Correcting Common Claim Rejections

Listed below are common claim rejections and how to correct them. A few important items about claims rejections to note: 

• Rejected claims are claims the payer has not accepted into the payer system. 

• Claims are often rejected by the payer because of a mismatch of information on the claims and information in the payer system. 

• The claims department at the payer cannot typically see "Rejected Claims" and therefore might say they are not on file. Be sure to reach out to the EDI department instead of the claims department. 

• The rejections seen in Checkpoint EHR are directly from the payer and not Checkpoint EHR. 

Rejection Reason	How to Correct
02 - INVALID MBR	Check members name, dob, address, and insurance number and eligibility dates with the payer.
02 - MEMBER NOT FOUND	Check members name, dob, address, and insurance number and eligibility dates with the payer.
09 - MBR NOT VALID AT DOS	Check members eligibility dates with the payer.
ACK/REJECT MISS INFO - ENTITYS SPECIALTY/TAXONOMY CODE. USAGE: THIS CODE REQUIRES USE OF AN ENTITY CODE.	Compare the billing and rendering taxonomies submitted on the claims to what the payer has on file.
Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected.	This reason code is typically accompanied by another more descriptive rejection. Use other rejection for reference.
Billing Taxonomy Code ___________ is not a valid code.	Compare the billing taxonomy submitted on the claim to the billing taxonomy the payer has on file. Contact Checkpoint if the billing taxonomy needs to be changed on your Office Settings page.
BILLING/RENDERING PROVIDER TAXONOMY CODE IS REQUIRED/INVALID	Compare the billing and rendering taxonomies submitted on the claims to what the payer has on file.
CK/RETURNED - ENTITY NOT FOUND. USAGE: THIS CODE REQUIRES USE OF AN ENTITY CODE. - PATIENT	Check members name, dob, address, and insurance number and eligibility dates with the payer.
Entity's National Provider Identifier (NPI): Rendering Provider	Compare the rendering NPI submitted to the rendering NPIs the payer has on file.
ONE OR MORE OF THE PLACE OF SERVICE CODES WAS NOT VALID ON THIS CLAIM. PLEASE VERIFY THE INFORMATION AND RESUBMIT A NEW CLAIM ELECTRONICALLY.	Check the session to ensure the place of service billed aligns with the billing code selected and vice versa. For example, maybe you chose telehealth location for a service that does not allow telehealth.
Patient /Subscriber Demographic information (DMG) Date of Birth is not valid for Member ID. Incorrect Data: (2010BA-DMG-3)	Compare members date of birth in Client Profile and compare to date of birth listed in the payer's system.
Patient Eligibility not found at the payer. Please verify the patient information submitted is exactly as it appears on the insurance card.	Check members name, dob, address, and insurance number and eligibility dates with the payer.
Patient Eligibility Not Found. Please verify patient/subscriber information entered is exactly as it is on the insurance card and that the patient had active medical coverage on the date of service billed.	Check members name, dob, address, and insurance number and eligibility dates with the payer.
Payer rejected with a generic error indicating they cannot provide further status electronically. Please review any additional errors on the claim for more specific reasons for this claim rejection.	This reason code is typically accompanied by another more descriptive rejection. Use other rejection for reference.
Per the Payer this Patient is not eligible for benefits for the date of service submitted.	Check client's eligibility with the payer to ensure coverage on dates of service submitted.
Returned to Entity.: Submitter; SMARTEDIT DLP THIS LINE IS A POSSIBLE DUPLICATE OF ANOTHER LINE BILLED BY THE SAME PROVIDER FOR THE SAME DATE OF SERVICE.; Procedure Code _____	Check to ensure the session has not already been billed and paid by the payer.
SUBMITTED RENDERING PROVIDER NPI IS NOT ACTIVE ON THE SERVICE START DATE	Check the rendering NPI submitted on the claim and ensure the NPI is credentialed/registered with the payer.
Subscriber and Subscriber id not found	Check members name, dob, address, and insurance number and eligibility dates with the payer.
Subscriber and subscriber id not found.; Member pick reject	Check members name, dob, address, and insurance number and eligibility dates with the payer.
Subscriber Name Full 14 Position BCBSNC Member ID Required. Incorrect Data: (2010BA-NM1-9)	BCBS requires a 14-digit member ID. All member IDs end with 00, 01, 02, 03, etc.
Subscriber Name Member ID must be valid. Incorrect Data: (200BA-NMI-9)	Check members name, dob, address, and insurance number and eligibility dates with the payer.
The Rendering Provider NPI is not registered with BCBSNC. Please register the Rendering Provider NPI with BCBSNC.	Check the rendering NPI submitted on the claim and ensure the NPI is credentialed/registered with the payer.
THIS PATIENT WAS NOT ELIGIBLE FOR BENEFITS UNDER THIS PLAN ON THE DATE(S) OF SERVICE USING THE PATIENT INFORMATION SUBMITTED (ID, DOB, NAME, ADDRESS). IF YOU BELIEVE THE INFORMATION ON YOUR CLAIM IS CORRECT, PLEASE FAX PROOF OF ELIGIBILITY TO 1-877-277-1	Check members name, dob, address, and insurance number and eligibility dates with the payer.