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Insurance Claim Rejection

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36 comments

  • Jon Boschen

    Hi Everyone!

    I just started my own practice but have been billing under my NPI in a group setting previously.  I processed my claims but the were all rejected because of my NPI.

    • The billing provider's NPI does not satisfy the HIPAA check digit algorithm
    • The rendering provider's NPI does not satisfy the HIPAA check digit algorithm

    I read through the corrections but nothing is resolving can you please help?

    Many Thanks. 

     

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  • Tom Herman

    Hi Jon, 

    If the claims are with BCBS, I have had really good luck talking to their electronic billing number. Someone has always answered right away and been really helpful. Good luck, and I hope you get it resolved soon!

    Tom Herman, LCSW

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  • Ruth

    Hi Everyone, to clarify, a "Rejected" claim has been rejected by the clearinghouse and hasn't been sent to the insurance payer yet. If you're in a Group Practice, you won't be able to use a different Billing NPI than the one for your Group Practice. However, the best way to verify how you should resubmit your claim is by reaching out to our Insurance Team here, via Help Request.

    If your claim was "Denied," as Tom mentioned, you can call the Insurance Payer directly using the Provider Number on the back of your client's insurance card and the Claim Reference Number to identify the claim to the insurance. 

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  • Michael Evans

    I'm getting this error now.

    Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system. (A3) Missing or invalid information. THE PROVIDER ID AND/OR DEPARTMENT ID ARE MISSING. (21)

    What is the problem and what do I need to do to fix it?

    Michael Evans

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  • Kay Ostensen

    Hello, please look at my most recent Medicare claim (initials S McC).  After a year of trying, I've been successful with other clients for Medicare submittals.  Not sure what's wrong with this one.  Looks like problem may be with diagnosis.  I keep changing it to 43.21 but it doesn't seem to help.  Thank you, Kay

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  • Ruth

    Hi Michael and Kay, the best way to get help investigating a claim issue is by contacting our Insurance Team. They'll be able to look into your claims, contact our clearinghouse if necessary and provide you with the best possible solution. To reach out, click on the ? icon in your account > Ask Questions > No > Contact Support > Send an Email Request! Here's more on how to email us for further investigation: https://support.simplepractice.com/hc/en-us/articles/360002795252-Logging-in-to-SimplePractice-and-submitting-help-requests 

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