516 - Other Entity's Adjudication or Payment/Remittance Date. Usage: An Entity code is required to identify the Other Payer Entity, i.e. primary, secondary.

This rejection of a secondary insurance claim to the payer usually occurs due to missing primary payment information or the Payer Name information is mismatched with the payment.

Note: When posting payments, the insurance name should match the insurance payer name invoiced. Notice in the above image the Ins Pmt entry indicates BS rather than Blue Shield - California / Blue Shield (FEP).

Error Variations

PAYER RESPONSIBILITY SEQUENCE NUMBER: INVALID, MUST NOT HAVE A SECONDARY PAYER WITHOUT A PRIMARY PAYER, MUST NOT HAVE A TERTIARY PAYER WITHOUT A PRIMARY AND SECONDARY PAYER [02]^^^\\\\R^^PAYER RESPONSIBILITY SEQUENCE NUMBER: INVALID; MUST BE A VALID SEQUENCE NUMBER^^^

H46474 THE OTHER SUBSCRIBER INFORMATION WAS NOT FOUND BUT WAS EXPECTED BECAUSE THE DESTINATION PAYER IS NOT THE PRIMARY PAYER

COB REPORTING INCONSISTENT/INVALID

To Resolve

Follow the steps below to remove and repost your payments from the primary payer for all affected sessions.

1. From the Edit Claim Information section of the EDI rejection page click on the affected Date of Service (DOS) under Claim Sessions.
   
2. Then click the (black dollar sign) to open the session.
   
3. Take note of the payment and adjustment details for each CPT code in the Payment History section. You will need this information to re-enter all payments and adjustments in step 7.
   
4. Once you have noted the details of each payment and adjustment, use the button to delete each payment.
5. After removing all the payments and adjustments, use the Type drop-down in the New Payments/ Adjustments section and choose Insurance w/ Adjudication Info.
   
6. Then fill in or update the Received from field with the name of the Primary Insurance payer.
   Tip: Once you begin typing in this field the Payer Listing will pop up, you can then click on the correct payer.
   
   
   1. 1. This payer's name must match the insurance card listed on the client’s chart.
         
      2. If necessary follow the steps in this article to remap the insurance.
7. Complete the Payment & Adjustment Entry section as shown below:
   1. 1. Re-Enter the New Pmt and New Adj for each CPT code that you noted in Step 3 above. 
      2. Ensure the correct Remark code is added for each entry.
      3. Check the Post Adj box for each CPT code.
      4. Then use the Action drop-down and select Keep Current Session Status.
         
8. Once all the payments and adjustments have been re-entered click Submit to complete the session for resubmission.
   
9. Resubmit this claim from the EDI rejection page by clicking Resubmit Electronically.
   
10. To confirm resubmission, click Submit.