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| PROVIDER ID IS MISSING OR INVALID |
The provider Identification Number must be entered in 24 and 33 Pin#. Add provider id in ADM/ProviderID |
| PAYER ID=00803: ENTER SOURCE OF PAY 'C' (EMPIRE MEDB) OR 'G' (EMPIRE BLUE SHIELD) |
If the Payer Organization ID entered is equal to 00803 then the
Source of Payment code must be equal to 'C' (Medicare) or 'G' (Empire Blue Shield).
Modify ADM/Insurance/Editing Indicator: Choose Medicare for Medicare, BCBS for BCBS
Don't choose Commercial as Editing Indicator for Medicare/BCBS! |
VALID NEIC PAYER ID IS REQUIRED
|
If Source of Payment is equal to 'F' (Commercial Payer) or a 'H' (Champus)
and the Claim Filing Indicator is equal to 'P' a valid NEIC Payer ID must be entered. |
PATIENT'S STATE, IF PRESENT, IS INVALID
|
Check the patient address, no spec characters, use uppercase letter |
PATIENT'S ZIP CODE, IF PRESENT, IS INVALID
|
Check the patient address, no spec characters, use uppercase letter |
- PAYER STATE, IF PRESENT, IS INVALID
- INSURED STATE, IF PRESENT, MUST BE VALID
- INSURED ZIP CODE, IF PRESENT, MUST BE VALID
|
Check insured information, no special characters, use uppercase letter |
| LINE CHARGES ARE MISSING, OR NOT NUMERIC AND MUST BE > ZERO |
Charges must be >zero, check 24 |
IF FB1 PRESENT: REND PROV ORGANIZATION OR LAST & FIRST NAME REQ
|
NEIC requires that all claims that contain the FB1 record must also contain the Rendering
Provider Last and first Name or the Organization name. |
PATIENT'S LAST NAME CONTAINS INVALID CHARACTER(S)
|
The first character of the last name may only contain a value of A-Z (may not be a
space or special character). The remainder of the field may contain A-Z, 0-9, period,
comma, hyphen, and trailing spaces. No other special characters or embedded spaces
are allowed. |
PATIENT'S FIRST NAME CONTAINS INVALID CHARACTER(S)
|
The first character of the first name may only contain a value of A-Z (may not be a
space or special character). The remainder of the field may contain A-Z, 0-9, period,
comma, hyphen, and trailing spaces. No other special characters or embedded spaces
are allowed. |
INSURED ID FORMAT IS INVALID
|
The Insured ID may contain A-Z, 0-9, No other special
characters are allowed. The Insured ID may not contain all 1's, 2's, 3's, 4's, 5's, 6's,7's, 8's, 9's or 0's.
May not contain any of the following literals:
1234567890, NONE, UNKNOWN, INDIVIDUAL, SELF |
| WRONG BODY SIZE FOR PREFIX ENTERED (REMOVE SUFFIX IF PRESENT) |
If an alpha character is present in any of the first three positions of the Insured ID
Number (subscriber ID) field, the subscriber ID will be considered to have a prefix. When
the insured is an Empire subscriber, the subscriber ID body must contain the number of
digits required for the prefix on Empire¡¯s Central Certification File (internal use only).
Usually, the ID body is 9 digits except for FEP ID¡¯s that have a ¡°R¡± prefix followed by an 8
digit body. Otherwise, the ID body should be between 4 to 14 alphanumeric for out of area.
(non-Empire) subscribers. This information is available on the subscriber¡¯s insurance
card.
Note1: This edit does not apply to an Insured ID Number that has a prefix of YLG, GC,
G, YLN, or 3HN.
Note2: Entry of a suffix is not allowed.
Example: correct format of subscriber ID YLS125566788 01 is as follows:
Prefix = YLS
Body = 125566788
Suffix = Leave blank (01 is a suffix).
|
SUBSCRIBER ID MUST BE 6 TO 9 NUMERICS WHEN ID HAS NO PREFIX
|
When the Insured ID Number (subscriber ID) is for an Empire subscriber (Payer ID is
00803 or spaces) and the ID does not begin with a prefix, the Insured ID Number must
contain at least six and no more than nine numbers.
Note1: This edit does not apply to an Insured ID No. that has a prefix of YLG, GC, or G.
Note2: If the Payer Organization ID, Field 7, contains spaces, Empire will default this
field to ¡°00803¡± to perform validation.
Note 3: The valid format for an Insured ID Number without a prefix is as follows:
Body = nnnnnn (minimum of 6) to nnnnnnnnn (maximum of 9)
Suffix = Leave blank. |
| TYPE OF SERVICE MUST EQUAL '05' |
If the CPT code is a dynostic lab code, type of service=05. After create a claim, add '5' or '05' in 24/TOS position manually |
| DENIED CODE 4 |
A required modifier is missing. After create a claim, add modifier in 24 manually |
| NETWORK ID\REQ: RENDER NETWORK ID FOR PAYER |
Please check 24 and 33 Pin# in the rejected claim |
| INSURED NAME/ADDRESS DOES NOT MATCH CARRIER FILES FOR SSN/INSURED ID |
Check patient's eligibility |
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SOCIAL SECURITY/EMPLOYEE NUMBER NOT FOUND ON CARRIER FILES |
Check patient's eligibility |
