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HELP! Claim Rejection

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Kim Murachver
  • Edited

Does anyone know how to fix the following claim rejection for Tufts?

Rejected due to the following error: Adjusted Repriced Claim Reference Number (517)

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18 comments

Date Votes
  • Gillian

    Hi Kimberly, I'm going to have the Insurance Specialist team reach out to you directly to better understand this claim rejection.

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  • Mika Nitta

    I also had two rejections from Tufts "Adjusted Repriced Claim Reference Number (517)" today, which I did not have a few months ago. Please get back to me with the answer. 

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  • Gillian

    Mika, I'll have a member of our Insurance Specialist team reach out to you to assist. 

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  • Renee Hunter

    Hi,

     

    We just signed up with Simplepractice and I received a claim rejection I'm trying to figure out what is missing and how to fix.

     

    Missing or invalid information. Value of sub-element SV101-02 is incorrect. Expected value is from external code list - HCPCS Code (130) when SV101-01='HC'. Segment SV1 is defined in the guideline at position 3700. (21).

    • Value of sub-element SV101-02 is incorrect. Expected value is from external code list - HCPCS Code (130) when SV101-01='HC'. Segment SV1 is defined in the guideline at position 3700.
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  • Gillian

    Hi Renee, welcome to SimplePractice. I'll have a member of our team reach out to you to understand and clarify this rejection message.

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  • Megan Oka

    Hi,

    I'm having trouble figuring out how to resolve this claim rejection:  VALUE OF SUB-ELEMENT HEALTH CARE CODE INFORMATION-02 IS INCORRECT. EXPECTED VALUE IS FROM EXTERNAL CODE LIST - ICD-10-CM DIAGNOSIS CODE (897) WHEN HEALTH CARE CODE INFORMATION-01='ABK'. HEALTH CARE INFORMATION CODES IS DEFINED IN THE GUIDELINE AT POSITION 2310. (21)

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  • Gillian

    Hi Megan, it's tough for us to resolve rejected claims in the Community Forum, so I'm going to have a member of our Insurance Specialist team reach out to you directly to assist. 

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  • Aimee Castro

    Hi do I resolve a rejected claim due to missing payment information?

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  • Gillian

    Aimee, please reach out to our Success team through the red Help bubble in your account to learn more about this rejected claim. 

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  • Jiselle Roman, LCPC

    I got the rejected code:

     DUPLICATE FILE ID-CANNOT USE TWICE IN 12 MONTHS (21).
     
    Can we not bill for two assessment sessions? In my group practice we could. 
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  • Ruth

    Hi Jiselle, It sounds like you're referring to a BCBS insurance claim you submitted. If so, I'd like to provide some clarity regarding the Duplicate File Rejection message generated by certain BCBS Payers (specifically Illinois and Texas).

    This doesn't have anything to do with you creating two assessment sessions to bill, rather BCBS experienced a system error where they reprocessed some claims that had already been accepted. This issue has since been resolved and won't require any additional steps on your part. 

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  • Jiselle Roman, LCPC

    Thank you Ruth. So I didn't do anything wrong? Thank goodness. Should I look to do anything more in the future? Will the claim status change from rejected to accepted anytime soon? Also, is it okay to bill two assessments 90791 as that is what I use to do at my group practice? 

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  • Ruth

    Hi Jiselle - You can bill for two assessments. You shouldn't experience this issue again because the payer has resolved it.

    Although the claims' statuses won't change back to "Accepted," they will be updated to "Paid" once an insurance payment is allocated to these claims. If you're enrolled in Payment Reports through SimplePractice, these claims' statuses will update from "Rejected" to "Paid" when the Payment Report is issued. If you typically add insurance payments manually, you'll want to leave the claim as is until you receive a corresponding insurance payment and then add the payment as you normally do. This will update the claims' statuses from "Rejected" to "Paid."

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  • Becky Brown

    I am continually getting rejected claims when I bill Tricare East.   What can I do to correct this?

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  • Gillian

    Happy to help, Becky. Because this is specific to your account and the claims, we'll reach out to you privately to assist.

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  • John Frisbie

    Hello all,

    I recently had a active duty AF client move from TricareEast to TricareWest but his spouse is still seeing me via Telehealth with SP. Tricare denied a claim, requiring a consult from a supervising physician.

    TricareWest wants me to resubmit the claim with the physician's information. I have the new doctor's information but I have no knowledge of how to include it in a CMS1500, if that is even possible.

    Any thoughts?

        

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  • Michelle Lynn

    Hello all, does anyone know how to fix a rejected claim due to error HCPCS (507)? This is a Medicare claim.

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  • Ruth
    • Edited

    Hi John - You can auto populate a Supervising Physician's information to a claim by going to your client's file > Edit > Billing and Insurance. Navigate to the Insurance Claim/ CMS Fields section, check the box to "Show additional claims fields" and Select "DQ Supervising Provider under Referring Provider. Now, when you generate a claim, the information you enter for this provider will appear. Here is a screenshot: 

     

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