Here’s the Top 5 COMMON CLAIM REJECTIONS And How To Fix It
Fixing claim rejections is easy once you know what’s going on. Multiple rejection messages may appear for one entry because each payer/clearinghouse worded their rejection message differently.
MISSING OR INVALID PAYER ID
According to this rejection, the payer ID used on the claim isn’t eligible for electronic submission. An electronic connection must be established between a payer and a clearinghouse to send claims. Every payer has a unique payer ID, but sometimes the clearinghouse has a payer ID that’s different from the payer’s. Those claims should be submitted with the clearinghouse payer ID. With the clearinghouse’s outbound payer ID, claims go to the payer.
THE ZIP CODE OF THE SUBSCRIBER IS MISSING OR INVALID.
This rejection indicates that the claim has an invalid ZIP code. Payers typically require the full 9-digit ZIP code on electronic claims. The rejection usually indicates that the claim does not include the 4-digit extension. You can verify your zip code by using Zip Code Lookup provided by the US Postal Service. If all corrective actions have been completed, rebill and resubmit all affected claims.
SUBSCRIBER PRIMARY IDENTIFIER IS INVALID
There are three possible explanations for this rejection:
- The claim was sent to the incorrect payer ID. If this rejection was received on claims for multiple patients, this is the most likely cause.
- The patient’s demographics or insurance policy were ineligible for the date of service billed.
- The patient is either a newborn or has recently been added to the guarantor’s insurance policy.
Depending on the cause, the following steps will be taken to resolve the issue:
- Verify and edit the payer ID if the claim was submitted to the incorrect payer ID.
- Verify the patient’s eligibility if the patient’s demographics or policy are incorrect.
NPI OF BILLING PROVIDER IS MISSING OR INVALID
Most likely, this error is caused by an incorrect billing NPI. Your NPI is likely on file with payers. Upon receiving a claim, they look in their system if they have the billing NPI on file. In the absence of it on file, they’ll deny the claim. Quoting not having your NPI and Tax ID on file.
As a result, this error could also refer to a claim that was submitted with the incorrect Tax ID reported in (the equivalent of) Box 25 on the claim. Be sure to submit claims using the same NPI & Tax ID.
INVALID DIAGNOSIS CODEDiagnostic codes are updated, changed, and deleted every year on October 1. To avoid this rejection, ensure that the diagnosis is current as of the date of service. Also, double-check that the diagnosis matches the procedure being performed. Make certain that the diagnosis code is coded accurately.
Fixing claim rejections is a critical process, but it’s time-consuming. WWS can help you avoid claim rejections and submit clean claims. For more info about our medical billing services, call +1(302)613-1356 or email us at support@wonderws.com