The other payer adjudication date or service line payer adjudication date is required. Exception: when the corresponding other payer non-covered charge amount is present, this requirement does not apply. Loop 2330B DTP03.

This issue is related to payment posting. Review all payments posted to the encounter to ensure they are posted correctly. You may need to reverse and repost to balance the primary payment. If everything looks correct, submit a ticket to Relay Exchange.

When the service line payer adjudication date and the other payer prior paid amount are present, the sum of the associated service line claim adjustment plus the associated other payer prior paid amount must be equal the total claim charge amount.

When any service line payer adjudication date is present and the associated service line other payer paid amount is present, the sum of the service line adjustments and payments must equal the service line charge amount. 

When any service line payer adjudication date is present, it must be present on all service lines.

Exception: when the service line charge amount is zero

When the active payer is not Medicare, or Medicare is the active primary payer, the active subscriber insurance type code is not allowed.

When entered, the active subscriber insurance type code must be one of the following values: 12, 13, 14, 15, 16 41, 42, 43, 47.

Check the patient’s case.

1. If Medicare is primary, remove the Medicare Secondary indicator.  This can be found in the yellow folder on the payer line in the patient case.
2. This Case Payer section should only be used when Medicare is secondary.

Check for special characters within the patient's name, correct the name, and then submit the claims.

If you prefer to add a nickname you cannot use any special characters. The client should use the box for “Preferred Name” to add any nickname.

Check the Billing Utilities to ensure the CPID is present and correct.

1. Add and correct as needed, then resubmit.
2. Be sure to use OKC Only ID if it exists.
3. If the CPID is present, check the history inside the insurance payer screen to see when the CPID was added and compare it to the Initial Billed Date on the claim. If the CPID was added after the claim was submitted, you will need to resubmit the claim.

Check to ensure you are using the most descriptive code within the encounter. For example, if using code G20, you should pick between G20.A1 or G20.A2.

Check the payer list to confirm the payer’s status.

Access the Payer List within this article.

This rejection indicates there are multiple or duplicate payers listed on the claim and their sequence numbers are not listed or unique. Sequence numbers correlate with the patient's coordination of benefits.

• 1 = Primary
• 2 = Secondary
• 3 = Tertiary

This is possibly a COB issue with the patient’s insurance coverage, or the same payer was added more than once.

The active subscriber member ID must be in the following format: C A AN N A AN N A A N N

1. C represents a numeric character 1-9
2. A represents an alphanumeric character A-Z but excluding L, O, I, B and Z.
3. N represents a numeric character 0-9

Check the Member ID against the rules in the box to the left.

1. It may be possible you are using the wrong prefix in the member ID, or something is either missing or incorrect with the member ID # in the patient’s case.
2. You should also verify you are sending the claims to the correct payer. 

Check to ensure the Primary Payer ID in the Billing Utilities is present and matches the Payer ID on the Relay Exchange payer list, update if necessary, then the claims can be resubmitted to the secondary payer. 

Access the Payer List within this article.

The previous payments posted to the encounter may be posted incorrectly. There may be an adjustment code that does not belong or a payment or adjustment amount that does not match the total claim amount. Also be sure if there is any copay, coinsurance, deductible or other on the EOB, these must be filled in on the appropriate columns before saving and posting.  Be sure to check all payment information. You will need to reverse the payments and repost them correctly, then resubmit the rejected claim. 

The service line adjudication adjustment group code is not allowed for payers that follow the active payer.

60.1 – Group Codes (Rev. 2843, Issued: 12-27-13, Effective: 01-28-14, Implementation: 01-28-14) A group code is a code identifying the general category of payment adjustment. A group code must always be used in conjunction with a claim adjustment reason code to show liability for amounts not covered by Medicare for a claim or service. MACs do not have discretion to omit appropriate codes and messages. MACs must use appropriate group, claim adjustment reason, and remittance advice remark codes to communicate clearly why an amount is not covered by Medicare and who is financially responsible for that amount. Valid Group Codes for use on Medicare remittance advice: • CO - Contractual Obligations. This group code shall be used when a contractual agreement between the payer and payee, or a regulatory requirement, resulted in an adjustment. Generally, these adjustments are considered a write off for the provider and are not billed to the patient. • OA - Other Adjustments. This group code shall be used when no other group code applies to the adjustment. • PR - Patient Responsibility. This group code shall be used when the adjustment represent an amount that may be billed to the patient or insured. This group would typically be used for deductible and copay adjustments.

Check the previously posted payments. Ensure the disallowed amount, copay, coinsurance, deductible, other patient responsibility, and the adjustment code column and amounts have the correct information based on the EOB. If posted incorrectly, you will need to reverse and repost.

Check the patient’s case payer information (yellow folder in the patient’s case on the payer line).  The Medicare Secondary indicator should ONLY be used when Medicare is secondary. Be sure to check BOTH payers. Update the case and resubmit claims. 

1. Check the place of service code.
2. Update if necessary or remove the discharge date. 
3. Resubmit the claim(s).

When the accident date is present, the related causes code must be AA, OA, or EM.

AA: Auto Accident

EM: Employment

OA: Other

In the patient’s case, select the appropriate type in the “Patient’s Condition Related To” section.

This may be due to billing for a New Patient or Initial Consult visit more than once for the same patient. This includes when different providers within the same practice bill as well. It does not matter if the provider has not personally seen the patient before, if an initial or new patient visit has already been billed under the group, any future visits thereafter must be billed as follow-up or subsequent visits. 

Under Additional Providers/Billing Provider, you must remove any additional phone numbers under "Communication Preferences" on the far right column.  Relay Exchange only allows one (1) phone number on the claim, even if they are different.

Check the patient’s case payer information (yellow folder in the patient’s case on the payer line).  The Medicare Secondary indicator should ONLY be used when Medicare is secondary. Be sure to check BOTH payers. Update the case and resubmit claims. 

Review payments posted inside the encounter to ensure they are posted correctly and the dates match the EOB/Check or the ERA. If all looks correct, resubmit.

Review payments posted inside the encounter to ensure they are posted correctly and the dates match the EOB/Check or the ERA. If all looks correct, resubmit.

Review the other payments posted to the encounter to see if they were posted correctly. If incorrect, you will need to reverse those payments and repost prior to resubmitting the claim to the secondary payer.

Review the other payments posted to that encounter to see if they were posted correctly. If incorrect, you will need to reverse those payments and repost prior to resubmitting the claim to the secondary payer.

Review payments posted inside the encounter to ensure they are posted correctly and the dates match the EOB/Check or the ERA.  If all looks correct, advise the client to resubmit.

Check the patient’s case payer information (yellow folder in the patient’s case on the payer line).  The Medicare Secondary indicator should ONLY be used when Medicare is secondary. Be sure to check BOTH payers. Update the case and resubmit claims. 

You cannot use the 08 resubmission code when the payer only allows 01. You will need to resubmit by going through Manage Claims/Create Claim and selecting the 01 resubmission code before resubmitting.

Please review any payments posted to the encounter. Ensure the payments are posted correctly. 

Please review payments posted inside the encounter to ensure they are posted correctly and the dates match the EOB/Check or the ERA. If all looks correct, resubmit.

The payer requires the secondary claim to be submitted 30 days after the primary payer adjudication date.

Note: this rule is specific to BCBS of AR and BCBS of CA.

Claims should not be submitted to the secondary payer until 30 days after the primary payer payment date. Note: this is payer specific and not a general rule.

Please review any payments posted to the encounter. Ensure the payments are posted correctly.

Check the Medicare payer in the utilities and ensure the Filing Indicator is for the correct Medicare payer (A or B). You will need to update, save, and resubmit claims.

Ensure the taxonomy code is present in the billing provider (secondary identifier ONLY necessary if the ZZ is not allowed). Then apply the claim-specific rule for this under the payer and resubmit claims. 

Learn more about Claim Specific Rules here.

Ensure the taxonomy code is present in the billing provider (secondary identifier ONLY necessary if the ZZ is not allowed). Then apply the claim-specific rule for this under the payer and resubmit claims. 

Learn more about Claim Specific Rules here.

Payments posted to the encounter will need to be reviewed to see if they were posted incorrectly. If confirmed, reverse and repost before resubmitting to the secondary.

Secondary payer is requiring the ICN # from the primary payer EOB on the claim. Resubmit through Manage Claims/Create Claim and add the ICN# before sending.

Use claim specific rule: “Remove PR Segments that contain only $0 from the EDI.”

Learn more about Claim Specific Rules here.

Update the CPID to the correct CPID based on the Payer List.

Access the Payer List within this article.

Incorrectly using “Medicare” as the claim filing indicator for non-Medicare secondary payers. Update before resubmitting the claim. 

Open the encounter and correct the diagnosis codes, remove any duplicates, then resubmit the claims.

Verify the member’s insurance ID is correct in the patient’s case based off of the insurance card and/or calling the payer to confirm. Be sure to include the appropriate prefixes when applicable.

Determine the correct CPT code to use for the service based on CMS guidelines, as the code currently being used has been retired/removed by CMS. 

Payments posted to the encounter will need to be reviewed to see if they were posted incorrectly. If confirmed, the client will need to reverse and repost before resubmitting to the secondary.

Ensure the taxonomy code is present in the rendering provider (secondary identifier ONLY necessary if the ZZ is not allowed). Then apply the claim-specific rule for this under the payer and resubmit claims.

Learn more about Claim Specific Rules here.

Verify the correct zip code extension and add it to the payer, billing provider, and Service Facility Location in the Billing Utilities.

Ensure you are using the diagnosis code at the most detailed level. If this is not the issue, you will need to verify you are using the correct DX code for the visit type. 

Ensure you are using the DX code to the most detailed level.

Check the ID against the rules in the box to the left. It may be possible you are using the wrong prefix in the member ID, or something missing/incorrect with the member ID # in the patient’s case. Also, verify you are sending the claims to the correct payer. 

Check the ID against the rules in the box to the left. It may be possible you are using the wrong prefix in the member ID, or something missing/incorrect with the member ID # in the patient’s case. Also, verify you are sending the claims to the correct payer. 

1. Check the place of service code.
2. Update if necessary or remove the discharge date. 
3. Resubmit the claim(s).

Check the subscriber postal code against the city and state provided to ensure you are sending a valid zip code.

There is specific formatting for this payer 4 eligible patterns exist): 

1. R followed by 8 numeric characters
2. one alpha followed by 2 numeric and ending with 12 alphanumeric characters
3. 3 alpha followed by minimum of 5 alphanumeric
4. alpha character followed by one numeric followed by one alpha character, ending with at least 6 alphanumeric characters.

Check the ID against the rules in the box to the left. It may be possible you are using the wrong prefix in the member ID, or something missing/incorrect with the member ID # in the patient’s case. Also, verify you are sending the claims to the correct payer.  

Check the ID against the rules in the box to the left. It may be possible you are using the wrong prefix in the member ID, or something missing/incorrect with the member ID # in the patient’s case. Also, verify you are sending the claims to the correct payer. 

Check the payer address in the Billing Utilities to see if there are any additional spaces in any of the fields. Remove them if found, then resubmit.

Check the ID against the rules in the box to the left. It may be possible you are using the wrong prefix in the member ID, or something missing/incorrect with the member ID # in the patient’s case. Also, verify you are sending the claims to the correct payer.  

Check the subscriber postal code against the city and state provided to ensure you are sending a valid zip code.

Check the ID against the rules in the box to the left. It may be possible you are using the wrong prefix in the member ID, or something missing/incorrect with the member ID # in the patient’s case. Also, verify you are sending the claims to the correct payer. 

Check the ID against the rules in the box to the left. It may be possible you are using the wrong prefix in the member ID, or something missing/incorrect with the member ID # in the patient’s case. Also, verify you are sending the claims to the correct payer. 

Remove any additional phone numbers under Communication Preferences within the Billing Provider Screen in utilities.  There should only be Preference 1 with a phone number and no others. Click on save after removing and resubmitting the claims.