EDI PROFESSIONAL CLAIMS ARE NOT AVAILABLE FOR THIS PAYER ID
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
