Problem: Loop 2430, Segment DTP, Element NA (not available)
Correction: The Date of the EOB from the primary insurance is missing (probably relates to error above) or no payment was entered from the Primary for this service(s)
Problem: Loop 2320 is missing. It is expected to be used when other payers are known to be
involved in paying this claim.
Correction: If this is a primary insurance claim, review the Insurance Plans and change the plan
in error to be the primary (use green up arrow key). Also on Claim tab, change the
1/2/3 column to a 1.
Problem: Medicare - Not Authorized Billing Provider
A) Medicare Electronic Submitter ID missing in PayerGroups\ElectClaims & Provider ID
B) NPI missing
C) If no Clinic Fed TaxId (ie Soc Sec No) then PayTo must be ‘Yes’ for Provider
in PayerGroups\ElceClaims & Provider Id\Provider tab
Problem: Medicare Secondary Claim - Missing information (AMT last valid segment)
Make sure that the primary insurance and Medicare were created together ie
their Claim Set Id is the same. Usually happens when the office tries to
re-bill a Medicare secondary, but does not create the primary along with it.
Problem: Medicare Secondary Claim - MA04 Error code
Check the Medicare Secondary Type in
Administration\Tables\PayerPlans\MedicareIsSecondaryType ie 12, 43 etc
Problem: NPI incorrect or missing (Clinic, Provider or Referring Provider)
Open Administration/Tables, check Clinic, Provider, Referring Provider to
Insure that NPI is present and correct.
Problem: Plan Route Code in invalid
Correction: The insured’s Id is incorrect (Field 1a on HCFA 1500)
Problem: PO Box not allowed in address…
Correction: This error usually occurs when the Clinic NPI and the Provider NPI are the same
ie the Provider is the same as the clinic.
To resolve this do the following
() Put PO Box in first address line in either the Clinic and Provider
the MAILING address - depending on which is the PayTo
() If PO Box is in Physical Address - PO Box will print on HCFA 1500 in Box 33
() In electronic claims the PO Box will be passed in Loop2010AB if it exists
in the mailing address -
Problem: Statement has services showing as Private Due when still awaiting insurance
Correction: On Patient Screen\Ledger, find the service that is the problem and mark the
column - ‘Due Privately?’ to No
Error Subscriber and policy number/contract number not found
Correction: This is referring to Field 11 on the HCFA 1500 form. Contact the insurance
company to get the correct information.
Problem: Railroad Medicare - No indication if RR Medicare is primary or secondary.
Solution: Put the word NONE in field 11 on the claim and also in the Insurance Plan for the
patient.
Problem: Taxonomy code not printing on DSHS claims in box 24J
Solution:
Check the following fields in the PayerPlan(not PayerGroup)
1) InsTypeCd: should be MC - Medicaid
2) State should be - WA
