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Claim rejection

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Renee Johnson

Optima Claim rejection message, "wrong R name/DOB sent is invalid  (21). Called Optima and verified that I submitted same name/DOB as on file. They had not received the claim so I guess SP scrubbed?? Any help greatly appreciated.

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14 comments

Date Votes
  • Gillian

    Hi Renee, because this is specific to your account and the claim, I'm going to have a member of the Insurance Specialist team reach out to you to investigate one-on-one.

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  • Maria Staropoli-Hafner

    Can someone please call reach out to me asap.

    There is an error in the system with payer ID and address.

    Thank you!

     

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  • Brian

    Hi Maria,

    Because this is specific to your account and the claim, I'm going to have a member of the Insurance Specialist team reach out to you to investigate one-on-one.

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  • Glenda Huntley

    I am getting this rejection notice:

    Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system. (A3) claim[service_lines][0][procedure_code] has data errors. Parameter claim[service_lines][0][procedure_code] has an invalid code value (21).

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  • Gillian

    Hi Glenda, is there a chance the service code you're using is non-billable, or that you manually edited the claim to use a different service code?

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  • Rada West

    Claim rejected, message "PROCEDURE CODE FOR SERVICE S RENDERED" - what needs to be done to correct it.?

     

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  • Anne
    • Edited

    Hi Rada,

    Because the rejected message is for a specific claim in your account, I will go ahead and reach out to you privately via email addressing this claim. Thank you. 

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  • Dr. Ken Taylor, EdD

    acknowledgment/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system. (A3) Missing or invalid information. R CLAIM LEVEL COB INFORMATION INVALID; CLAIM TOTAL CHARGE MINUS CLAIM ADJUSTMENT AMOUNTS MUST EQUAL PAYER PAID AMOUNT WHEN LINE LEVEL ADJUDICATION IS NOT PRESENT FOR THAT PAYER (21)

     

    This was a secondary claim.  Where and how do I enter a line level adjudication?

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  • Gillian

    Hi Ken, in order to help with this, we'll need to look at the actual claim in your account. A member of our Success Team will reach out to you shortly to assist.

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  • David Klimisch

    WI Medicaid keeps rejecting the claim of my 14 year old client. When I call them they tell me that it's because my 3rd Party Biller (Simple Practice) keeps inputting his mother's name instead of the child's name. This causes error code

    0614  FIRST NAME DOES NOT MATCH MEMBER ID.

    Help? How can we get Simple Practice to submit the correct name. Everything is correct on my end --- his name is in the correct field and I have the correct Medicaid Member ID number.

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  • Anne

    Hi David,

    For claim rejections, we'll need to look at the actual claim in your account. A member of our Success Team will reach out to you shortly to assist. Please be on the look out for an email from our team. Thank you. 

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  • Margaret Leafstedt

    Hello. I am in need of some help. My claim is error_scrub due to "The dependent's relationship is required as dependent(patient)'s info is not same as subscriber(insured)'s info". I cannot seem to figure this one out as all the info seems correct on the claim. Thank you.

     

    Margo

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  • Gillian

    Hi Margaret, I'd be happy to help. Check to ensure that you have all the fields filled out for the client's insurance under Edit > Billing and Insurance, including the patient's relationship to the insured. If you continue to experience issues, we'd be happy to help - just reach out to our team directly through the ? bubble and we can investigate. 

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  • Shobha Nandivada

    I am having a problem with my claim. I have contacted United health care and they informed me my credentials are verified and i should resubmit my claim. when i did this the processor rejected my claim with an A3 error. this is going on for a few months now. I need help,

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