Clearinghouse Issue

Rejection Message:

REJECTED AT CLEARINGHOUSE COB claim balancing failed. Total charge amount does not equal sum of paid amount and all adjustment amounts. (SMFL0)

Possible Causes:

This type of rejection comes from a secondary claim submission when the sum of the payment amounts, adjustments, and patient responsibility that you entered from their primary insurance does not equal the charge amount. For each session on this claim, look at the payments and adjustments that you entered from primary. The sum of the payments, adjustments and patient responsibility must equal the charge amount. For example, if the charge amount was $150.00, then the sum of payments from primary, adjustments from primary and the patient responsibility that you entered from primary must equal $150.00.

Possible Solutions:

Go into the original insurance payment and make sure the paid amount, patient responsibility (Copay, Deductible, etc.), adjustment amount, and balance equal the Billed amount. If it does not, change the adjusted amount so that everything equals appropriately. This can happen if a patient payment is applied to an encounter before the ERA is received. Offices should wait to apply patient payments to encounters until they get the ERA back to avoid these types of miscalculations.

Rejection Message:

MM/DD/YYYY 14-07-42 NM1-09 BILLING PROVIDER ID QUALIFIER, PROVIDER NPI NOT REGISTERED WITH BCBSNC. PLEASE CONTACT NETWORK MANAGEMENT AT 1-800-777-1643 TO RESOLVE THIS MATTER.

Possible Causes:

The clearinghouse does not recognize certain non-alphanumeric characters such as /, -, (, and )

Possible Solutions:

Removing these special characters and then try resubmitting the claims, making sure that the updated information is correctly reflected within the claims as well.