Electronic Claim Errors
A knowledge base of common electronic claim errors and possible solutions.
- Dr Not On FileNot in System
- SUBSCRIBER ENROLLMENT NOT ON FILE
- Acknowledgement/Rejected for Invalid Information-The claim/encounter is has * invalid information specified in the Status details and has been rejected. * STATUS DETAILS: Member Not Auto-matched - awaiting manual review.
- 86 - Diagnosis and patient gender mismatch.
- 158 - Entity's date of birth. Usage: This code requires use of an Entity Code.
- InvalidData Location 2400 - DTP03 Svc The Modifier Code was not valid for date
- Rejected - Invalid Data WCN This patient was not eligible for benefits under this plan on the date(s) of service using the patient information submitted (ID, DOB, Name, Address). If you believe the information on your claim is correct, please fa :
- 132 - Entity's Medicaid provider id. Usage: This code requires use of an Entity Code.
- PROVIDER SUBMITTER ID: REQUIRED; MUST BE VALID IDENTIFIER FOR PAYER. PLEASE CONTACT HEALTH NET TO OBTAIN SUBMITTER ID.
- Subscr BCBSNE Rule Subscribers last name is missing or
- 197 - Effective coverage date(s).
- 198 - Medicare effective date.
- 166 - Entity's employer name. Usage: This code requires use of an Entity Code.
- Duplicate Procedure Modifier
- 749 - Date of Injury/Illness
- CLAIM SERVICE LOCATION NPI: REQUIRED; PAYER HAS MANDATED USE OF NPI
- Value of element N403 is incorrect. Expected value for ZIP Code is 9 digits. Segment N4 is defined in the guideline at position 0300. Invalid data:
- 148 - Entity's social security number. Usage: This code requires use of an Entity Code
- MEMBER INVALID ON DATE OF SERVICE
- CLAIM REJECTED BY MEDICA^^^/A^^Payer Trace ^^^/A^^MEDICA STATUS CODE: A6:743:82:65,^^^/R^^Rejected for Missing Information - The claim is missing the information specified in the Status details and has been rejected.^^^/A^^ Undefined statu
- ACK/REJECT INVAL INFO - ENTITYS CONTRACT/MEMBER NUMBER. - INSURED OR SUBSCRIBER
- CLIENTS FULL NAME, CLIENT NUMBER, SEX amp;amp;amp; DATE OF BIRTH DO NOT MATCH INFORMATION ON FILE.
- BILLING PROVIDER NPIAPI TO TPI COMBINATION OR NPIAPI INFORMATION IS INVALID. OUR RECORDS INDICATE PROVIDER IS NOT ENROLLED IN THIS PROGRAM. CONTACT TMHP CU :
- RENDERING PROVIDER LOOP(2310B) IS MISSING Missing
- Subscriber City Missing/Invalid Length
- Payer Specific Edit: Member ID must be length 9, 12, 13, or 14
- Insured Group Policy Number Cannot Equal Insured ID
- BILLING NPI TAX ID COMBINATION IS INVALID
- Claims submitted with an Accident diagnosis must indicate if the accident was due to a work injury, an auto accident or other accident.
- 674 - Authorization exceeded