Incorrect/Invalid Data Entry

Rejection Message:

2000B SBR09, SUBSCR- BCBSNE RULE- SBR09 MUST EQUAL BL

Possible Causes:

Policy Type is incorrect on the patient's insurance profile. Should be Blue Cross/Blue Shield

Possible Solutions:

Change policy type on insurance profile to BCBS, update the insurance profile in the claim and resubmit.

Rejection Message:

MM/DD/YYYY 22-32-16 ACK/RETURNED - DUPLICATE OF A PREVIOUSLY PROCESSED CLAIM/LINE.

Possible Causes:

This rejection message indicates that the payer has received the exact claim or service before.

Possible Solutions:

Update the encounter (if necessary) so that it is not being resubmitted with the exact same information as the previous submission.

Or, if the claim needs to be resubmitted as a corrected claim (per payer request), enter the submit reason on the encounter and resubmit.

 You can contact the payer to verify the status of the previous claim submission and determine if the claim needs to be corrected and (if so) how to properly resubmit.

Rejection Message:

"Message from payer received:mm/dd/yyyy 04-43-48 TRADING PARTNER HAS FORWARDED THE CLAIM TO THE PAYER, WAITING FOR ACKNOWLEDGEMENT FROM THE PAYER; 04/19/2019 07-25-28 PAYER ACKNOWLEDGED RECEIPT OF THE CLAIM;mm/dd/yyyy 03-28-43 TRADING PARTNER HAS FORWARDED THE CLAIM TO THE PAYER, WAITING FOR ACKNOWLEDGEMENT FROM THE PAYER;mm/dd/yyyy 13-07-46 ACK/RETURNED - MISSING OR INVALID INFORMATION. USAGE- AT LEAST ONE OTHER STATUS CODE IS REQUIRED TO IDENTIFY THE MISSING OR INVALID INFORMATION.;mm/dd/yyyy 13-07-46 P4999INFO SMARTEDIT (INFO) FOR SUPPORTING DOCUMENTATION REGARDING THIS EDIT REFER TO UNITEDHEALTHCARE POLICIES FOR THE SMART EDITS POLICY REFERENCE GUIDE AT UHCPROVIDER.COM/SMARTEDITS. IF APPLICABLE, UPDATE YOUR SUBMISSION.;mm/dd/yyyy 13-07-46 P4999UIBC SMARTEDIT (UIBC) [PATTERN 25871] BILLING CLIA ID SUBMITTED ON THE CLAIM IS NOT VALID BASED ON QIES AND CDC DATABASE. SUBMIT CLAIM WITH A VALID CLIA ID. (Capario Claim ID "XXXXXXXXXXXXXXX", Payer Claim ID "XXXXXXXXXXXXXXX")"

Possible Causes:

Incorrect or invalid CLIA number and/or incorrect or invalid provider demographics

Possible Solutions:

Any claim that does not contain the CLIA ID, invalid ID, and/or the complete servicing provider demographic information will be considered incomplete and rejected or denied. Claim line edits will also be applied if the lab certification level does not support the billed service code. Laboratory service providers who do not meet the reporting requirements and/or do not have the appropriate level of CLIA certification for the services reported will not be reimbursed

Rejection Message:

Message from Capario received: REJECTED AT CLEARINGHOUSE CLAIM LEVEL DATE IS MISSING OR INVALID. DATE MUST BE IN THE CCYYMMDD FORMAT. (SMID0) (Capario Claim ID "XXXXXXXXXXXXXXX")

Possible Causes:

Incorrect or invalid Date

Possible Solutions:

Check each date field to make sure that the correct information is entered.  In this case, the Hospital Admission date was missing.

Rejection Message:

Message from Capario received: REJECTED AT CLEARINGHOUSE OTHER PAYER SUBSCRIBER ZIP CODE IS MISSING OR IS NOT A VALID USPS ZIP CODE (000009998) (BS002) (Capario Claim ID "XXXXXXXXXXXXXXX") Message from Capario received: REJECTED AT CLEARINGHOUSE OTHER PAYER SUBSCRIBER ZIP CODE IS MISSING OR IS NOT A VALID USPS ZIP CODE (000009998) (BS002) (Capario Claim ID "XXXXXXXXXXXXXXX")

Possible Causes:

Incorrect or invalid zip code

Possible Solutions:

Some payers require the full 9-digit zip code for addresses on electronic claims. This rejection typically indicates that the claim includes a zip code without the 4-digit extension.

Try USPS ZIP Code Lookup tool for this patient's address and the full 9-digit code and entering that information into the patient's demographics and resubmitting the claim.

Rejection Message:

mm/dd/yyyy 10-49-32 REJECTED CLAIM BECAUSE BOTH BILLING PROVIDER NPI AND TAXONOMY PRESENT BUT NOT VALID AGAINST THE STATE OF TEXAS MASTER FILE

Possible Causes:

Multiple Taxonomy codes listed in the NPPES NPI Registry

Possible Solutions:

Update Default Billing Configuration, under Advanced Settings -> Billing Provider Other ID -> then select ZZ - Provider Taxonomy -> and enter the desired number in the Value field, then click Done.

Rejection Message:

mm/dd/yyyy 13-56-16 ACK/REJECT INVAL INFO - ENTITYS SOCIAL SECURITY NUMBER. 

Possible Causes:

Incorrect or incomplete social security number in the patient's Demographics.

Possible Solutions:

Adding the full social security number in the patient's Demographics.