Insurance Claim Rejection
Answered
I received a rejection from Blue Cross Blue Shield of Illinois that I've never seen before and not sure how to fix. It says: (A3) Missing or invalid information. DUPLICATE FILE ID-CANNOT USE TWICE IN 12 MONTHS (21)
I've gotten so few rejections that I'm not sure where to start, though I expect to be on hold forever if I call BC. Any clue as to what this means? Not even sure what File ID refers to And is "A3" or "21" referencing a certain section of the claim form? Box 21 is the dx code...but that doesn't seem like File ID...and it's a typical code.
Would greatly appreciate any help in sleuthing this one. Thanks.
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Hi Everyone, thank you all for your patience during our investigation. We found that this is an issue on our clearinghouse's end, they're currently working on changing their scrubbing error logic. Once they've done this, you'll be able to resubmit the rejected claims! I'll keep you all posted on when this issue is solved!
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Here is a notice from the BCBS Website:
Due to a system problem, some electronic claim files that had already been accepted and processed were re-processed.
This issue resulted in the following “Duplicate File” rejection message on electronic claim reports to providers: R^^1SG - Duplicate File ID-Cannot Use Twice in 12 months^^
If you received the above message, please note that no action is needed on your part.
We apologize for any inconvenience this issue may have caused your practice. If you have any questions regarding this notice, please contact our Electronic Commerce Center at 800-746-4614.
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Hi Mark - You won't want to delete 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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Hope this helps eveyone....on the BCBS website its explained in a paragraph dated 10/8/20 "HFS IMPACT File Discrepancies Causing Claim Rejections for BCCHP", and talks about what and why. I just want to make sure I do what's correct within SP, since stated above we should simply leave it alone and things will reconcile on their own.
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For what it's worth, I checked status on Availity for some of my rejected clients...looks like we don't have to do anything.
Status as of 10/13/2020
- Pending: Adjudication/Details This is a generic message about a pended claim. A pended claim is one for which no remittance advice has been issued, or only part of the claim has been paid
- Claim has been adjudicated, awaiting payment cycle
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Hi Everyone, according to our Insurance Team, Eligible is currently working with the insurance payers ILBLS, TXBLS, and OKBLS on these rejected claims. Once the issue is resolved, we will be resubmitting them on your behalf. There was another issue with the payer ILMCR that caused the NPI to be missing from claims, which was resolved Friday, 10/16. Claims rejected between 10/1 and 10/7 by the payer ILMCR have been successfully resubmitted. If you have any more specific questions regarding rejected claims submitted to any of these payers, please reach out to our Insurance Team directly by submitting a Help Request.
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Hi Everyone, I'm happy to report the "Duplicate File ID" BCBS rejection issue is now resolved. There is no action required on the provider's end and all rejected claims have been accepted on the payer's end. If you're enrolled in Payment Reports, the Payment Report will come through once the claim is processed and update the "Rejected" status. If not, you'll receive an EOB/ Remittance Advice as usual. When you manually add the insurance payment, the "Rejected" status will update!
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Hi Kimberley and Patricia,
We'd be happy to help with your questions. Because these are specific to your accounts, I’ve created a help request for each of you so that a member of our Insurance group can investigate this for you further. They’ll be reaching out to each of you with more information over email.
For future reference, the quickest way to get support for account-specific questions is to send us a help request by clicking the blue question mark icon on the lower right of your SimplePractice account > clicking Get Help. For more details, feel free to check out this Help Center guide: Logging in to SimplePractice and submitting help requests.
Although we're periodically monitoring the Community Forum, this is also a place for customers to exchange ideas and engage with one another on how to best use our platform. Thank you for acting as resources for each other in the meantime.
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