Alabama Top 5 Reasons for Claims Rejection June, 2008 - Make Your Revenue Smarter

Audit trails show which of your claims were accepted by the Cahaba GBA Part B processing system, along with claims that were rejected and the reason for the rejection.  Referring to this report will allow you to correct and resubmit claims quickly, resulting in a dramatically reduced turnaround time.  You will also become aware of any major problems with your claims so they can be corrected before they create an interruption in your cash flow.  Audit trail reports are available the next business day for files that are received before 3:30 p.m. Central Time.  If you are not receiving your audit trails contact your software vendor, billing service, or clearing house. See Audit Trail Explanations for a more complete list of edits, along with descriptions of loops that might be referenced in an edit.  In order to increase the number of claims that successfully pass through audit trails and into processing Cahaba GBA Part B EDI Services is providing you with the top five reasons for claim rejections.
For the month of June 2008, these are:

Procedure code billed was for a diagnostic procedure such as an x-ray or lab work which requires the NPI of the ordering physician, or a consultation, which requires the NPI of the referring physician, and this was not submitted on the claim.

Claim was submitted after May 22, 2008 and contained a legacy (P-TAN) provider number in the indicated loop.

3. 209- INVALID LAST NAME FOR HIC NUMBER- 9,299 claims
The last name submitted for the beneficiary does not match the last name we have on record for the HIC number on the claim.  The beneficiary’s last name must include apostrophes, spaces, hyphens, etc., if they appear in the beneficiary’s last name on his or her Medicare card.

4. 210- INVALID FIRST NAME/INIT FOR HIC– 8,482 claims
The first name submitted for the beneficiary does not match the first name we have on record for the HIC number on the claim.  The beneficiary’s first name must appear as it does on the beneficiary’s Medicare card.  This includes spaces, hyphens, apostrophes, etc.

5. 888- INSTREAM REJECTION– 7,794 claims
There was a problem involving HIPAA required loops, segments, or values.  The specific loop will be identified, for example, ‘ELEMENT N401 (D.E. 19) AT COL. 4 IS MISSING, THOUGH MARKED “MUST BE USED” (LOOP:2010BA POS:3140)’.  The number after ‘POS’ indicates the position in the file where the error occurred. 

December 2016 update:
Top Electronic Data Interchange (EDI) rejection data can be accessed here





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