Common Billing Rejections

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:

Unable to get field information


There is missing/incomplete information on the Referring Provider setup screen. To correct this type of rejection:

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).

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.

SBR-Subscriber Information

There is missing/incomplete information on the patientís insurance setup screen. To correct this type of rejection, open the patientís insurance setup screen and:

Transmission Type Code

There is missing/incomplete information on the patientís insurance setup screen. To correct this type of rejection:

CLM-Health Claim

Claim is currently set to a billing type of paper


T
he 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:

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 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:

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.

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 New Payer

Copy Claim

How To Setup A CPT Code

Payer List