| 00000 is an invalid date of birth. |
Check date of birth using Member Inquiry tool. Dates are accepted in MM/DD/YYYY format. Correct and resubmit. |
Begin date not present or invalid.
|
Enter or correct the beginning date of service and resubmit. |
End date not present or invalid.
|
Enter or correct the end date of service and resubmit. |
|
Invalid length member ID |
Member ID may be missing characters or have duplicate characters. Check using Member Inquiry tool. Correct and resubmit. |
| Invalid date type |
Dates are accepted in MM/DD/YYYY format. Correct and resubmit. |
Member ID does not match a Priority Health member at DOS
|
Check the member ID using Member Inquiry tool. Correct and resubmit. |
| Member was not eligible at time of service |
Check that the member was eligible for coverage using Member Inquiry tool. The link labeled "contract summary" shows the time periods of the member's eligibility. |
| Format error or qualifier present with missing ID |
Check with your software vendor for formatting errors. |
Missing CPT/HCPCS code on line [00]
|
Enter a valid CPT or HCPCS code and resubmit. |
Missing units on line [00]
|
Enter the units provided and resubmit. |
| Invalid character in name |
Member names containing numeric characters (or numbers containing alpha characters) will cause rejections. Correct the error or contact your software vendor to make sure they are formatted correctly. |
Total amount on EOB does not equal amount billed
|
COB claim adjustments must add up to the service total. Correct and resubmit. |
| POA data elements are missing indicators |
Example: Exempt facilities must bill using the exempt indicator on all codes. Add the indicators and resubmit. |
| Non-anesthesia services cannot be billed in minutes |
Only anesthesia services are billed in minutes. Correct service unit(s) and resubmit.
|
Missing secondary ID (EIN or SSN in addition to NPI)
|
You must include a tax ID or SSN in addition to your NPI number. Enter and resubmit.
|
| Invalid CPT/HCPCS code XXXXX and/or modifier XX on line [00] |
Enter a valid CPT or HCPCS code or modifier and resubmit. |
| Missing service date for CPT/HCPCS code XXXXX and/or modifier XX on line [00] |
Enter a service date for the code or modifier and resubmit. |
| Invalid revenue code format on line [00] |
All revenue codes are 4 digits, so 555 should be entered as 0555. Correct and resubmit. You may need to contact your software vendor to ensure that your system is not removing the 0. |
| Invalid revenue code XXXXX on line [00] |
Correct and resubmit.
|
| Invalid diagnosis code XXXXX |
Correct the diagnosis code and resubmit. |
Code XXXXX is a title diagnosis
|
Section title numbers are not billable codes. Enter the service-specific code and resubmit. |
| Missing procedure code |
Enter a valid procedure code and resubmit. |
| Missing diagnosis code |
Enter a valid diagnosis code and resubmit. |
