ACKNOWLEDGEMENT/ RETURNED AS UNPROCESSABLE CLAIM THE CLAIM/ ENCOUNTER HAS BEEN REJECTED

Rejection Details

Claim may be getting rejected due to one of the following reasons:
1) Subscriber is ineligible
2) Subscriber’s policy number is incorrectly entered
3) Claim is being submitted to incorrect payer ID

Resolution

Reason 1:

(If available) run an eligibility check for the patient within CureMD to check for active coverage:

• Open up patient’s profile from patient module
• Click on Registration > Profile
• Click Insurance > Click on (E) or (P) in Blue
• Click on Inquiry
• Select Search Criteria as “Patient ID, Name & DOB” and click inquire
• Also verify the patient’s eligibility with the payer for the date of service being billed

Reason 2:

Verify the patient’s policy number, name, gender, and DOB were submitted correctly on the claim and match the information shown on the patient’s insurance and identification cards.

• Go to Patient > Registration > Profile > Demographics > Click on the Identification Card
• Go to Patient > Registration > Profile > Insurance > Click on the Insurance Card

Reason 3:

Verify that the claim was submitted to the correct payer ID and cross reference the insurance name and payer ID listed on the patient’s insurance card.

• Go to Patient > Registration > Profile > Insurance > Click on the Insurance Card
• Go to Settings > Billing > Plan > Search Plan > Check Payer ID and Plan Name