Electronic Claim Errors
A knowledge base of common electronic claim errors and possible solutions.
- SUBSCRIBER ID NOT ON FILE AS ENTERED
- H65 MEMBER ID MUST BE 9 DIGIT SSN OR 11 DIGIT DBN
- S112 OUT OF AREA ID# INVALID
- Element NM102 (Entity Type Qualifier) does not contain a valid identification code: '2' is not allowed. Segment NM1 is defined in the guideline at position 2500.
- X040 PROVSUBM NOT ON TBL FOR
- Mbr not valid at DOS
- 97 - Patient eligibility not found with entity. Usage: This code requires use of an Entity Code.
- 735 - This service/claim is included in the allowance for another service or claim.
- BILLING NPI IS NOT ON FILE >
- 54 - Duplicate of a previously processed claim/line.
- SUBSCRIBER FIRST NAME CONTAINS LOWER CASE CHARACTERS
- ACKNOWLEDGEMENT/REJECTED FOR INVALID INFORMATION
- Acknowledgement/Returned as unprocessable claim | Subscriber and subscriber id not found.
- Acknowledgement/Returned as unprocessable claim | OUR RECORDS INDICATE PROVIDER IS NOT ENROLLED IN THIS PROGRAM. CONTACT TMHP CUSTOMER SERVICE
- 586 - Line Note Text
- RENDERING PROVIDER NPI: INVALID; MUST MATCH THE NPI REGISTERED WITH PAYER
- BILLING PROVIDER NPI: INVALID; MUST MATCH THE NPI REGISTERED WITH PAYER
- Acknowledgement/Returned as unprocessable claim | Entity not found.
- Acknowledgement/Returned as unprocessable claim | Entitys contract/member number
- 109 - Entity not eligible. Usage: This code requires use of an Entity Code.
- EMBLEM UNABLE TO LOCATE ELIGIBILITY SPAN FOR THE PATIENT
- Payer Requires Pre-Enrollment for Electronic Claims Submission. Provider is not yet approved to submit claims electronically to this payer
- SUBSCRIBERS CONTRACT NUMBER NOT FOUND IN BCBSMS FILES
- 249 - Place of service.
- Value of sub-element HI02-02 has been already used. Diagnosis Codes (primary and secondary) are expected to be unique within claim. Segment HI is defined in the guideline at position 2310
- Value of element NM108 is incorrect. Expected value is 'XX' for covered providers when National Provider ID is mandated for use. Segment NM1 is defined in the guideline at position 0150
- Segment DTP (Date - Admission) is missing. It is required on all inpatient claims and some outpatient claims as defined by NUBC
- 125 - Entity's name. Usage: This code requires use of an Entity Code
- RENDERING NPI IS NOT ON FILE
- Value of element N403 is incorrect. Expected value is from external code list - ZIP Code (51) when country is US. Segment N4 is defined in the guideline at position 0300.