Electronic Claim Errors
A knowledge base of common electronic claim errors and possible solutions.
- 464 - Payer Assigned Claim Control Number
- Subscriber ID (loop 2010BA, NM109) must begin with three alphabetic characters followed by 9 numeric characters or begin with 9HP followed by 9 numeric characters. Spaces and special characters are not allowed.
- 541 - Claim Submission Reason Code
- 742 - Payer Responsibility Sequence Number Code
- 554 - Date Claim Paid
- SUBSCRIBER MEMBER IDENTIFICATION NUMBER: INVALID; SUBSCRIBER MEMBER IDENTIFICATION NUMBER INVALID FOR PAYER
- REJECTED AT CLEARINGHOUSE DEPENDENT LEVEL INFORMATION IS NOT ALLOWED FOR THIS PAYER. (KS005) ()
- Patient Relationship Cd 19 is Invalid. Payer Requires 18(Self) for Medicaid Claims
- INSURED NAME, SSN EMPLOYEE ID NUMBER, ACCOUNT GROUP NUMBER, GROUP NAME NOT FOUND ON CARRIER
- A3 164 P615 CONTRACT ALPHA PREFIX IS REQUIRED :
- MISSING/INVALID PROVIDER ID PREVENTS CARRIER FROM PROCESSING CLAIM
- REFERRING PROVIDER LAST NAME CANNOT CONTAIN NUMERIC CHARACTERS. 2310A.NM1-03
- PRENDERING NOT PRESENT
- Category: Acknowledgement/Rejected for Invalid Information The Claim/Encounter has invalid information as specified in the Status details and has been rejected Status: Entity's commercial provider id
- ACK/RETURNED - ENTITYS ID NUMBER. - PATIENT
- Value of element NM109 is incorrect. Expected value is National Provider ID (format is 10 digits with optional 80840 prefix and last check digit) when NM108=XX. Segment NM1 is defined in the guideline at position 2500. Invalid data:
- 124 - Entity's name, address, phone and id number. Usage: This code requires use of an Entity Code.
- Billing Provider Zip Code Invalid or Doesnt Match State Code
- INVALID PREFIX FOR DATE OF SERVICE :
- 557 INVALID PATIENT LAST NAME (NO SYMBOLS)
- Dependent not eligible.
- 31 - Subscriber and policyholder name mismatched.
- If either of PRV02, PRV03 is present, then all must be present. The syntax rule P0203 of Segment PRV is violated. Segment PRV is defined in the guideline at position 2550. Invalid data: PXC
- 158 - Entity's date of birth. Usage: This code requires use of an Entity Code.
- 633 - Related Causes Code (Accident, auto accident, employment)
- 616 - Policy Name
- Member not active on Date of Service
- 550 - Coordination of Benefits Code
- C567 NPI TAX ID COMBO NOT FND
- PAT DOB YEAR NOT ON BC FILE