Most Common Rejections
Each month a report is issued listing the most common reasons that claims are rejected. Here are the most frequent rejection reasons in June, July, and August, and the steps you can take to correct your claims.
*000 ERROR Provider’s specialty code
This can mean that either the specialty or taxonomy code is not set up. If your Billing Method is ‘C’linic, go to Utility --►Set Up --►Clinic --►Modify and verify that the <Specialty> and <Taxonomy Code> fields are set up correctly. If your Billing Method is ‘D’octor, go to Utilty --►Provider and verify that the <Specialty> and <Taxonomy> fields are set up correctly for each Provider for whom you have received this rejection notice.
NOTE: Your Billing Method is displayed in the Blue Bar located at the top of your screen, or by going to Utility --►Set Up --►Parameter --►View. If your Billing Method is L, you will need to verify the information on both the Clinic and Provider screens.
Admission Date is required on inpatient medical visits
When billing charges for inpatient services; i.e., Hospital Consultation 99255 or Hospital Visit 99231, or procedure performed as an in-patient, etc., you must include the Hospital From date (admission date). This information should be entered in the Encounter and linked to the patient’s charges.
Note: An easy way to ensure that you always submit the Hospital From date is to set up the Utility --►Procedure <Encounter Screen> and <Claim Requirement> fields which, if there is incomplete information, will generate a pop-up screen to allow entry of missing information before actually billing claims. Refer to our online documentation for Utility --►Procedure <Encounter Screen> for instructions on setting up the Claim Requirement feature.
Payer Name, Address, City, State, and Zip are required
All electronically billed claims must have the Payer Name, Address, City, State, and Zip submitted for Primary and Secondary insurances. This information is entered in the Utility --►Insurance screen, fields <Name>, <Address>, <City>, <State>, and <Zip Code> fields.
The following rejections are also quite common:
Claim Rejected as a same day duplicate
Facility city is required.
Facility state is required.
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