Electronic Claim Errors
A knowledge base of common electronic claim errors and possible solutions.
- 88 - Entity not eligible for benefits for submitted dates of service. Usage: This code requires use of an Entity Code.
- DTP03 NOT IN POLICY DATE RANGE
- 567 - Facility Code Qualifier
- Element NM104 is missing. It is recommended to be used when Referring Provider is a person (NM102=1). Segment NM1 is defined in the guideline at position 2500.
- A3 125 P147 REFERRING PROVIDER FIRST NAME IS MISSING OR INVALID - CLAIM
- 145 - Entity's specialty/taxonomy code. Usage: This code requires use of an Entity Code.
- 477 - Diagnosis code pointer is missing or invalid
- Sub-Element SV101-02 (Product/Service ID) is missing. This Sub-Elements standard option is Mandatory. Segment SV1 is defined in the guideline at position 3700.
- 40659 InvalidData F802 Location 2300 - HI03-02 Clm The Diagnosis Code XXX has been used more than once
- MEM - MEMBERSHIP FOR PATIENT NAME IS INACTIVE OR UNABLE TO LOCATE MEMBER. AN INCORRECT BIRTHDATE OR GENDER MAY HAVE BEEN SUPPLIED, CONTACT CUSTOMER SERVICE
- Description required when submitting a non-specific procedure code. FE39
- Patients name doees not match the name in the payers system.
- Payer Specific Edit: Original Ref No (Box 22, REF*F8) not a Martins Point Claim Number. Must be 11 or 13 digits.
- Secondary Claims Submission Unsupported for this Payer
- Invalid Facility Zip
- A3 562 P531 BILLING NPI NOT PRESENT ON CORPORATE CROSSWALK
- PROV - PERFORMING / RENDERING PROVIDER NUMBER IS REQUIRED NPI
- Svc BCBSNE Rule 837P - HME procedure requires RR or NU :
- Missing Primary Insureds Last Name
- Patient Not Found
- REJECTED AT CLEARINGHOUSE SUBSCRIBER GROUP/POLICY NUMBER IS MISSING OR INVALID (PHP00)
- CLAIM REJECTED ID NUMBER DOES NOT EXIST OR IS INVALID ID NUMBER DOES NOT EXIST OR IS INVALID ID NUMBER DOES NOT EXIST OR IS INVALID :
- CLAIM REJECTED DENY-NOT A CONTRACTED SERVICE. PROVIDER RESPONSIBLE. DENY-NOT A CONTRACTED SERVICE. PROVIDER RESPONSIBLE. DENY-NOT A CONTRACTED SERVICE. PROVIDER RESPONSIBLE.
- 255 - Diagnosis code.
- EJECTED-Mem Match Error-DOBGender Mismatch :
- 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.
- 128 - Entity's tax id. Usage: This code requires use of an Entity Code
- PROVIDER NOT MAPPED - BILLING :
- 2010BADMG02 Subscriber Date Of Birth Cannot Be Validated :
- Missing Invalid subscriber identifier