The claimencounter has been rejected and has not been entered into the adjudication system. Entity not eligible. Missing or invalid information. Missinginvalid data prevents payer from processing claim.

There are many reasons why you may be getting this error.  With this type of error, you may need to call the insurance company to check on why they cannot find the member.  While on the phone with the insurance company, should should have a copy of the CMS-1500 claim for that you sent to them in front of you.  You can open and view the CMS-1500 claim form by clicking the PDF icon  associated with the claim in your CMS-1500 filing cabinet in Therabill (click Filing in the top green navigation bar when logged in to Therabill).  You can use the information on the CMS-1500 to verify what you sent versus what the insurance company has on file.

Possible Causes

Most of the error types listed below have to do with insurance information that you may have entered in to Therabill.  The insurance information is entered on the add / edit insurance card form in Therabill.  From the error page, this is accessible by clicking the edit icon  next to the insurance card on the error page.  Some of the errors may have to do with the client / patient information.  To edit client information from the error page, click the edit icon  next to the client name on the error page.

The patient is no longer covered on that insurance plan

It could be that the patient is no longer covered under that insurance plan.  If this is the case, you will either need to get new insurance information from your patient or bill the session to your patient by closing the session.

Sent to the wrong payer

Make sure you are submitting to the correct insurance company.  You may want to call the phone number on the copy of the insurance card you received from your patient and ask them for their EDI Payor ID.  Make sure that matches the EDI Payor ID that is associated with the insurance card you set up for the client in Therabill.    If it is not the correct payor ID in Therabill, then change it in the Ins Company text box on the edit insurance card form in the client record.  From the error page, you can then click Resubmit Electronically at the top and then click on the new insurance company.

Incorrect Primary ID

On the insurance card in Therabill, what you have entered in the text box labeled Primary ID is what goes out in Box 1A of the insurance claim.  This is the unique ID that identifies the patient.  Make sure that is entered correctly. 

Make sure you don't have any invalid characters in the primary ID.  For example, a lot of insurance companies will have trailing numbers at the end of their primary ID separated by a dash or a space.  You may want to ask the payer if they want the trailing numbers in Box 1A of the CMS-1500.

Submitting extra information

It could be that you have extra information entered on the insurance card in Therabill.  For example, if there is no policy number on the copy of the insurance card you received from the patient, then do not enter a policy number on the insurance card in Therabill.  From the error page, click the edit icon next to the insurance card and verify what you have entered.

Invalid / Missing / Incorrect insured's information

Surprisingly, sometimes a misspelled name can cause this error.   Or maybe the birthdate is wrong.  Different insurance companies will handle this type of thing differently.  It is always best to make sure you enter it correctly in to Therabill.

Invalid / Missing / Incorrect client / patient information

Sometimes a misspelled name given for the patient can cause this error.  From the error page, click the edit icon next to the client and verify the information that you have entered.

Resubmitting the claim 

Once you have made any required edits, from the error page, you can then click the Resubmit Electronically button at the top to send the claim out with the new information.