This rejection means that a provider number or secondary ID has not been found for the referring provider. To correct this rejection:
Claim Submitter's Identifier
Missing or Invalid Other Payer Referring Provider other ids
This rejection means that a provider number or secondary ID has not been
found for the referring provider. To correct this rejection:
Go to the Payer Setup screen for the secondary and/or tertiary insurance that is on the claim
Under Secondary IDs, check line 18 (1G Provider UPIN)
Save the changes
Repeat for additional payers as needed
Unable to get field information
There is missing/incomplete information on the Referring Provider setup
screen. To correct this type of rejection:
Verify on the provider setup screen that a UPIN number has been setup.
If the UPIN has been setup, go to How To Setup A New Payer for instructions on adding UPIN as a secondary identification number.
If the claim is being sent to Medicaid, the referring provider's Medicaid provider number needs to be setup as a credential on the provider setup screen.
Missing or Invalid Other Payer Patient Name value
This rejection indicates that for the patient's secondary and/or tertiary
insurance on the claim, that there is information missing on the patient
insurance setup screen (member ID# is missing, Insurance type is missing,
etc).
Verify all information is completed for the patient's secondary and/or tertiary insurance for this claim.
Missing or Invalid Other Payer Insured Address value
This rejection indicates that one of the patient's insurances on the claim is missing the address information for the insured.
Go to the patient insurance setup screen and verify that under Insured Additional Information, that the address information section on the right hand side of the screen is completed for each of the patient's insurances.
SBR-Subscriber Information
There is missing/incomplete information on the patient’s insurance setup screen. To correct this type of rejection, open the patient’s insurance setup screen and:
Verify on the patient insurance setup screen that a value has been entered for the Member ID# for all insurances for the patient. BillingMD validates all insurances for the patient, regardless of whether or not all the insurance(s) are used on the claim.
Verify that the Address Information section has been completed for all insurances, including the Country code.
Verify that the insurance type code has been completed for all insurances.
Verify that the Signature on file/date has been completed under Insured Additional information.
Transmission Type Code
There is missing/incomplete information on the patient’s insurance setup screen. To correct this type of rejection:
Verify on the patient insurance setup screen that if a Secondary ID type has been selected, that a value has been entered. If no Secondary ID value exists, but Secondary ID type has been selected, remove the value from the Secondary ID type field.
CLM-Health Claim
Claim is currently set to a billing type of paper
The billing type on the claim is set to paper and the claim is being
sent electronically. If the payer can accept electronic claims, open the
claim and change the billing type to electronic.
Payer accepts only paper claims
The payer that the claim is being sent to is setup as a payer that can
only be billed on paper. A payer can be updated to be able to be sent
electronically if the payer can be found on the Payer
List. If the payer is found on the payer list, go to the payer setup
screen and update the Payer ID and billing type accordingly.
OR
The billing type on the claim is set to paper and the claim is being sent electronically. If the payer can accept electronic claims, open the claim and change the billing type to electronic.
No insurance found for claim
The insurance(s) on the claim is not valid for the date(s) of service on
the claim. Verify the effective start and effective end dates for the
insurance(s) and compare to the date(s) of service on the claim. Update
the insurance(s) on the claim screen as needed to correct.
Claim failed BillingMD validation rules
There is missing/incomplete information on the Encounter screen. To correct
this type of rejection open up the Encounter screen and look at Messages
tab for reason(s) for rejection. Possible reasons for this type of rejection:
Service Location is missing from the Encounter screen
Missing/Invalid Diagnosis (ICD9) code(s)
Missing/Invalid Procedure (CPT/HCPCS) code(s)
Missing/Invalid Place of Service code (POS)
Missing/Invalid Type of Service code (TOS)
Missing Related Cause for Accident Date
Claim contains patient-only-responble procedure codes
This rejection indicates that one or more of the procedure codes on the
claim have been marked that they are only allowed to be billed to the
patient/responsible party, and not to insurance. If the claim contains
only the procedure code that needs to be billed to the patient/responsible
party, open the claim and change the status of the claim to Ready to Send,
Statement. If the claim contains other procedure codes that can be billed
to insurance, copy claim can be used to make a copy of the claim, and
then the patient billable codes can be billed to the patient on the original
claim (remove the additional codes from this claim) and then the insurance
billable codes can be billed on the newly created copied claim (remove
the patient billable codes from this claim before sending it to insurance).
For instructions on using Copy Claim, go to Copy
Claim.
Identification Code Qualifier
There is missing/incomplete information on the Provider Setup screen. To correct this type of rejection, go to the provider setup screen and verify the following:
Provider mailing address is missing
Provider Specialty Code
The provider specialty type is missing from the provider setup screen.
Patient Country
The country code is missing from one of the following screens:
The Address Information on the Patient Insurance Setup
The Patient Setup Screen
The Responsible Party Setup Screen
Individual Relationship Code
The relationship field on the patient insurance field has not been completed.
Failed Required Field Validation
There is a required field that has not been completed. Open up the Encounter screen and look at the Required Fields & Code Limitations message boxes to see which fields are missing a required field.
Total Patient Statement Balance Is Less Than Or Equal To Zero
Although the selected claim may have a balance remaining, the patient has a credit balance which is causing the total statement balance to be less than zero dollars.
Review the patient transaction history to see if the patient is owed a refund
Review the Refund report to see if the patient has any refunds, missing refunds, or refunds in error.
CPT Description
This rejection indicates that one or more of the CPT or HCPCS codes on the claim is missing the description of the code on the code setup screen. To update the description of the code, go to the code setup screen for the code. For instructions on using the code setup screen go to How To Setup A CPT Code.
Date of Birth - Patient
This rejection indicates that the patient's date of birth is missing. To update the patient's date of birth, go to the patient setup screen for the patient and update the date of birth.
Address 1
This rejection indicates that the address information is missing for the responsible party for the patient's insurance. Go to the patient insurance setup screen for the patient and verify that the address information section (under Insured Additional Information) has been completed for all of the patient's insurances.
Gender Code
This rejection indicates that the patient's gender code (F for female, M for Male, or U for unknown). To update the patient's gender code, go to the patient setup screen for the patient and update the gender field.
Document Links
How To Setup A CPT Code