing Provider NPI
- Service Facility Primary ID is Missing or Invalid
- SERVICE FACILITY SECONDARY IDENTIFICATION NUMBER QUALIFIER IS MISSING OR INVALID
- Service Unit Count is required and must be valid. 2400.SV1*04
- Site is not allowed to send claims to the specified payer
- Submitter ID is Required
- Submitter not approved for electronic claim submissions on behalf of this entity
- Subscriber and Other Subscriber Claim Filing Indicator Codes cannot both be MB
- Subscriber Group or Policy Number - Required; Must be Entered for Payer
- SUBSCRIBER PRIMARY ID# MUST BE 10 OR 11 CHARACTERS
- Subscriber Primary Identification Number is Missing or Invalid
- Subscriber Primary Identifier - Invalid; Must be in a Valid Format for Payer
- SUBSCRIBER ZIP CODE IS MISSING OR IS NOT A VALID USPS ZIP CODE, WITHOUT PUNCTUATION
- SUPPLEMENTAL DIAGNOSIS CODE IS MISSING OR INVALID FOR DIAGNOSIS TYPE GIVEN (ICD-9, ICD-10)
- SV1 01-07 is missing. It is required when procedure code is non-specific
- TEST REFERENCE IDENTIFICATION CODE IS MISSING OR INVALID. MUST BE OG OR TR. REJECTED AT CLEARINGHOUSE LINE LEVEL - TESTS RESULTS QUALIFIER IS MISSING OR INVALID
- THE DIAGNOSIS CODE (_____) AND MODIFIER (__) COMBINATION ARE INAPPROPRIATE
- The last position of the Bill Type Code is not a valid NUBC Frequency code for this transaction
- The Supervising Provider Information was found but not expected since it is the same as the Rendering Provider
- This claim is NOT REJECTED and has been submitted to United Healthcare
- Unable to Identify as Member
- WARNING: INVALID DIAGNOSIS CODE QUALIFIER PER PAYER REQUIREMENTS
- Warning: Invalid diagnosis version indicator per payer requirements
- Trizetto Claim Rejections
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- 2000A THE PROVIDER INFORMATION SEGMENT (LOOP 2000A, PRV) MUST BE SUBMITTED
- 2010BA SUBSCRIBER PRIMARY ID (LOOP 2010BA, NM109) CANNOT INCLUDE AN ALPHAPREFIX THAT BEGINS WITH XOD, XOJ, ZGD, ZGJ, YID, YIJ, YUB, YUX, YDL, OR YDJ
- As of 1/1/12, Medicare only accepts claim frequency code of 1
- Auto Accident State is required if Related Causes Code is AA. 2300.CLM*11-4
- CHECK MEMBER ID OR ELIGIBILITY. CONTACT PAYER FOR FURTHER INFORMATION
- Claim submitted to incorrect payer
- Dependent : Entity not eligible
- Diagnosis Code Pointer1 must be present. 2400.SV1*07-1
- Initial Treatment Date is required when reporting Spinal Manipulation. 2300.DTP*454
- Insured Last Name INVALID CHARACTER(S)
- Insured or Subscriber
- Insured or Subscriber: Policy Canceled
- Insured or Subscriber : Entity's contract/member number
- Member ID must be valid
- Member id number not valid for DOS
- MEMBER NOT VALID AT DATE OF SERVICE. PLEASE CONTACT THE PAYER
- MEMBER NUMBER AND DATE OF BIRTH DO NOT MATCH
- MEMBER NUMBER CANNOT BE FOUND
- Onset of Current Illness or Symptom Date cannot be a future date. 2300.DTP*431
- Patient eligibility not found with entity
- Provider : Entity not approved as an electronic submitter
- Provider : Medical notes/report Pending/Provider Requested Information-The claim or encounter is waiting for information that has already been requested from the provider
- Referring Provider Last Name cannot contain numeric characters. 2310A.NM1*03
- Referring Provider NPI is invalid. 2310A.NM1*09
- Rendering Provider: Entity's tax id
- Rendering Provider NPI is invalid. 2310B.NM1*09
- Rendering Provider NPI or Atypical Identifier is required. 2310B
- Service Date is invalid. 2400.DTP*472
- Service Location : Entity's Postal/Zip Code
- Submitter : Entity not approved as an electronic submitter
- Submitter : No agreement with entity
- Subscriber and policy number/contract number not found
- Subscriber First Name contains invalid characters. 2000BA. NM*04
- Subscriber ID must be 9 or 11 digits
- Subscriber ID number must be 6 or 9 digits with 1-3 letters in front
- Subscriber Last Name contains invalid characters. 2000BA. NM1*03
- UB-04 Claim Rejections
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- Jopari Workers Compensation and Auto Rejections
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