Common Payer Rejections

Claim/encounter has been rejected, subscriber notfound

This rejection means that the payer is not able to verify the patient as a member by the member ID# that was used on the claim.

Subscriber Not In File

This rejection means that the payer is either not on file with the member ID#, or the patient is no longer eligible for benefits with this payer.

2010AA REF02 Provider ID Missing

                   OR

Error: Billing Provider ID (Loop 2010AA, REF01)

This rejection means that the payer assigned provider number was not submitted on the claim.

10002 INVALID Member ID Invalid - # doesnt exist

This rejection means that the member ID# for the patient is invalid.

Type: D0 NO: 01 Field: Insured ID Data In Err

                     OR

Error: Member ID (Loop 2010BA, NM109) is invalid

The reason for one of these rejections is because the member ID# that was used on the claim is invalid.

4R ;No record of eligibility based on submitted member ID and/or patients date of birth

This rejection means that the patient is not eligible for benefits based on the member ID# and/or the patients birth date.

M012 Billing Prov Not On File, M012 Submit BPRV Not on File

This rejection means that the provider has not been approved to submit claims electronically under the payer assigned group and/or individual provider number that is being sent with the claim.

Acknowledgement/Returned as Unprocessable Claim

This rejection means that the payer is denying the claim because it is unprocessable. An additional message should be provided with this rejection in order to clarify why the claim is unprocessable.

A387 Denied:  Entity not found

This rejection means that the payer is unable to identify the patient as a member.

8L Risk Member Verified But Inactive As Of Date Of Service

This rejection means that the payer recognizes the patient as a member; however, the patientís benefits were not active for the date of service on the claim.

F2015 Patient not eligible for benefits for submitted dates

This rejection means that the payer recognizes the patient as a member; however, the patientís benefits were not active for the date of service on the claim.

550: Payor Organization Id is required

This rejection means that the secondary insurance on the claim has a payer ID of Paper and the payer is unable to accept the claim because of this reason.

Referring Provider ID Qualifier Missing/Invalid Blank

This rejection means that the referring provider does not have an ID# that was sent on the claim. The ID# could be a UPIN, or it could be a payer assigned provider number (PIN). Verify on the provider setup screen for the referring provider that the UPIN is completed (if applicable) and/or that the payer assigned provider number (PIN) has been setup as a credential. If the credential is not listed on the provider setup screen, the credential can be added by following the instructions on Provider Credentials.

 

Document Links
Electronic Provider Credentials

P
rovider Credentials