Electronic Claim Errors
A knowledge base of common electronic claim errors and possible solutions.
- 252 - Entity's prior authorization/certification number. Usage: This code requires the use of an Entity Code.
- Per Payer - Patient Relationship To Insured Must Be Self, Patient should be listed as both Patient and Insured.
- 401 - Source of payment is not valid
- MISSING/INVALID BILLING PROVIDER ID
- INVALID HCPCS/CPT4 AND MODIFIER COMBINATION
- Professional claims must be filed directly to the Home Plan
- REJECTED AT CLEARINGHOUSE SUBSCRIBER PRIMARY ID# IS MISSING/INVALID/CANNOT EQUAL GROUP NUMBER FIELD
- Subscriber and subscriber id mismatched
- SUBSCRIBER/MEMBER ID NOT FOUND
- Segment DTP (Date - Accident) is used. It may be used only when CLM11 is used. Segment DTP is defined in the guideline at position 1350.
- Unprocessable Claim N70006 Claim submitted to incorrect payer
- 755 - Entity's primary identifier. Usage: This code requires the use of an Entity Code.
- Sub-element CLM11-04 is missing. It is required when CLM11-1,-2, or -3 = 'AA'. Segment CLM is defined in the guideline at position 1300.
- 796 - Procedure code not valid for date of service.
- 500 - Entity's Postal/Zip Code. Usage: This code requires use of an Entity Code.
- Subscriber group name (loop 2000B, SBR04) must not be present.
- RELATED CAUSES CODE: INVALID; PAYER ONLY ACCEPTS CODE VALUE INDICATING AUTO ACCIDENT
- Tax ID is not on file for the Billing NPI
- PROVIDER T.I.N. NOT ON FILE
- 750 - Auto Accident State or Province Code
- Value of element PRV03 is incorrect. Expected value is from external code list - Health Care Provider Taxonomy Code (682). Segment PRV is defined in the guideline at position 0030.
- Sub-element CLM11-04 is missing. It is required when CLM11-1,-2, or -3 = 'AA'. Segment CLM is defined in the guideline at position 1300.
- 306 - Detailed description of service.
- Subscriber group or policy number (loop 2000B, SBR03) can only contain alphanumeric characters. Special characters are not allowed
- PROC CODE W/ MULTI UNITS INVALID/DATE OF SERV
- Member number and date of birth do not match.
- 496 - Submitter not approved for electronic claim submissions on behalf of this entity. Usage: This code requires use of an Entity Code.
- Value of element N301 is incorrect. Expected value should not be a 'PO BOX' or 'P.O. BOX'. Segment N3 is defined in the guideline at position 0250
- Billing provider requires a Physical Address (PO,Lockbox,File,Dept Invalid)
- Value of element PER04 is incorrect. Expected value is Telephone Number (format is '10 digits') when PER03='TE'. Segment PER is defined in the guideline at position 0400.