Top 10 ANSI Claim Rejections Examples
Top 10 ANSI Claim Rejections occur at multiple locations within the electronic EDI claim. Suppliers are strongly encouraged to review all aspects of a claim denial. Find below Top 10 ANSI Claim Rejections.
- X222.087. 2010AA. NM109.050 This Claim is rejected for relational field due to Billing Provider’s submitter not approved for electronic claim submissions on behalf of this Billing Provider The billing provider must be “associated” to the submitter (from a trading partner perspective) in 1000A. NM109.
- X222.351. 2400.SV101- 3.010 This Claim is rejected for relational field Information within the Procedure Code Modifier(s) for Service(s) Rendered 2400.SV101-3 must be valid procedure modifier on the date in 2400.DTP03 when DTP01 = “472”. Procedure Modifier must be valid for the Service Date. (DTP01 = “472”)
- X222.351. 2400.SV101- 2.020 This Claim is rejected for relational field Information within the HCPCS “When 2400.SV101-1 = “HC”, 2400.SV101-2 must be a valid HCPCS Code on the date in 2400.DTP03 when DTP01 = “472”. When Product or Service ID Qualifier = “HC”, the Procedure Code must be a valid HCPCS Code for the Service Date (DTP01 = “472”). This can also be caused by sending an invalid HCPCS and modifier combination. “
- X222.121. 2010BA. NM109.020 This Claim is rejected for Invalid Information for a Subscriber’s contract/member number The subscriber HICN is invalid. Verify the HICN is entered exactly as it appears on the beneficiary’s red, white, and blue Medicare card. Medicare number can only be 10 to 11 characters only. Here are the valid formats: NNNNNNNNNA or NNNNNNNNNAA or NNNNNNNNNAN. If the patient’s Medicare number is not in these formats, your claim will reject. If MBI: 2010BA.NM109 must be 11 positions in the format of C A AN N A AN N A A N N , where “C” represents a constrained numeric 1 thru 9, “A” represents alphabetic character A-Z but excluding S, L, I, O, B, Z, “N” represents numeric 0 thru 9 and “AN” represents “A” or “N”. CSCC A7: “Acknowledgement/Rejected for Invalid Information…”CSC 164: “Entity’s contract/member number” EIC: IL “Subscriber” If the HICN/MBI format is valid, 2010BA NM109 must be a HICN format pre-SSNRI transition.2010BA NM109 may be either a HICN (Part B or RRB format) or MBI during the SSNRI transition period.2010BA NM109 must be an MBI format post-SSNRI transition.
- X222.430. 2420A. NM109.030 This Claim is rejected for Invalid Information within the Rendering Provider’s National Provider Identifier (NPI) 2420A.NM109.