Rejected claim messages

Follow

 

We are constantly updating this list, please check back soon if you do not see you claim's rejection message.

 

"Payer Assigned Claim Control Number required"

Typically this rejection reason occurs on a resubmitted claim. When a resubmitted claim does not have the reference number of the previously submitted claim you may get this rejection depending on the payer. Not all payers require resubmitted claims to reference the previous claim but some do.

When you resubmit a claim that was rejected for this reason, make sure that the "Re-submit" option is checked in box 22. The software should do this by default anytime you're resubmitting a rejected claim. This will also populate the previous claim's reference number. Make sure not to delete this reference number.

 

 

"For claim re-submissions or cancellations, you need to provide the original claim reference ID in Field 22"

"The claim's payer control number should be present if claim frequency is 7 or 8"  

These messages mean that box 22 indicates this is a "Resubmission", but the original claim's reference ID number is not entered in the adjacent field. 

When you're resubmitting a claim, SimplePractice will auto-fill these fields in box 22. Do not adjust or delete these fields. 

 

 

To resolve this issue, find the reference ID from the original claim. You can do this 1 of 2 ways:

1) Click on the claim status label to reveal the claim's filing history. There you'll find the original claims's Reference ID number.

 

2) If you've deleted the original claim, you may be able to find the reference ID number from an email update.

If you are not able to find the original claim's reference ID number, it's best to mark the claim as "Original" in box 22 and leave the Original Reference Number field blank.

 

"Subscriber and subscriber id not found"

This means that the member ID does not match the member name on file with the payer. 

Double check to make sure you have the client's member ID entered correctly. If it has special characters in it like these -, /, (, \, | it's recommended that you strip them out. Some payers will not recognize the ID's when they include special characters.

Then be sure to check the spelling of the client's name everywhere it exists on the form. All instances of the client's name must match the name on file with the insurance company. Be sure not to include a nickname or abbreviation. 

If you're still not able to resolve this subscriber ID issue, we've put together an extensive troubleshooting guide to help get the required information from the payer.

Please read this this helpful guide about how to resolve a Subscriber ID error message

 

"Invalid subscriber contract/member number. (164)"

This means the payer didn't recognize the client's member number. For many payers (especially Medicare) this is because the member number was submitted with dashes in it. Be sure to remove any dash or other special characters like these ones: -, /, (, \, |

 

"No agreement with entity."

This error message from the payer indicates that they do not recognize you as one of their registered providers and you do not have permission to submit claims based on the info you've submitted.

If you have multiple NPI numbers, be sure to enroll using your Billing NPI number. 

Enrolling with an NPI number the payer doesn't recognize could cause the rejection reason. We typically see this error message when enrolling with Medicare and Medicaid.

 

"The claim/encounter is missing the information specified in the Status details and has been rejected. (A6) Missing or invalid information. Note: At least one other status code is required to identify the missing or invalid information. (21)"

This means that the payer was not able to identify you based on the NPI number(s) and address(es) entered in box 32 and/or 33. Typically we see this when a billing NPI is required for box 33a. Or when the billing NPI in box 33a does not match the address in box 33. 

 

"DEPENDENT LEVEL INFORMATION IS NOT ALLOWED FOR THIS PAYER"

This means that the payer does not accept claims filed with "dependent" information. In this case, the dependent needs to be filed as the subscriber herself. To do this, change the CMS claim form to indicate that the client is the primary insured. You'll do this in box 4, 6, 7, and 11.

 

"Payer Claim Office Number is missing or incorrect. Verify with Authorization of Care letter or your authorizing Service Center. If the number was entered correctly Magellan is not the payer."

This means that the claim was filed with the incorrect Magellan payer. Read more here: Filing online claims with Magellan.

 

"Parameter service_facility[address][state] is too long"

This typically indicates that the state name has been spelled out instead of using the state's abbreviation. e.g. You've spelled out "New York" instead of writing "NY". Payers will almost always reject claims if the state is spelled out on any address in the claim form. 

Have more questions? Submit a request

Comments