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Claim Rejection

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Elizabeth Purto Bahner

I have submitted a claim a few times and it gets rejected each time for a different reason.  I have now received the below message and do not know how to resolve the issue.  Can someone please help??

Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system.
Missing or invalid information. R ACK/REJECT INVAL INFO - ENTITYS NATIONAL PROVIDER IDENTIFIER (NPI). USAGE THIS CODE REQUIRES USE OF AN ENTITY CODE. - BILLING PROVIDER (A3 - 21)

 

Thanks!!

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Comments

9 comments

Date Votes
  • Corin Pilo-Comtois

    Looks like your NPI number is missing from the claim form somewhere. You can hit "edit" and scroll down on the claim and enter it in manually in the box labeled NPI. "Save" and then you should be able to "re-submit" or "submit." (Mine was doing this when I started and I had to click through my profile a bit to find out where it was missing. Now it transfers to the claim automatically.) 

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  • Nellie Peppel

    I'm having the same issue with all my Regence claims.  I checked and everything is entered correctly.  Is this possibly a Simple Practice software issue?

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  • Meegan Hargrave

    Also having this error code, "Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system. Missing or invalid information. Payer is missing or has invalid information. Payer Assigned Claim Control Number (A3 - 21)" showing up on a Regence BCBS claim. All NPIs are present and I can't see anything wrong with the claim. 

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  • Annie Jones

    This is a clearing house issue, SP said two days ago they are wrongorking on it.

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  • Annie Jones

    This is a clearing house issue, SP said two days ago they are working on it.

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  • Guadalupe Marino
    • Edited

    Having a similar issue with 1199

    Claim rejected

    Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system.
    Missing or invalid information. R Acknowledgement/Rejected for Invalid Information-The claim/encounter is has invalid information specified in the Status details and has been rejected. STATUS DETAILS Entity not found. Usage This code requires use of an Entity Code. Entity Code D (A3 - 21)

    All NPI's are listed correctly on section 24J, 32 & 33

    Based on the comments above SP was working on it. Was this issue fixed?

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  • Eduardo F. Moreno

    Guadalupe, mine did the same for NC Tracks/Amerihealth

    Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system.
    Missing or invalid information. R ACK/RETURNED - ENTITY NOT FOUND. USAGE THIS CODE REQUIRES USE OF AN ENTITY CODE. - PATIENT (A3 - 21)

     

    Just submitted this one over the weekend. 

     

     

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  • Erica Cornelius

    ACK,RETURND AS UNPRCESSBLE CLM- CLM,ENCNTER BEEN REJECTD AND NOT ENTERD INTO ADJUDICATION SYS.:ENTITY'S NATIONAL PROVIDER IDENTIFIER - NPI:PATIENT

    Does anyone know what this means? Thanks.

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  • Debra J. Bruemmer

    I have recently started getting rejections, something to do with my NPI.  Nothing has changed and they were processed previously.

    mine are usually with medicaid and thru the clearing house I’ve noticed. FRUSTRATING

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