When a claim is rejected by Relay Exchange, it means the claim did not reach the insurance payer. These are clearinghouse rejections, as opposed to payer denials, and can typically be corrected and resubmitted quickly. 

Research clearinghouse rejections in Connect Center:

Reviewing the rejection in the Connect Center allows you to better understand the rejection and determine the appropriate next steps before resubmitting the claim. 

1. Log in to the Connect Center.
2. Select Payer Tools from the main menu.
3. Click Edit Search.
4. Enter the rejection code (for example, PNM109A5) in the Edit Name field. (If the rejection reads PNM109A5: INVALID SUBSCRIBER MEMBER ID, enter only PNM109A5).
5. Review the description for full details about the edit and its requirements.

You may also refine your search using the following filters:

• Edit Type (ANSI, Payer, or Both)
• Claim Type
• CPID
• Additional available search criteria

If you need further assistance, you can submit a request through the Customer Care Hub by clicking here! This allows their support team to review your specific claim and provide detailed guidance. If you do not yet have access to the Customer Care Hub, click here for step-by-step instructions on how to create your login and get started. 

For additional details regarding payer-level rejections, including how they differ from clearinghouse rejections and steps for resolution, please click here!

Most common rejection

PDTP0326: INVALID PAYER ADJUDICATION DATE

This rejection occurs when a secondary claim is submitted to the clearinghouse before the primary insurance has completed processing and posting payment for the same encounter. The clearinghouse expects the primary payer’s payment information, including the adjudication date and amount, to be available before they can accept a secondary claim. 

In RXNT, this happens when the Claim Sent Date is earlier than the Primary Payment Posted Date. 

To confirm this in RXNT:

1. Open the Encounter
2. Select Manage Claim
3. Locate the rejected secondary claim
4. Review the Sent Date
5. Click the red warning triangle to confirm the rejection code is PDTP0326
6. Scroll to the Insurance Payment section
7. Review the Posted Date on the primary insurance payment

If the Sent Date is earlier than the Posted Date, the clearinghouse will reject the claim. 

To resolve in RXNT:

• Do not change the Posted Date
• Do not suppress previous payment information
• Wait until the Posted Date has passed
• Resubmit the secondary claim

Once the claim is sent on or after the Posted Date, the rejection will clear. 

Important Notes:

• This is a clearinghouse rejection, not a payer denial. 
• An ICN reference number is not required.
• The claim did not reach the payer
• It can be resubmitted immediately after the Posted Date. 
• Do not use "Suppress Previous Payment Information” when resubmitting secondary claims. This removes primary payment details and may cause additional rejections. 

Payment & balancing rejections

These rejections are typically caused by issues with how the primary payment is posted, such as the payment not balancing to total charges, missing adjustments like copay, deductible, or coinsurance, incorrect adjustment group codes (CO, PR, OA), a missing adjudication date, or $0 charge lines not being included in the payment. These rejection codes include:

• PAMT0202
• PAMT0217
• PAMT0223
• PAMT02D1
• PSVD0200
• PSVD0202
• PDTP0367
• PDTP0370
• PCAS0104
• PCAS0300

To fix payment-related rejections in RXNT:

1. Open the encounter
2. Compare the payment to the EOB/ERA
3. Verify:

• Payment amount
• Adjustment amounts
• Adjustment group codes
• Adjudication date

4. Ensure all service lines (including $0 lines) are included. 

If incorrect:

• Reverse the payment
• Correct the identified errors
• Resubmit the claim

Please note: PDTP0370 - Missing Payer Adjudication Date is often caused by not including $0 charge lines in the primary payment. 

To fix in RXNT:

• Open the primary payment
• Click into each $0 charge line (it should highlighted)
• Post the payment
• Resubmit to the secondary payer

Insurance type & filing indicator rejections

These rejections are typically caused by the Medicare Secondary indicator or filing indicator. This can happen when the Medicare Secondary indicator is incorrect, such as marking Medicare as secondary when it is actually the primary payer, or when the filing indicator does not match the payer type (e.g., using a Part A indicator for a Part B claim). 

These rejection codes include:

• PSBR0500
• PSBR0502
• PSBR0509
• PSBR0900

To fix in RXNT:

1. Open the patient’s case
2. Click the yellow folder on the payer line
3. Verify that Medicare is marked secondary only when appropriate
4. Confirm the correct claim filing indicator (Part A vs Part B)
5. Save and resubmit 

Subscriber member ID rejections

These rejections typically occur when there are issues with the Member ID on the claim. Common causes include a missing prefix, an incorrect format, the wrong number of characters, or submitting the claim to the wrong payer. 

These rejection codes include:

• PNM10900
• PNM109B4
• PNM10955
• PNM10969
• PNM10928
• PNM10934
• PNM109B0
• PNM10949
• PNM109D8

To fix in RXNT:

1. Verify the ID exactly as shown on the insurance card
2. Confirm required prefix
3. Remove extra spaces
4. Confirm the correct payer
5. Update and resubmit

Provider & taxonomy code rejections

These rejections are most often caused by issues with the Billing or Rendering Provider’s taxonomy code. Common causes include a missing taxonomy code, failure to link it as a secondary identifier when required, using the default “ZZ” qualifier when the payer requires a specific code, entering an incorrect taxonomy code, or omitting the code entirely when the payer mandates it for claim processing.  

These rejection codes include:

• PPRV0302
• PPRV0304
• PPRV0324

To fix in RXNT:

1. Go to Billing Utilities
2. Click Providers, and choose either Rendering or Additional Providers
3. Verify that the taxonomy code is present
4. Save and resubmit

Address & ZIP code rejections

These rejections typically occur when the patient’s ZIP+4 digit extension code is missing, the ZIP code does not match the city and state on file, or there are extra spaces in the address fields. 

These rejection codes include:

• PN4–0305 - INVALID SUBSCRIBER POSTAL CODE
• PN4-0326 - MISSING/INVALID SUBSCRIBER POSTAL
• PN4-0379 - INVALID BILLING PROVIDER POSTAL
• PN4-0380 - INVALID SERVICE FACILITY POSTAL

To fix in RXNT

1. To access the necessary information, navigate to the appropriate screen within the system, either the Patient Profile, Billing Provider, or Service Facility screen, depending on where the update is required.
2. Verify Zip+4 digit extension is correct
3. Remove extra spaces
4. Save and resubmit

Missing ICN (PREF0283) rejection

This rejection typically occurs when a secondary claim is submitted without including the primary payer’s Internal Control Number (ICN) from the Explanation of Benefits (EOB). The ICN is required by the secondary payer to link the claim to the original payment. Without it, the claim will be rejected by the clearinghouse and must be updated with the correct ICN before resubmission. 

To fix in RXNT:

1. Go to Manage Claims
2. Select the payer
3. Click Create Claim
4. Enter the ICN number from the primary EOB in the Original Ref No field
5. Send Claim

Claim frequency code (PCLM0500) rejection

This rejection typically occurs when the claim is submitted with an incorrect frequency code. For example, using 08 (resubmission) when the payer requires 01 (original claim).

To fix in RXNT:

1. Go to Manage Claims
2. Select the payer
3. Click Create Claim
4. Choose the correct code from the Resubmission Code dropdown menu
5. Send Claim

Diagnosis & CPT rejections

These rejections are most often caused by using an invalid, expired, or non-specific diagnosis code, missing diagnosis pointers, or submitting HCPCS/CPT codes that are incorrect or no longer valid for the date of service. 

These rejection codes include:

• PHI-0117 - INVALID DIAGNOSIS CODE
• PHI-0125 - INVALID DIAGNOSIS CODE
• PSV10100 - INVALID NCPCS/CPT CODE
• PSV10122 - INVALID NCPCS/CPT CODE

To fix in RXNT:

1. Use the most detailed code valid for DOS
2. Ensure the code is active for DOS, in the proper 5-character format, and not retired by CMS

Crossover claim tips

When sending a claim back to the primary payer after secondary processing, you may receive the following rejections:

• INVALID OTHER PAYER PAID AMOUNT
• INVALID ADJUSTMENT GROUP CODE
• INVALID PAYER ADJUDICATION DATE

If the payer requires removal of prior payment information:

• Open the encounter
• Select Manage Claims
• Choose the payer
• Select from the Suppress Previous Payment Information on claim dropdown menu 
• Click Create Claim
• Select the Resubmission Code & enter the Original Ref No
• Send Claim

Important reminders and tips

1. Clearinghouse Rejections:

• A rejection from the clearinghouse means the claim never reached the payer
• Tip: Review the rejection reason immediately, correct any errors, and resubmit promptly to avoid delayed reimbursement.

2. Payment Posting Rejections:

• Most rejections are caused by mistakes in payment posting
• Tip: Always compare the posted payment to the Explanation of Benefits (EOB) to ensure amounts, patient responsibility, and adjustments match

3. Secondary Claims:

• Secondary claims must follow proper adjudication timing rules, meaning the primary claim must be fully processed before submission
• Tip: Confirm the primary payer’s payment or denial before sending the secondary claim to prevent denials for untimely filing. 

4. Insurance Sequencing and Formatting:

• Accurate sequencing and correct formatting are essential for smooth claim processing.
• Tip: Double-check the order of insurance coverage and ensure all fields (e.g., policy numbers, dates of service) are correct before submission. 

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