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

Rejection Details:

If the same claim is being submitted twice within 48-72 hours of the original submission then this rejection can occur. This rejection will not affect the status of the initial submission however. Alternatively, this can also occur if a rejection has been received which needs to be rectified and the rejected claim was resubmitted without any corrections within 48-72 hours of original submission.

Resolution: 

Contact the payer to verify the status of the previous claim submission and determine if the claim needs to be corrected and (if so) how to properly resubmit.  

Rejection Details: 

This rejection is caused by having a missing or invalid "Drug Unit Count Code Qualifier” on the charge page for procedure (CPT/HCPCS) codes with an NDC (National Drug Code) Number.

Valid Drug Unit Code Qualifiers: * F2 -International Unit * GR -Gram * ME -Milligram * ML -Milliliter * UN -Unit

Resolution:

• Go to Settings > Billing > Procedure
• Search the relevant CPT
• Scroll down and confirm the 11 digit NDC
• Now go to patient's charge page
• Click on the "+" sign next to the CPT on the line level
• Right next to NDC, verify and select the right drug unit from F2 or GR or ME or ML or UN

Rejection Details:

This rejection indicates that the claim contains an NOC code, which is a "Not Otherwise Classified" code that requires a detailed text description. This description is currently missing on the charge page.

Resolution:

Kindly check if relevant description is added for these codes and resubmit the claim. Use the following workflow

• Patient > Billing > Charges
• Click on Appointment Date
• Click on the Note icon next to Ordering Provider to Add the comments for non-specific codes
• Save and resubmit claim

Rejection Details:

This rejection indicates that the claim was submitted with an invalid Claim Filing Indicator. Certain payers will not accept claims without the appropriate claim filing indicator tied to the insurance being billed.

Resolution:

Verify or correct the Claim Filing Indicator by using the following workflow:

• Open up concerned patient's profile from the patient's module
• Click on insurance
• Click on the relevant plan
• Correct the claim filing indicator accordingly and save it.

Rejection Details:

This rejection indicates the payer does not recognize the provider matched to the NPI/tax ID combination in their system.

Resolution:

• Click on Settings > Practice > Provider Groups
• Search the plan and click on group name
• Verify the combination of Tax I.D and NPI and rectify if needed.
• Click on Settings again > Practice > Provider > Practice Provider
• Click on relevant provider's name
• Verify the tax type and the combination of Tax I.D and NPI and rectify if needed
• Save the profile and resubmit the claim

In case all information is correct in the application then:

• Contact the payer and verify the Tax ID and NPI combination they have in their records.
• Get the Tax ID and NPI information updated on file if incorrect in insurance's records.

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:

Case# 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

Case# 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

Case# 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:

This rejection indicates that a tertiary insurance was included on the claim. Majority of the plans do not cater the COB claims or simply do not offer the claim submission to them as a tertiary plan. Such claims cannot be submitted electronically to a tertiary insurance and will need to be sent on paper. Note: If billing to a secondary insurance, the tertiary insurance will need to be made inactive on the case before submitting claims electronically.

Resolution:

In such cases, submit the claims on paper by using the following workflow:

• Open patient's profile from patient module
• Go to Billing > Charges and click on the Appointment Date
• Hover the mouse over to "Claim" option next to Payment
• Click on Professional
• Select the appropriate HCFA Template
• Click on Print and then print the claim and submit to insurance

Rejection Details:

This rejection means that standard Tricare payers (North region, South region, etc.) do not accept claims that have other payer of Medicare. These claims must be submitted through Tricare For Life or any plan as per the insurance's instructions

Resolution:

• Go to patient's profile from Patient's module
• Click on Patients Demographics
• Click on Patient's insurance tab
• Click on add and add a new plan as per the given instructions from Medicare as the claim has to be routed towards Tricare or if any other plan is mentioned
• Add the new insurance and deactivate the previous one
• Check the real time elegibility and resubmit the claims