Unknown/Invalid Payer

The clearinghouse is reporting back that the payer (based on Payer ID) is no longer valid.   This can happen when 1.) the clearinghouse removes the payer from their payer list or 2.) the clearinghouse changes the payer ID associated with this payer.

Unfortunately, when the clearinghouses make changes to their payer lists, they do not notify the software vendors (such as Therabill).   The only way we can really find out about it is through these EDI rejections.

What happens if the payer was removed from the clearinghouse payer list?

Therabill will make every attempt to make another connection with the payer.  We will first look to see if they are available from any other clearinghouse that we have partnered with.  If they are not in another clearinghouse list, then Therabill will reach out to the payer to see if we can make a direct connection with them.

What should I do with my claim?

Because the process of creating a direct connection with a payer cannot be guaranteed (it is largely up to the payer) and even if they allow a direct connection from a software vendor, it could take a long time to make the connection (they require a lot of testing).

Therabill recommends that you print out the claim and mail it to the payer.  This way, you can reduce any cash flow issues as well as avoid any timely filing deadlines.

Do I need to notify Therabill

Nope.  Our integrations team automatically gets an e-mail when this rejection message is received by anyone.  We have probably already started the process.