Common Clearinghouse Rejections

Rejected at Proxymed Billing Provider Name Missing/Invalid

The reason for this rejection is because of one of the following reasons:

Rejected at Clearinghouse Claim Level - Rendering Provider Name / Primary Identifier is Missing or Invalid

The reason for this rejection is because the payer requires a payer assigned provider number (PIN) and/or another ID type (State License #, UPIN, etc.) to be sent on the claim. To add a provider number (PIN) for this payer for the rendering provider, go to Provider Credentials.

Rejected at ProxyMed Subscriber Postal Zone or Zip Missing/Invalid

The reason for this rejection is because the zip code is not valid for the city or state that was entered for the address of the policyholder for the insurance.  If the correct zip code is not known, users can reference the United States Postal Service website to search for the correct zip code for the address.

Rejected at Proxymed Responsible Party Postal Zone Missing/Invalid

The reason for this rejection is because the zip code is not valid for the city or state that was entered for the address of the responsible party.  If the correct zip code is not known, users can reference the United States Postal Service website to search for the correct zip code for the address.

Rejected at ProxyMed Diagnosis Code Missing/Invalid/Duplicate

The reason for this rejection is because an invalid diagnosis code was used on the claim. Look at the second set of parenthesis to see the diagnosis code that is incorrect. Verify with a current ICD9 code book to determine if the code is valid for the date of service on the claim, and whether or not it may require a 5th digit, for example.

Rejected at ProxyMed Payor Zip Code Invalid for State Code

REJECTED AT PROXYMED PAYOR ZIP CODE INVALID FOR STATE CODE (PAPER) (99999)

The reason for this rejection is because the zip code is not valid for the city or state that was entered on the payer setup screen.  If the correct zip code is not known, users can reference the United States Postal Service website to search for the correct zip code for the address.

Rejected at ProxyMed Payor City Missing

REJECTED AT PROXYMED PAYOR CITY MISSING (PAPER) ()

The reason for this rejection is because the city is missing from the payer setup screen.

Rejected at ProxyMed Payor Address Missing

REJECTED AT PROXYMED PAYOR ADDRESS MISSING (PAPER) ()

The reason for this rejection is because the address is missing from the payer setup screen for this payer.

Rejected at ProxyMed Invalid Claim Data Please Call Customer Support

REJECTED AT PROXYMED INVALID CLAIM DATA PLEASE CALL CUSTOMER SUPPORT (PAPER) (0)

The reason for this rejection can vary depending on the provider and the specialty. Anytime this rejection is on a claim, please notify support@isalushealthcare.com of the rejection so that the rejection can be researched.

Rejected at ProxyMed Procedure Code/Modifier Missing/Invalid

REJECTED AT PROXYMED Procedure Code/Modifier MISSING/INVALID (MR041) (98978A)

                      OR

Rejected at Clearinghouse Claim Level - Supplemental Diagnosis Code is Missing or Invalid

The reason for one of these rejections is because the procedure code and/or modifier used on the claim is incorrect. The procedure code and/or modifier that is incorrect will be listed in the second set of parenthesis. Open up the claim and verify that the procedure code and/or modifiers that were used on the claim are valid for the date of service(s).  Refer to a current CPT, HCPCS, and/or ICD-9 code book, if needed.

Rejected at ProxyMed Claim Level Date Missing/Invalid

REJECTED AT PROXYMED CLAIM LEVEL DATE MISSING/INVALID (MC022) (20060902)

The reason for this rejection is because a date that was used on the claim is incorrect or missing. The incorrect date will be displayed in the second set of parenthesis, if a date was entered and it is invalid. Verify that any dates used on the claim (admit/discharge/onset/last seen, etc.) are correct.

 

Document Links
Electronic Provider Credentials

How To Setup A New Payer

Provider Credentials