When you submit a claim with missing or invalid data in required fields, our system rejects it before it enters claims adjudication. This is called a front-end or up-front rejection. No Explanation of Payment (EOP) is generated for these claims.
All claims submitted to Priority Health electronically or by paper must first pass specific edits prior to acceptance.
- Electronic claims must pass required X12 HIPAA standard edits.
- Paper claims must first pass specific edits prior to acceptance.
Notification of front-end rejections
Find your front-end rejections and the reasons for them in our Claims tool. Use the Up-Front Rejected Claims search to locate your claim.
We notify providers by a front-end rejection letter or, if the claim was submitted electronically, via EDI transaction 277CA (note: service receipts will be retired on Sept. 1, 2026).
Front-end rejections are not denials
After you review the front-end rejection letter or 277CA, you can make the necessary corrections and resubmit the claim. A "corrected claim" is not required.
Choose how to receive service receipts
Up-front rejected claims and reasons are available in our Provider Portal.
- Log in to your Provider Portal account.
- Click on the Claims tab.
- There you can adjust the parameters of your Up-Front Rejected Claims search.
Common causes of front-end rejections
Common rejection causes include:
- Unreadable information - ink is faded, too light, or too bold (bleeding into other characters or beyond the box); the font is too small or hand-written information is not legible
- Member date of birth missing or incorrect
- Member name or Identification number missing
- Provider name, Taxpayer Identification Number (TIN), or National Practitioner Identification (NPI) number missing
- Attending provider information missing from Loop 2310A on Institutional claims when CLM05-1 (Bill Type) is 11, 12, 21, 22, or 72 or missing from box 48 on the paper UB claim form
- Date of service not prior to the received date of the claim (future date of service)
- Date of service or date span missing from required fields, such as "Statement From" or "Service From" dates
- Type of bill is invalid
- Diagnosis code missing, invalid, or incomplete
- Service line detail missing
- Date of service prior to member's effective date
- Admission type missing (inpatient facility claims – UB-04, field 14)
- Patient status missing (inpatient facility claims – UB-04, field 17)
- Occurrence code/date missing or invalid
- Revenue code missing or invalid
- CPT/procedure code missing or invalid
- CPT/HCPCS/modifier combination invalid
- Incorrect form type used
- Taxonomy code and qualifier missing in box 24 I, 24 J or box 33b on the CMS-1500 form