Rejection Reason:

This rejection indicates the claim was submitted with an invalid diagnosis (ICD-10) code. New edits has been placed for ICD-10 codes on 10/1/2016. NOTE: CureMD Support cannot provide coding assistance. Please contact your biller/coder with any CPT or ICD code questions.

Rejection Resolution:

1. Check an up-to-date ICD Code Book (or online code resource) to make sure ALL diagnosis codes submitted on the claim are valid for the date of service being billed. 2. Go to Settings>Billing>Plan > Select the insurance plan and verify if the ICD 10 effective date is specified as 10/01/2015. If the date is not specified then simply enter the date and save the plan. If it cannot be determined why a diagnosis code is invalid then you will need to contact your coder or call the insurance for a resolution as many times it is not specified in the EDI file which code is invalid.  

Rejection Reason:

This rejection indicates the claim was submitted with an invalid diagnosis (ICD-10) code. New edits has been placed for ICD-10 codes on 10/1/2016. NOTE: CureMD Support cannot provide coding assistance. Please contact your biller/coder with any CPT or ICD code questions.

Rejection Resolution:

1. Check an up-to-date ICD Code Book (or online code resource) to make sure ALL diagnosis codes submitted on the claim are valid for the date of service being billed. 2. Go to Settings>Billing>Plan > Select the insurance plan and verify if the ICD 10 effective date is specified as 10/01/2015. If the date is not specified then simply enter the date and save the plan. If it cannot be determined why a diagnosis code is invalid then you will need to contact your coder or call the insurance for a resolution as many times it is not specified in the EDI file which code is invalid.  

Rejection Reason:

This rejection indicates the claim was submitted with an invalid diagnosis (ICD-10) code. New edits has been placed for ICD-10 codes on 10/1/2016. NOTE: CureMD Support cannot provide coding assistance. Please contact your biller/coder with any CPT or ICD code questions.

Rejection Resolution:

1. Check an up-to-date ICD Code Book (or online code resource) to make sure ALL diagnosis codes submitted on the claim are valid for the date of service being billed. 2. Go to Settings>Billing>Plan > Select the insurance plan and verify if the ICD 10 effective date is specified as 10/01/2015. If the date is not specified then simply enter the date and save the plan. If it cannot be determined why a diagnosis code is invalid then you will need to contact your coder or call the insurance for a resolution as many times it is not specified in the EDI file which code is invalid.  

Rejection Reason:

This rejection indicates the claim was submitted with an invalid diagnosis (ICD-10) code. New edits has been placed for ICD-10 codes on 10/1/2016. NOTE: CureMD Support cannot provide coding assistance. Please contact your biller/coder with any CPT or ICD code questions.

Rejection Resolution:

1. Check an up-to-date ICD Code Book (or online code resource) to make sure ALL diagnosis codes submitted on the claim are valid for the date of service being billed. 2. Go to Settings>Billing>Plan > Select the insurance plan and verify if the ICD 10 effective date is specified as 10/01/2015. If the date is not specified then simply enter the date and save the plan. If it cannot be determined why a diagnosis code is invalid then you will need to contact your coder or call the insurance for a resolution as many times it is not specified in the EDI file which code is invalid.  

Rejection Details:

The payer rejected the claim for provider not being found in their system. This could be due to five reasons: 1. Provider's NPI is not part of Group NPI 2. Billing Group is not created 3. Tax ID is incorrect 4. Enrollment is not completed 5. Provider is not credentialed

Resolution:

Cause #1 Provider's NPI is not part of Group NPI:

• Contact the insurance and have them link the doctor's NPI to the group NPI so it is recognized as such when billing under the group NPI.

Cause #2 Billing Group is not setup

• Go to Settings > Practice > Provider Groups > Billing Provider.
• Select the insurance for which the billing group is required and see if one exists.
• If a billing group exists then check if the provider is attached.
• If the billing group does not exist for the insurance, then click on "Add" to enter a new billing group for an insurance.
• Save the billing group and resubmit

Cause #3 Tax ID entered is incorrect Group Billing

• Go to Settings>Practice>Provider Groups>Billing Provider.
• Select the insurance for which the billing group is required and check if the tax ID is entered correctly.

Individual Billing

• Go to Settings>Practice>Provider>Practice Provider.
• Check if the tax ID is entered correctly for the concerned provider.

Cause #4 Enrollment is not complete

• Contact CureMD and we will verify the enrollment records to confirm if it was completed or not for whichever insurance the rejection occurred.

Cause #5 Provider is not credentialed:

• Verify when the credentialing will begin or when will it complete if it is on progress.

Rejection Details:

This rejection occurs when the 2300 Loop is missing the CRC segment (EPSDT indicator). The EPSDT (Early Periodic Screening, Diagnosis, and Treatment) referral information was expected but not found.

Resolution:

Follow the instructions below to add an EPSDT Indicator and fix this rejection:

• Go to Patient> Billing> Charges
• Click on the appointment date for which the indicator is requird.
• Click on the "+" icon next to CTP to expand line level options.
• Check the box for "EPSDT Service" to populate the CRC segment.
• Select "EPSDT Ref. Code" to populate "Y"/"N" (Yes/No) in the EDI file.
• Selecting "NU" = No - Selecting AV/S2/ST = Yes
• Save the charge and resubmit the claim

Note: This only applies for Medicaid plans or any plan with MC claim filing indicator.    

Rejection Details:

This rejection indicates that the Billing Taxonomy code is required and was either missing or not sent out correctly on the electronic claim (Loop 2000A, PRV segment).

Resolution:

To add taxonomy number kindly follow the instructions below:

• Go to Settings > Practice > Provider Groups
• Search the relevant plan
• Click on the group name
• Click on Specialty link
• Search Specialty by Specialty name or Taxanomy code
• Check mark the correct Specialty's blue hyperlink
• The specialty will now be automatically added in the background
• Close the Specialty pop up box and save the billing group

Note: Do not click "Save for all plans" if the change is not required for all plans. Always click on "Save" option instead. If the claims are not sent under group information then the Taxonomy code for the individual provider needs to be added. This can be done from Settings > Provider > Practice Provider > Select Provider and add specialty.

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:

Use the following work flow according to the reasons: Cause #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

Cause #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

Cause #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

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:

Use the following work flow according to the reasons: Cause #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

Cause #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

Cause #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