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Claim Rejections

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A guide to troubleshooting claim rejections, including a list of the height rejections received past Kareo customers, a description of possible causes, and suggestions for correcting in Kareo. To quickly find a specific merits rejection, press Ctrl+F on your keyboard and search for key words from the rejection message.

Claim Rejections

  • General
    General
    At Kareo, we understand that getting paid faster is essential to the wellness of your business organisation. One of the most significant areas that can delay getting paid is claim rejections. Watch the quick 10-minute video on some of the all-time practices we recommend, fugitive whatsoever setbacks that are within your attain to correct. Utilize Help Articles to get started, follow a checklist, etc.
    • Video: Best Practices for Preventing Claim Rejections
    • Best Exercise to Avoid Claim Rejection - Kareo Settings
    • Clearinghouse Report Rejections
    • Electronic Claim Processing and Rejections
    • Electronic Claim Submission Checklist
  • Mutual Merits Rejections
    No epitome available
    • CLIA Number
    • Duplicate of a Previously Processed Merits/Line
    • Entity's name
    • Entity's Postal/Zero Code
    • HCPCS Procedure Code is invalid in Professional Service
    • Insurance Type Code Missing
    • Service Location : Facility point of origin and destination ambulance
    • Subscriber and Subscriber ID Mismatched
    • Subscriber and Subscriber ID not establish
  • Claim Rejection Codes
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    • 2010BB VALUE OF ELEMENT N403 IS INCORRECT
    • 2310C Element NM109 is Used. It is not expected to be used when it has the aforementioned value as element NM109 in loop 2010AA
    • 2400 Loop 2420E (Ordering Provider Name) is Used
    • 2400 SUB-Chemical element SV101-07 IS MISSING
    • 2430 SVD02 Merits or Line Level Prior Payment Information Required for this Patient
    • Accident Date is required when the diagnosis code is between 800 - 999, or the diagnosis code is V015 or 53511
    • Acknowledgement/Rejected for Invalid Information Entity's Health Industry ID Number
    • Acknowledgement/Rejected for Invalid Information Process Code-XXXXX Modifier(s)-Xx SVC Line Response - Procedure Code Modifier(southward) for Service(due south) Rendered Process Code-XXXXX Modifier(s)-20 SVC
    • Acknowledgement/Rejected for Missing Information Entity's Tax ID. Rendering Provider
    • Acknowledgement/Returned equally unprocessable (BCBS/UHC/Aetna)
    • ACKNOWLEDGEMENT/RETURNED AS UNPROCESSABLE Claim THE Merits/ENCOUNTER HAS BEEN REJECTED AND H CATEGORY - BCBS
    • ACKNOWLEDGEMENT/RETURNED As UNPROCESSABLE CLAIM THE CLAIM/ENCOUNTER HAS BEEN REJECTED AND H - Humana
    • Adjudication or Payment Appointment is Required When Sending Line Adjudication Information. 2430.DTP*573
    • A data element is too curt. The length of Element NM109 (Identification Code) is '1'. The minimum allowed length is '2'. Loop 2330A NM109 Other subscriber name
    • A information element is too curt. The length of Sub-Element SV101-03 (Procedure Modifier) is 'i'. The minimum immune length is 'ii'
    • BCBSNE Rule: 837P Blow Related Injury Indicator (I00)
    • Billing Provider Address1 cannot be a PO Box or Lockbox Address. 2010AA.N3*01
    • Billing Provider NPI/API to TPI Combination or NPI/API Information is Invalid
    • Billing Provider Taxonomy Code Required
    • Billing Provider Tax ID/EIN Submitted Does Not Match BCBSF Files
    • BILLING TAXONOMY MISSING/INVALID
    • BWC Pay to Provider Number Invalid
    • CHARGE MUST BE GREATER THAN ZERO
    • Claims Submitted with an Accident Diagnosis Must Point if the Accident was due to a Work Injury, an Auto Blow or Other Accident
    • CLAIMS WITH MEDICARE OTHER PAYER CANNOT BE SENT TO THIS PAYER, PLEASE USE TRICARE FOR LIFE
    • Claim failed Pre-Membership Validation
    • Claim Frequency Code is invalid
    • Claim Frequency Lawmaking Acknowledgement/Rejected for Invalid Information
    • Claim Frequency Type Lawmaking is Invalid
    • Claim Level Date is Missing or Invalid. Date Must exist in the CCYYMMDD Format - CMS-1500
    • CLAIM LEVEL SERVICE FACILITY INFORMATION- INVALID; CLAIM LEVEL SERVICE FACILITY Data INVALID FO R PAYER
    • Merits must exist billed direct to Blue Shield CA
    • Merits SERVICE LOCATION NPI REQUIRED; PAYER HAS MANDATED Utilise OF NPI
    • Claim/Line Bank check or Remittance Date is Required on Adjudicated Claims. 2320/2430.DTP*573
    • COB Corporeality IS MISSING OR INVALID
    • Contract Number Not Found
    • Crosswalk did not requite one to ane match for NPI XXXXXXXXXX. Number of rows returned was 0
    • CURR-SOURCE OF PAYMENT IS REQUIRED
    • Destination Payer's Sequence Lawmaking must be "P" Primary
    • Detailed description of service Acknowledgement / Rejected for relational field in mistake
    • Belch Date (DTP-01=096) was not expected because this claim is not for Inpatient Services
    • Drug Unit Count Lawmaking Qualifier is required and must be valid
    • Duplicate Merits; Submitted Previously
    • EDI Professional CLAIMS ARE NOT Available FOR THIS PAYER ID
    • Entity's ID Number – Subscriber
    • ENTITYS SPECIALTY TAXONOMY Code. - BILLING PROVIDER
    • Entity not eligible for benefits for submitted dates of service
    • Entity Not Found Entity: Patient
    • EPSDT Indicator
    • Fault- Wrong Taxation ID Used | Error- Dr Not On File/Not in System
    • Mistake 026: PROVIDER IS Not VALID FOR THIS SUBMITTER
    • Facility admission appointment. Access Date is required on inpatient medical visits. 2300.DTP*435
    • FINAL/DENIAL - FOR MORE DETAILED Data, SEE REMITTANCE Communication
    • Offset Symptom Date Required
    • ICD x Diagnosis Code 2 must be valid. 2300.Howdy*02-2
    • ICD 10 Diagnosis Code 3 must be valid. 2300.HI*03-ii
    • ICD 10 Diagnosis Code 4 must exist valid. 2300.HI*04-ii
    • ICD x Principal Diagnosis Code must be valid. 2300.HI*01-ii
    • Insurance Blazon Code is required for not-Principal Medicare payer. Chemical element SBR05 is missing. Information technology is required when SBR01 is not 'P' and payer is Medicare
    • Insured or Subscriber: Entity'south Postal/Zippo Code
    • Internal Review/Audit Pending/Requested Information
    • INVALID DIAGNOSIS Code Type - EXPECTED VALUE IS ICD-9
    • INVALID OTH
    • Investigating existence of other insurance coverage Pending/Provider Requested Information
    • LINE COUNTER IS MISSING, INVALID, OR OUT OF SEQUENCE
    • LINE LEVEL PROCEDURE CODE IS MISSING OR INVALID
    • MEDICAID ALLOWANCE INCLUDES Total MEDICARE DEDUCTIBLE AND MAY INCLUDE FULL OR Partial COINSURANCE
    • Missing No Vendor Match for NPI
    • Modifier ii cannot exist the same every bit Modifier 3 or 4
    • No Trading Partner Associated with this Claim
    • ORDERING PROVIDER NAME / PRIMARY IDENTIFIER IS MISSING OR INVALID
    • Ordering provider required for DMERC claims
    • Other Entity's Arbitrament or Payment/Remittance Date Entity- Payer
    • Other Insurance Coverage Data: Health, Liability, Auto, Etc
    • Other Insured Claim Filing Indicator Code Must be Valid. 2320.SBR*09
    • Other Payer Claim Filing Indicator Code is Invalid. Cannot = Medicare
    • OTHER PAYER Merits LEVEL ADJUSTMENT IS MISSING OR INVALID
    • Other Payer Insurance Type is required when Payer is Medicare - Not Primary
    • Other Subscriber Identification Code Qualifier is required and must exist II or MI. 2330A.NM1*08
    • Patient Not Covered
    • Patient Non Found
    • Patient/Subscriber is not Eligible Please Verify Member ID/Insurance/Coverage
    • Pay-To Provider Country Code should be Blank, CA, or MX. 2010AB.N4*04
    • Payer ID Number is required and must exist valid
    • Payer Responsibleness Sequence Number Lawmaking cannot occur more than once within a claim
    • Pay To Affiliation Error - No Pay To Provider Found
    • Pay to Provider Number is Authorized for Rendering Only
    • Performing Provider Number Not Identified equally Part of the Group Billing Number
    • Per CCI Guidelines Procedures Code XXXXX has an Unbundle Human relationship With Procedure Lawmaking XXXXX Billed for the Same Date of Service. Review Documentation to Decide if a Modifier Override is Appropriate
    • PLEASE SUBMIT SECONDARY/COB CLAIMS ON PAPER WHEN PRIMARY IS NOT MEDICARE
    • Prefix for Entity's Contract/Member Number
    • Master DIAGNOSIS Code IS MISSING OR INVALID FOR DIAGNOSIS TYPE GIVEN (ICD-9, ICD-10) OR CANNOT BE EXTERNAL Cause Lawmaking
    • PROCEDURE CODE Clarification IS MISSING OR INVALID
    • Process Code Modifier(s) for Service(s) Rendered Acknowledgement/Rejected for Invalid Data
    • Procedure CODE MODIFIER IS MISSING OR INVALID
    • Provider ID Non on File
    • Provider Not Motorcar-matched - pending manual review
    • Receiver Reject Reason Cod
    • Reference Number is Missing, Contains Invalid Characters, or Greater than 30 Bytes
    • Referring Doc Provider Number Missing
    • Rejected at clearinghouse 2 alpha/five numeric noridian issued submitter ID is requred. The submitter ID was submitted or bridged incorrectly. Please contact Capario EDI services for assistance
    • Rejected at Clearinghouse Billing / Pay-To Provider Taxonomy Lawmaking - Provider Blazon Qualifier is Missing or Invalid
    • Rejected at Clearinghouse Billling and Rendering Provider NPI Cannot exist the Same Value
    • Rejected at Clearinghouse Claim Level Appointment is Missing or Invalid
    • Rejected at Clearinghouse Claim Secondary Identifier Description is Not to be Used
    • REJECTED AT CLEARINGHOUSE CLM REJECTED AT CLEARINGHOUSE FOR HIPAA COMPLIANCE
    • Rejected at Clearinghouse Diagnosis Lawmaking Pointer (X) is Missing or Invalid. Must Point to a Valid Diagnosis Code
    • Rejected at Clearinghouse This Payer Is Non Active (xxxxx)
    • Rejected for Invalid Information NDC Number
    • Related Causes Code 1 must be AA, EM, or OA. 2300.CLM*xi-i
    • Related Cause Data is Missing or Invalid (Error Lawmaking: 2300~CLM~11)
    • Relationship to Insured must be xviii - Cocky for Medicare. 2000B.SBR*02
    • RENDERING NPI IS Non ON FILE
    • Rendering Dr. is Required
    • Rendering Provider Specialty Code is Missing or Invalid
    • Requests for readjudication must reference the newly assigned payer merits command number
    • REQUIRED REFERRAL Code FOR Kid HEALTH CHECK-UP IS MISSING
    • Same Mean solar day Duplicate
    • Segment has information element errors Loop:2300 Segment:Hello Invalid Character in Data Chemical element
    • Service Facility NPI Must Not Match Billing Provider NPI
    • Service Facility Primary ID is Missing or Invalid
    • SERVICE FACILITY SECONDARY IDENTIFICATION NUMBER QUALIFIER IS MISSING OR INVALID
    • Service Unit Count is required and must be valid. 2400.SV1*04
    • Site is non allowed to ship claims to the specified payer
    • Submitter ID is Required
    • Submitter non approved for electronic merits submissions on behalf of this entity
    • Subscriber and Other Subscriber Claim Filing Indicator Codes cannot both be MB
    • Subscriber Group or Policy Number - Required; Must exist Entered for Payer
    • SUBSCRIBER PRIMARY ID# MUST BE x OR 11 CHARACTERS
    • Subscriber Main Identification Number is Missing or Invalid
    • Subscriber Master Identifier - Invalid; Must be in a Valid Format for Payer
    • SUBSCRIBER Cypher Code IS MISSING OR IS NOT A VALID USPS ZIP CODE, WITHOUT PUNCTUATION
    • SUPPLEMENTAL DIAGNOSIS CODE IS MISSING OR INVALID FOR DIAGNOSIS TYPE GIVEN (ICD-9, ICD-10)
    • SV1 01-07 is missing. It is required when procedure code is not-specific
    • TEST REFERENCE IDENTIFICATION CODE IS MISSING OR INVALID. MUST BE OG OR TR. REJECTED AT CLEARINGHOUSE LINE LEVEL - TESTS RESULTS QUALIFIER IS MISSING OR INVALID
    • THE DIAGNOSIS CODE (_____) AND MODIFIER (__) COMBINATION ARE INAPPROPRIATE
    • The last position of the Neb Blazon Code is not a valid NUBC Frequency code for this transaction
    • The Supervising Provider Information was found merely not expected since it is the same as the Rendering Provider
    • This claim is Not REJECTED and has been submitted to United Healthcare
    • Unable to Identify as Member
    • Alert: INVALID DIAGNOSIS CODE QUALIFIER PER PAYER REQUIREMENTS
    • Warning: Invalid diagnosis version indicator per payer requirements
  • Kareo Validation
    Kareo Validation
    • 5010 Edit: Claim filing indicator code is either missing or one of the invalid codes such as 09, 10, LI for a 5010 merits. Change the insurance program type on the "Edit Insurance Visitor" screen nether the General tab such as CI, MB, etc
    • 5010 Edit: Procedure lawmaking XXXXX is an NOC type lawmaking and requires a clarification note per service line
    • Accident related claims must have accident date
    • Car blow related claims must have blow state and date
    • Billing Provider Name is too Long
    • Appointment of Service From and To dates are invalid. Your claims cannot be submitted considering the Date of Service From date is after the Date of Service To date
    • Invalid N402 country abbreviation
    • Missing Insurance Policy Number for (patient). Your claims cannot be submitted without a valid insurance Policy Number
    • Missing N301 street address
    • Missing N301 street accost for (payer) Missing N401 urban center in accost for (payer) Missing N402 state in address for (payer)
    • Missing N301 street address for (referring provider) Missing N401 city in address for (referring provider) Missing N402 state in address for (referring provider)
    • Missing N301 street accost for (rendering provider) Missing N401 urban center in accost for (rendering provider) Missing N402 state in address for (referring provider)
    • Missing N301 street address for (service location) Missing N401 city in address for (service location) Missing N402 country in accost for (service location)
    • Missing N301 street address for (subscriber) Missing N401 urban center in address for (subscriber) Missing N402 state in address for (subscriber)
    • Missing N401 metropolis in address
    • Missing N402 country in accost
    • Missing NM103 - subscriber last proper name
    • Missing NM104 - subscriber first name
    • Missing NM104 - subscriber offset proper name Missing NM103 - subscriber last name
    • Missing NPI
    • Missing NPI for (practice)
    • Missing NPI for (referring provider)
    • Missing NPI for (rendering provider)
    • Missing other payer subscriber'southward insurance policy number, plan name:
    • Must have hospitalization outset engagement if identify of service code is 21 (Inpatient Hospital). Add together hospitalization start engagement to the see or to the case
    • NDC lawmaking [] is invalid. Process code <CPT> NDC lawmaking [] must be xi digits
    • No Rendering Provider NPI. you must supply rendering provider NPI or override NPI in the provider's Claim Settings
    • Patient DOB in the future
    • Patient DOB missing
    • Patient state missing Your claims cannot be submitted without a valid patient address
    • Patient street address missing Your claims cannot be submitted without a valid patient accost. Delight open the Edit Patient task in Kareo and enter a valid U.S. street address
    • Patient nada code missing Your claims cannot be submitted without a valid patient address
    • Patient goose egg lawmaking non valid Please open up the Edit Patient task in Kareo and enter a valid U.S. zip code in five or 5+4 format
    • Payer zero code not valid Your claims cannot be submitted without a valid payer address
    • Referring physician Provider Numbers are missing Your claims cannot be submitted without appropriate referring provider information. Delight open up the Settings > Edit Referring Physicians task in Kareo and enter valid provider numbers to identify the physician to Payers
    • Your claims cannot exist submitted to the secondary insurance because the charge amount does non equal the sum of the paid amount and all line adjustment amounts
    • Your claims cannot be submitted without a valid adjudication appointment from the other payer's payment Please open up the Edit Payment ID= job in Kareo and enter a valid adjudication date
    • Your claims cannot exist submitted without a valid date of birth for the other payer's subscriber. Please open the Edit Patient task in Kareo, open Case, Insurance Policy and enter a valid engagement of birth for the Insured
    • Your claims cannot exist submitted without a valid date of birth for the patient. Delight open up the Edit Patient task in Kareo and enter a valid date of birth
    • Your claims cannot be submitted without a valid gender for the other payer'due south subscriber. Please open the Edit Patient job in Kareo, open Example, Insurance Policy and enter a valid gender for the Insured
  • Jopari Workers Compensation and Auto Rejections
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    • Rejected by Jopari. Condition Message: A6 - Acknowledgement/Rejected for Missing Information - The merits/meet is missing the information specified in the Status details and has been rejected.; 135 - Entity's commercial provider id. Note: This code requires use of an Entity Code
    • Rejected by Jopari. Status Bulletin: A6 - Acknowledgement/Rejected for Missing Information - The claim/see is missing the information specified in the Condition details and has been rejected.; 143 - Entity's land license number. Annotation: This code requires utilize of an Entity Code
    • Rejected by Jopari. Status Bulletin: A6 - Acknowledgement/Rejected for Missing Information - The merits/encounter is missing the information specified in the Status details and has been rejected.; 148 - Entity's social security number. Note: This code requires use of an Entity Code
    • Rejected past Jopari. Status Message: A6 - Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the data specified in the Status details and has been rejected.; 562 - Entity's National Provider Identifier (NPI). Annotation: This code requires utilize of an Entity Code
    • Rejected by Jopari. Status Message: A6 - Acknowledgement/Rejected for Missing Information - The merits/come across is missing the information specified in the Status details and has been rejected.; 749 - Date of Injury/Illness
    • Rejected by Jopari. Status Message: A7 - Acknowledgement/Rejected for Invalid Information - The merits/encounter has invalid information as specified in the Status details and has been rejected.; 364 - Is blow/affliction/condition employment related
    • Rejected by Jopari. Status Message: A7 - Acknowledgement/Rejected for Invalid Data - The claim/encounter has invalid information equally specified in the Status details and has been rejected.; 78 - Duplicate of an existing claim/line, awaiting processing
  • UB-04 Claim Rejections
    UB-04 Claim Rejections
    • Access SOURCE Lawmaking IS REQUIRED ON ALL INPATIENT AND OUTPATIENT CLAIMS
    • Merits Level Appointment is Missing or Invalid. Date Must be in the CCYYMMDD Format - UB-04
    • CLAIM LEVEL DATE TIME Blazon FORMAT QUALIFIER IS MISSING OR INVALID
    • CLAIM LEVEL – INSTITUTIONAL CLAIM CODE IS MISSING OR INVALID
    • DIAGNOSIS/ PROCEDURE/ Condition/ OCCURRENCE/ Handling/ VALUE Code/ DATE IS MISSING, INVALID OR Indistinguishable
    • Facility Type Code is Required
    • NUBC Value Lawmaking(due south) Acknowledgement/Returned every bit unprocessable claim
    • PATIENT STATUS CODE IS REQUIRED AND MUST Be VALID
    • Service Line Revenue Code is required. 2400.SV2*01
  • Trizetto Claim Rejections
    Trizetto Claim Rejections
    • 2000A THE PROVIDER INFORMATION SEGMENT (LOOP 2000A, PRV) MUST BE SUBMITTED
    • 2010BA SUBSCRIBER Principal ID (LOOP 2010BA, NM109) CANNOT INCLUDE AN ALPHAPREFIX THAT BEGINS WITH XOD, XOJ, ZGD, ZGJ, YID, YIJ, YUB, YUX, YDL, OR YDJ
    • Every bit of 1/i/12, Medicare only accepts claim frequency code of 1
    • Auto Accident State is required if Related Causes Code is AA. 2300.CLM*xi-4
    • CHECK Member ID OR ELIGIBILITY. CONTACT PAYER FOR Farther Data
    • Merits submitted to incorrect payer
    • Dependent : Entity not eligible
    • Diagnosis Code Pointer1 must be present. 2400.SV1*07-ane
    • Initial Treatment Date is required when reporting Spinal Manipulation. 2300.DTP*454
    • Insured Final Name INVALID Graphic symbol(Due south)
    • Insured or Subscriber
    • Insured or Subscriber: Policy Canceled
    • Insured or Subscriber : Entity's contract/member number
    • Member ID must be valid
    • Member id number not valid for DOS
    • MEMBER Non VALID AT DATE OF SERVICE. Delight CONTACT THE PAYER
    • Member NUMBER AND Engagement OF BIRTH DO NOT Friction match
    • Fellow member NUMBER CANNOT BE FOUND
    • Onset of Current Illness or Symptom Date cannot be a time to come engagement. 2300.DTP*431
    • Patient eligibility not found with entity
    • Provider : Entity not approved every bit an electronic submitter
    • Provider : Medical notes/report Pending/Provider Requested Information-The merits or encounter is waiting for information that has already been requested from the provider
    • Referring Provider Last Name cannot contain numeric characters. 2310A.NM1*03
    • Referring Provider NPI is invalid. 2310A.NM1*09
    • Rendering Provider: Entity's tax id
    • Rendering Provider NPI is invalid. 2310B.NM1*09
    • Rendering Provider NPI or Singular Identifier is required. 2310B
    • Service Date is invalid. 2400.DTP*472
    • Service Location : Entity's Postal/Zip Code
    • Submitter : Entity not canonical as an electronic submitter
    • Submitter : No understanding with entity
    • Subscriber and policy number/contract number not constitute
    • Subscriber Beginning Name contains invalid characters. 2000BA. NM*04
    • Subscriber ID must be 9 or 11 digits
    • Subscriber ID number must exist vi or 9 digits with ane-3 messages in forepart
    • Subscriber Last Name contains invalid characters. 2000BA. NM1*03
  • Common Claim Rejections Resolutions
    No paradigm available
    • Verify and Edit Payer ID
    • Verify Claims Billing Data
    • Verify Patient Eligibility
    • Verify Submitted Cipher Codes

User Guide

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Source: https://helpme.kareo.com/01_Kareo_PM/Claim_Rejections

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