eTrans eClaims Reports Rejection Statuses and their Meanings
Details
1ST CHAR PAT F NAME MUST=A the patient's first name does not began with a letter
ACCIDENT DATE Accident date is missing or the date came across as 00/00/00 or the date is not in this format 12/25/2003
CARRIER NOT ACCEPTING DENT The carrier (insurance company) is not accepting dental claims, or the payer id is for medical claims
CHARACTERS IN ORG/LST NAME Invalid characters in the last name or organization
CLAIM HAS BEEN ADJUDICATED AND IS AWAITING PAYMENT CYCLE. Adjudicated means formally reviewed or judged. Awaiting payment cycle means waiting to be paid on the insurance carrier's payment schedule.
CLAIM OFFICE ID FOR PAYER This is also referring to the payer id
CLAIM REMOVED FROM ECS AND PRINTED This means most of the time that their is a registration issue meaning that the registration isn't complete. You could call Eservices or go to the insurance company's website and print out their registration form for ECLAIMS.
CODE 99 FOR PAYER The patients relation is marked as other in the insurance information screen, or under the patients information screen
DATE OF SERVICE The service date 09/24/01 is prior to the birthday and the birthday being 07/04/2014 Field REC
DATE(S) OF SERVICE NOT FOUND
It could be invalid dates of service such as the policy had ended before the date of service or started after the date of service.
DENTAL CLAIMS MUST=COMMERC This is referring to the source of payment field in the insurance information screen NOTE: You may get this error if the payer id is wrong
DENTAL LICENSE FROM PAYER State ID has a dash or a space in it
DENTAL PROCEDURE CODE The procedure code is not a dental procedure code
ENTITY NOT ELIGIBLE FOR SUBMITTED DATES OF SERVICE - PATIENT
This means that the patient is not eligible for dental benefits for the submitted dates of service. See eTrans - Entity Not Eligible For Submitted Dates Of Service .
ENTITY NOT FOUND DEPENDENT INSURED
The dependent or insured was not found in the insurance carrier's records. See Error: Subscriber/Member ID Not Found
ENTITY WAS UNABLE TO RESPOND WITHIN THE EXPECTED TIME FRAME (Entity is Insurer--see below)
This means that the insurance carrier could not respond at this time with a status update. It is not a rejection. It means they have not yet updated the status of the claim.
GROUP POLICY # Group policy number is invalid
INS ZIP NOT W/IN STATE RAN The insured or the patient’s zip or state is wrong in the patients screen The zip code 07010 is incorrect or the state entered in the Patient's information screen is wrong
INSURED NAME/ADDRESS DOES NOT MATCH CARRIER FILES FOR SSN/INSURED ID The patient's name or address does not match the insurance carrier files. This error is from the carrier and not from Henry Schein, Dentrix, or the clearinghouse.
INSURED ADDR 1 This error is referring to the patients address, in the patient’s information screen. This could also be the subscribers address that is missing, not just the patients. The address is on line two when it should be on line one
INSURED ID Requires the insured id, it is most likely missing
INSURED STATE The insured/ Patient state can not be in the UK it needs to be with in the United States
INTERNAL REVIEW / AUDIT
The insurance carrier is reviewing the claim before they decide whether to pay it or not. If there is a DC# assigned, give that to the office and they can contact the carrier for more information.
INV: SAME DAY DUPLICATE CLAIM The claim that was submitted was sent twice Field Duplicate with claim 123456789 This means that the claim is a duplicate with claim number 123456789
LINE INFORMATION. DETAILED DESCRIPTION OF SERVICE. [PROCEDURE CODE] The carrier requires a report, detailed description, remarks, or narrative on the noted procedure code.
MISSING OR INVALID INFORMATION. DUPLICATE OF A PREVIOUSLY PROCESSED CLAIM
1. Missing or invalid information. The carrier should let the office know what the missing or invalid information is. They would receive that information through an EOB (Explanation of Benefits) or an ERA (Electronic Remittance Advice).
2. Duplicate of a previously processed claim
MUST BE 5 OR 10 ALPHA/NUM Provider Id must be 5 or 10 alpha/numeric characters. In this case 67024377MON the provider id is too long
NO PAYMENT WILL BE MADE, EOB TO FOLLOW. The insurance will not pay the claim and sent an EOB to either the patient or the dentist office. The office will need to call the carrier for the reason the claim will not be paid.
NOT FOUND DATE(S) OF SERVICE
It could be invalid dates of service such as the policy had ended before the date of service or started after the date of service.
NOTRETURNEDBYPAYER : MEMBER NOT FOUND, NOTE GRP 4310 SUBSCRIBER ID 'S HAVE BEEN CHANGED VERIFY WITH MEMBER. This means that the Sub ID has been changed in the insurance's information and the office needs to check with the patient because they should have the new number
PAT BIRTHDATE AFTER PROC D Received when the patients birthday (07/04/2014) happened before the procedure date
PAT BIRTHDATE YEAR The patients birthdate year 00/00/0034 is smaller than 1800
PATIENT BIRTHDATE CENTURY The patients birthday century is wrong in this case 12/21/7960 the person is either really old or the century date is wrong
PATIENT BIRTHDATE The patient’s birthday is missing or the birthday is 00/00/0000
PATIENT ENTITY'S DATE OF BIRTH and RESPONSE NOT POSSIBLE
The patient's date of birth does not match what the carrier has on file.
PATIENT RELATION MUST=01 The patients relation is marked as other in the insurance information screen, or under the patients information screen But this one requires the relationship to be marked as self.
PAYER ADDR 1 This error is in reference to the insurance company’s address, in the insurance information screen (if secondary insurance company’s address in line two the office will get this error. Also if they are just sending off the primary claim) The address is on line two when it should be on line one
PAYER ID NOT ENVOY PARTICI The payer id 65935 is not on the envoy participating payer id list?
PAYER ID NOT ON FILE The payer id in this case is 'MAIL' and is invalid, if the insurance company does not have a payer id then the office needs to leave it blank or enter in 06126 and we will drop it to paper and mail it out for them.
PAYR ZIP CODE The zip 2117 is wrong for the insurance company, in this case its to short. It needs to be five characters long.
PAYR ZIP NOT W/IN STATE RA The zip code or the state for the insurance company is wrong on insurance information screen. The zip code 292243859 is too long, the system will only accept five digit zip codes
PROCEDURE CODE FOR DENTAL Office needs to check the procedure code.
PROVIDER LICENSE NOT REGISTERED FOR ECS This means that the insurance requires a special enrollment for all providers before electronic claims can be submitted electronically. Take the office to our payer search tool https://www.dentrix.com/products/eservices/eclaims/payor-search to get the form that needs completed. See article 10167 for instructions.
REJECTED Most of the time this rejection is going to come from MetLife or delta dental. This means Patient not on file. Check the insurance companies web site and if you type in the Sub ID\SSN number and don't pull up anything, this means the insurance company is using a different Id number. Check with insurance company.
REMARKS FOR PROC CD FOR PA Requires remarks for the procedure sent on the claim
RENDER PROV ID FOR PAYER The insurance company requires the rendering provider Id That is in the practice resource setup screen in the provider’s information.
REQ: RENDER PROV ID FOR PAYER The insurance company requires the rendering provider Id That is in the practice resource setup screen in the provider’s information.
REQ: TOOTH # Does it have a tooth number on it?
RTD0 MUST PRECEDE RTE3 The record E3 is invalid It is to provide information relating to California Medicaid dental claim processing.
RTD2 FOR PAYER The record D2 is missing
RTE6 FOR PAYER The record E6 is missing, not all insurance company’s use this record but for the few that do you would put this in the NPI in the providers screen Also the payerid has to be setup to grab the E6 information
SAME DAY DUPLICATE CLAIM The claim that was submitted was sent twice Field Duplicate with claim 123456789 This means that the claim is a duplicate with claim number 123456789
SERVICE DATE PROCESS DAT The service date is greater than the process date, this means that we received the claim with service date later than the date the claim was received.
SUBM PROC DT TOO NEW Procedure date is too new. Check the date on the procedures on the claim submitted
SVC DATE LATER THAN PROC D The service date is later that the procedure date