Common claim rejection reasons

Common Claim Rejection Reasons

Claim rejections occur before adjudication and mean the payer returned the claim due to a data or format error. Rejections are different from denials — they can almost always be corrected and resubmitted.

Top rejection categories

Missing or invalid subscriber ID Verify the subscriber identifier matches exactly what appears on the payer's eligibility file. Even a single transposed digit will cause a rejection.

Invalid NPI Confirm the rendering and billing provider NPIs are both active and enrolled with the payer. Use the Provider Verification tool under Settings to run a live NPI check.

Unsupported service codes Some payers reject claims containing procedure codes not on their approved fee schedule. Check the payer's current code set under Payer Policies in the AdvancedCare library.

Duplicate claim A claim with the same service date, provider, and procedure code was already accepted. Review the original claim in the Duplicates queue before resubmitting.

How to correct and resubmit

1. Open the rejected claim and read the rejection reason code in the Status tab.
2. Click Edit Claim and make the necessary correction.
3. Click Validate, then Resubmit.

If you see a rejection reason that is not listed here, contact support and include the full rejection code so we can assist quickly.