Handling Claim Rejections

Use this list of common rejection messages and tips for resolving each one.


 

Provider PIN Missing

Affiliations are relationships between billing providers and the insurers who represent patients. All Insurers assign a unique Provider Identification Number (PIN) to any organization that submits claims.

Enter a provider PIN by going to Staff > Staff Info.

You can also enter a staff affiliation by going to BillingTracker > File > Affiliations or by clicking the Modify button on the Referral Source form.

Subscriber Address Missing

If the insured is the client, go to Patients > Demographics > Demographics tab and enter an address.

If the insured is someone other than the client, go to Patients > Demographics > Insurance tab and enter an address.

If the Demographic form displays an address, your next option is to navigate to BillingTracker > Manage Accounts > [select patient] > [double-click claim]. On the Edit Claim screen, make sure that: 1) The correct insurance company is selected, and 2) The screen lists an address for the Responsible Party.

Double check the Balance Assignment by going to BillingTracker > Manage Accounts > [select patient ] > [single-click claim to highlight] > Balance Assignment tab.

If the balances are not properly allocated, click View/Update Balance Assignments to enter the information.

Billing NPI – Missing

NPI numbers for Billing, Rendering, and Referring Provider are determined by the Insurer Plan NM109 Priority setting. To set the NPI, go to: BillingTracker > File > Setup > Insurer Plan > Claim Details tab > NM109 Priority. Here are some of the details for each setting:

 

  • Provider: If you've configured the system to use the Provider NPI of the clinician listed on the Patient Contact record, it takes the NPI number from that provider's Staff Info record Staff > Staff Info > NPI
  • Appointment Location NPI: The system selects the NPI value for the Place of Service indicated on the Patient Contact record. You can modify this setting by going to:  Building Input Utilities > Maintenance > Building Input > NPI 
  • Main Building NPI: If you select the Main Building NPI, BillingTracker uses the NPI listed for the Main Building Utilities > Maintenance > Building Input > NPI. To set a building as the Main Building, go to: Utilities > Maintenance > Building Input > Main Building For Building. Note: Only one building can be selected as the Main Building.
  • Main Building Tax ID: When Main Building Tax ID is selected for any of these settings, the system uses the Tax ID entered on the Main Building Utilities > Maintenance > Building Input > Tax ID. To set a building as the Main Building,  go to: Utilities > Maintenance > Building Input -> Main Building For Building. Again, only one building can be selected as the Main Building.
  • None: When None is selected for any of these settings, no value will be used.

Provider Affiliations:

Go to BillingTracker > File > Affiliations or by clicking the Modify button on the Referral Source form to update Provider Affiliations.

Federal Tax ID or SSN Must Have a Length of 9 digits

Go to Utilities > Maintenance > Building Input. Enter the appropriate nine-digit value in the Tax ID field.

Missing/Invalid Discharge Hour

Go to BillingTracker > File > Setup > Electronic Claim Transmission Setup to enable the option for Send Discharge Hour.

This error applies to Institutional claims only.

Primary Insurance Plan Missing/Invalid Information

Go to BillingTracker > File > Setup > Insurer Plans > Claim Details tab and place a checkmark in the Send Primary Info field.

 

 

 

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