Rejected HIPAA Claims Basic Guides (CGS Administrators, LLC)
Rejected HIPAA Claims are claims that are in a rejected status and has failed one of the set validations. Find below some ANSI Claim Rejections. More ANSI Claim Rejections examples can be found in the previous posts.
- X222.262. 2310B. NM109.030 This Claim is rejected for Invalid Information for a Rendering Provider’s National Provider Identifier (NPI). “2310B.NM109 must be a valid NPI on the Crosswalk when evaluated with 1000B.NM109. The rendering provider NPI was not found on the crosswalk. Some parties recommend Sole-proprietors, IDTFs, and Ambulance providers, with only a group NPI, not send the Rendering Provider Loop(s) 2310B or 2420A in the Medicare Part B claims to avoid unnecessary front-end rejections. CGS only requires NPIs in the Billing Provider Loop for the above types of providers.”
- X222.094. 2010AA. REF02.050 This Claim is rejected for relational field Billing Provider’s NPI (National Provider ID) and Tax ID 2010AA.REF must be associated with the provider identified in 2010AA.NM109. Billing Provider Tax Identification Number must be associated with the billing provider’s NPI.
- X222.157. 2300.CLM05- 3.020 This Claim is rejected for Invalid Information within the Claim Frequency Code “Part B Medicare only accepts original claims. ****CLM05-3 must be 1 for Medicare Part B claims only****”
- X222.087. 2010AA. NM109.030 This Claim is rejected for Invalid Information in the Billing Provider’s NPI (National Provider ID) “2010AA.REF must be associated with the provider identified in 2010AA.NM109 Billing Provider Identifier must be a valid NPI on the Crosswalk. Verify that the NPI and PTAN are linked together.”
- X222.351. 2400.SV101- 7.020 This Claim is rejected for relational field Information within the Detailed description of service “2400.SV101-7 must be present. when 2400.SV101-2 is present on the table of procedure codes that require a description. Description must be present when Procedure Code requires a description/additional information.”